Diabetes insipidus is an uncommon disorder that causes an imbalance of fluids in the body. It causes the body to make a lot of urine that is “insipid,” or colorless and odorless.
Diabetes insipidus occurs when the body doesn’t produce enough antidiuretic hormone (ADH) or doesn’t respond correctly to its effects. ADH helps to control the balance of water in the body by regulating the production of urine. It’s produced by the hypothalamus and stored in the pituitary gland until it’s needed.
Diabetes Insipidus Types
There are four different forms of Diabetes Insipidus:
Central diabetes insipidus (neurogenic diabetes insipidus)
It is a type of diabetes insipidus that occurs due to a lack of vasopressin (ADH) production in the brain. This may be the result of a tumuor in the hypothalamus or pituitary gland, infection, radiotherapy, surgery to the gland or a head injury. Vasopressin acts to increase the volume of blood (intravascularly), and decrease the volume of urine produced. Therefore, a lack of it causes increased urine production and volume depletion.
It is also known as neurohypophyseal diabetes insipidus, referring to the posterior pituitary (neurohypophysis), which is supplied by the hypothalamus in the brain. This condition has only polyuria in common with diabetes and although not mutually exclusive, with most typical cases, the name diabetes insipidus is a misleading misnomer. A better name might be “hypothalamic-neurohypophyseal ADH deficiency”.
Damage to the hypothalamus or pituitary gland can result from the following:
- A tumor
- Head injury
Central diabetes insipidus can also result from an inherited defect in the gene that produces vasopressin, although this cause is rare. In some cases, the cause is unknown.
Nephrogenic diabetes insipidus (NDI)
It is a form of diabetes insipidus primarily due to the pathology of the kidney. This is in contrast to central or neurogenic diabetes insipidus, which is caused by insufficient levels of antidiuretic hormone. Nephrogenic diabetes insipidus is caused by an improper response of the kidney to ADH, leading to a decrease in the ability of the kidney to concentrate the urine by removing free water.
Nephrogenic diabetes insipidus can result from inherited gene changes, or mutations, that prevent the kidneys from responding to vasopressin. Other causes of nephrogenic diabetes insipidus include
- Chronic kidney disease
- Certain medications, particularly lithium
- Low potassium levels in the blood
- High calcium levels in the blood
- Blockage of the urinary tract
The causes of nephrogenic diabetes insipidus can also be unknown.
Dipsogenic diabetes insipidus
Dipsogenic DI is a result of excessive fluid intake due to damage to the hypothalamic thirst mechanism. It occurs more often in those with certain psychiatric disorders or on certain medications.
This defect results in an abnormal increase in thirst and liquid intake that suppresses vasopressin secretion and increases urine output. The same events and conditions that damage the hypothalamus or pituitary (surgery, infection, inflammation, a tumor, head injury) can also damage the thirst mechanism. Certain medications or mental health problems may predispose a person to dipsogenic diabetes insipidus.
Gestational Diabetes Insipidus.
This type of diabetes insipdus usually takes place only during pregnancy. In some cases, an enzyme made by the placenta (a temporary organ joining mother and baby) breaks down the mother’s vasopressin. In other cases, pregnant women produce more prostaglandin, a hormone-like chemical that reduces kidney sensitivity to vasopressin.
Most pregnant women who develop gestational diabetes insipidus have a mild case that does not cause noticeable symptoms. Gestational diabetes insipidus usually goes away after the mother delivers the baby; however, it may return if the mother becomes pregnant again.
Diabetes Insipidus and Diabetes Mellitus
Diabetes insipidus and diabetes mellitus are unrelated, although both conditions cause frequent urination and constant thirst. Diabetes mellitus causes high blood glucose, or blood sugar, resulting from the body’s inability to use blood glucose for energy. People with diabetes insipidus have normal blood glucose levels; however, their kidneys cannot balance fluid in the body.
Diabetes Insipidus Signs and Symptoms
Adults signs and Symptoms
- Extreme thirst
- Producing large amount of dilute urine
- Frequent need to pee
- Preference for cold drinks
- Unexplained weakness
- Muscle pains
Signs and Symptoms in Infants
Infants with hereditary nephrogenic diabetes insipidus may eat poorly and fail to gain weight and grow at the expected rate (failure to thrive). They may also be irritable and experience fevers, diarrhea, and vomiting.
Recurrent episodes of dehydration can lead to slow growth and delayed development. If the condition is not well-managed, over time it can damage the bladder and kidneys leading to pain, infections, and kidney failure. With appropriate treatment, affected individuals usually have few complications and a normal lifespan.
Diabetes Insipidus Causes
If you have diabetes insipidus, your body can’t properly balance fluid levels. The cause varies depending on the type of diabetes insipidus you have:
Central diabetes insipidus.
Damage to the pituitary gland or hypothalamus from surgery, a tumor, a head injury or an illness can cause central diabetes insipidus by affecting the usual production, storage and release of ADH. An inherited genetic disease can also cause this condition.
Nephrogenic diabetes insipidus.
Nephrogenic diabetes insipidus occurs when there’s a defect in the kidney tubules — the structures in your kidneys that cause water to be excreted or reabsorbed. This defect makes your kidneys unable to properly respond to ADH.
The defect may be due to an inherited (genetic) disorder or a chronic kidney disorder. Certain drugs, such as lithium or antiviral medications such as foscarnet (Foscavir), also can cause nephrogenic diabetes insipidus.
Gestational diabetes insipidus.
Gestational diabetes insipidus is rare. It occurs only during pregnancy when an enzyme made by the placenta destroys ADH in the mother.
Dipsogenic diabetes insipidus
Also known as primary polydipsia., this condition can cause the production of large amounts of diluted urine. The underlying cause is drinking an excessive amount of fluids.
Primary polydipsia can be caused by damage to the thirst-regulating mechanism in the hypothalamus. The condition has also been linked to mental illness, such as schizophrenia.
On some occasions, there’s no obvious cause of diabetes insipidus. However, in some people, the disorder may be the result of an autoimmune reaction that causes the immune system to damage the cells that make vasopressin.
Diabetes Insipidus Diagnosis
Diabetes insipidus is diagnosed by health care providers based on the following:
Medical and Family History
Taking a medical and family history can help a health care provider diagnose diabetes insipidus. A health care provider will ask the patient to review his or her symptoms and ask whether the patient’s family has a history of diabetes insipidus or its symptoms.
Urinalysis tests a urine sample. A patient collects the urine sample in a special container at home, in a health care provider’s office, or at a commercial facility. A health care provider tests the sample in the same location or sends it to a lab for analysis.
The test can show whether the urine is dilute or concentrated. The test can also show the presence of glucose, which can distinguish between diabetes insipidus and diabetes mellitus. The health care provider may also have the patient collect urine in a special container over a 24-hour period to measure the total amount of urine produced by the kidneys.
A blood test will measure the number of electrolytes and glucose in your blood. This lets the health care provider know you have diabetes mellitus or diabetes insipidus. It may even help them figure out which type.
MRI (Magnetic Resonance Imaging)
This test takes detailed pictures of your internal organs and soft tissues without using x-rays. The doctor uses it to see if you have a problem with your hypothalamus or pituitary gland.
MRIs cannot diagnose diabetes insipidus. Instead, an MRI can show if the patient has problems with his or her hypothalamus or pituitary gland or help the health care provider determine if diabetes insipidus is the possible cause of the patient’s symptoms.
A physical exam can help diagnose diabetes insipidus. During a physical exam, a health care provider usually examines the patient’s skin and appearance, checking for signs of dehydration.
Diabetes Insipidus Complication
The following are some of the complications that may occur if diabetes insipidus is not kept under control:
Diabetes insipidus makes it hard for your body to hold on to water. It’s easy to get dehydrated. If you have diabetes insipidus, watch out for signs like:
- Dizziness or lightheadedness
- Dry mouth and lips
- Sunken features (like your eyes)
- Confusion and irritability
Electrolytes are minerals in your body with a tiny electric charge. When you lose too much water, your electrolyte levels can go up. When this happens, you might notice:
- A headache
- Feeling tired all the time (fatigue)
- Muscle pain
Less sleep. Diabetes insipidus can lead to nocturia, a medical name for waking up in the night to pee. The result: a less restful night.
Diabetes Insipidus FAQs
What is diabetes insipidus?
Diabetes insipidus an uncommon disorder that causes an imbalance of fluids in the body. This imbalance makes you very thirsty even if you’ve had something to drink. It also leads you to produce large amounts of urine.
What does insipidus mean?
“Insipidus” comes from Latin language insipidus (tasteless), from Latin: in- “not” + sapidus “tasty” from sapere “have a taste” — the full meaning is “lacking flavor or zest; not tasty”.
What are the types of diabetes insipidus?
The types of diabetes insipidus include
- Central Diabetes Insipidus
- Nephrogenic Diabetes Insipidus
- Dipsogenic Diabetes Insipidus
- Gestational Diabetes Insipidus
What are the complications of diabetes insipidus?
The main complication of diabetes insipidus is dehydration if fluid loss is greater than liquid intake. Signs of dehydration include
- Dry skin
How is diabetes insipidus diagnosed?
A health care provider can diagnose a person with diabetes insipidus based on the following:
- Medical and family history
- Physical exam
- Blood tests
- Fluid deprivation test
- Magnetic Resonance Imaging (MRI)
How is diabetes insipidus treated?
The primary treatment for diabetes insipidus involves drinking enough liquid to prevent dehydration. A health care provider may refer a person with diabetes insipidus to a nephrologist (a doctor who specializes in treating kidney problems) or to an endocrinologist (a doctor who specializes in treating disorders of the hormone-producing glands)
What causes diabetes insipidus?
Diabetes insipidus is caused by problems with a chemical called vasopressin (AVP), which is also known as antidiuretic hormone (ADH). AVP is produced by the hypothalamus and stored in the pituitary gland until needed.
What happens if diabetes insipidus is left untreated in children?
If left untreated, diabetes insipidus can lead to problems in a child such as brain damage and poor growth. With treatment, a child with diabetes insipidus can lead a full, healthy life.
How much water should a diabetic insipidus drink?
A health care provider may advise you to drink a certain amount of water every day, usually at least 2.5 liters. However, if your cranial diabetes insipidus is more severe, drinking water may not be enough to keep your symptoms under control.
What are the symptoms of nephrogenic diabetes insipidus (NDI)?
The two main symptoms of NDI are chronic excessive thirst (polydipsia) and excessive urine production (polyuria). Excessive urination at night (nocturia) also occurs. Some infants may present with vomiting, retching, unexplained fevers, lethargy, and irritability. Constipation, diarrhea and poor feeding may also occur.
How common is nephrogenic diabetes insipidus?
The prevalence of nephrogenic diabetes insipidus is unknown, although the condition is thought to be rare. The acquired form occurs more frequently than the hereditary form.
Does diabetes insipidus affect blood sugar?
People with diabetes insipidus have normal blood glucose levels; however, their kidneys cannot balance fluid in the body.
Why does diabetes insipidus not change blood sugar?
Diabetes insipidus is a rare condition that has nothing to do with the pancreas or blood sugar. Instead, it happens when your kidneys produce a lot of extra pee.