When the body is unable to regulate how it handles the fluids that are within it, then diabetes insipidus will occur. The kidneys do more than just filter the blood to eliminate impurities. They also have a second job: to remove extra fluids. These extra fluids become urine and this gets stored in the bladder. When working properly, the system is self-regulating and will create less urine when more water is needed for exercise or sweat to cool off the body. It will create more when too many fluids are present.
In 3 out of the 4 types of diabetes insipidus, the regulation system malfunctions and causes the kidneys to think that there is too much water in the body. Because of this, they will continually pull out fluids from the blood stream and turn it into urine. Depending on how many fluids are consumed over the course of the day, a person with diabetes insipidus may expel over 20 liters of urine over the course of 24 hours.
That’s enough to fill 5 one gallon milk jugs with urine.
Normally the human body creates an anti-diuretic hormone (ADH) called Vasopressin that is stored in the pituitary gland. That’s located at the base of the brain and the amount of ADH that gets released is controlled by the hypothalamus. When the body gets dehydrated, more ADH is produced to tell the kidneys to absorb more water. This creates urine concentration. When the body is hydrated, then there is less Vasopressin and this tells the kidneys to take more water out of the blood.
Each type of diabetes insipidus has its own unique set of causes, symptoms, and treatments. Here is an in-depth look at this disease and what a diagnosis may mean.
1. Central Diabetes Insipidus Is the Most Common Form
Central diabetes insipidus is the most common form of DI because it occurs in all population demographics. There are genetic versions of this disease and it can be caused by an injury as well. To some extent, every person on the planet is at some level of risk of developing this form of DI every day.
How is it caused? The genetic version of central diabetes insipidus is caused by a direct transfer of a faulty gene from parent to child. It is usually from the father, but can also come from the mother or both parents. The signs and symptoms of this disease can be present at birth.
The most common reason for this version DI to occur, however, is through surgery. 1 in 5 people who have a surgery, especially near the pituitary gland, will develop this disease. An injury, inflammation, a tumor, or even an illness like tuberculosis or meningitis can also cause diabetes insipidus to develop.
What happens with this version of the disease is the hypothalamus doesn’t tell the pituitary gland to make enough of the hormone that is needed. This means that the kidneys always think that the fluids need to be taken out of the blood stream so that it can be converted to urine and then expelled. In return, people with central diabetes insipidus feel consistently thirsty because their kidneys are taking out too much water.
Treatment options for this form of DI are good. Many people respond well to Desmopressin treatments, which may be an injections, a pill, or a nasal spray. It is a synthetic hormone that replaces the amount that is missing and is taken on an “as needed” basis. When caused by surgery, there is a chance that a complete recovery may occur. All other forms of central diabetes insipidus will typically need to have lifelong treatments or lifestyle changes that increase fluid intake consistently.
2. Nephrogenic Diabetes Insipidus Reverses the Issue
Nephrogenic DI occurs when the kidneys are unable to understand what the hormone levels within the body happen to be. The pituitary gland is producing the right levels of ADH that are required, but the kidneys are unable to absorb the water when requested. This defect typically happens within the tubules of the kidney, but may be within the entire functioning mechanism of the organ as well.
The most common reason for nephrogenic diabetes insipidus to occur is because of a long-term medication that is being taken. People who chronically take lithium, for example, have a 40% chance of developing this form of DI. Those who must take a long-term antibiotic such as demeclocycline will also have a higher than average risk of disease development.
Like central diabetes insipidus, the nephrogenic version may also be caused by genetic factors. The symptoms of DI may also be present from birth or may develop slowly over time throughout childhood.
An overabundance of certain minerals may also cause this form of DI. Calcium especially can be problematic for the kidneys and too much of it may cause them to stop responding to the flucuating ADH levels.
Because the kidneys can’t respond to the ADH that is being generated, adding synthetic hormones to the body only improves urine concentrations by 10% or less. A more effective treatment tends to be a combination of diuretics and NSAID medications. For some reason, taking ibuprofen and other OTC painkillers concentrates the urine within the kidneys and relieves many of the bothersome symptoms of DI.
Most treatment options are effective for nephrogenic diabetes insipidus, but because of the individualized nature of this disease, finding the right combination can take some time. Making sure enough fluids are consumed will help to prevent dehydration throughout the evaluation and treatment plan creation phases.
3. Gestational Diabetes Insipidus Can Be Cured
This form of DI is the only version that can actually be cured. It also targets one specific population demographic: pregnant women. That’s because gestational diabetes insipidus can only occur when placental enzymes interact with the ADH that a mother’s body produces. The enzymes interfere with the communication systems between the kidneys and the hormone and will even counteract the hormone to reduce the amount there is within the body.
The good news for expectant mothers is this: virtually all cases of gestational DI will resolve themselves in 6 weeks or less after the pregnancy. The bad news is that the extreme thirst and frequent need to urinate is probably not going to go away. Gestational diabetes mellitus is also a threat, which is why when the symptoms of DI are experienced, an immediate examination should be scheduled.
Treatment options may include the addition of Desmopressin, but many doctors will only prescribe the synthetic hormone if the symptoms are very bothersome. Many women simply increase their water intake to prevent dehydration and are monitored by their doctors to prevent disease development.
4. Dipsogenic Diabetes Insipidus Reverses the Course
The other 3 versions of DI cause people to not have enough water. This version actually causes people to have too many fluids in their body. That’s because the damage that occurs due to dipsogenic diabetes insipidus is caused by drinking too many fluids. When people drink too many fluids for a prolonged period of time, it naturally depresses the amount of ADH that is made and this creates fluid retention.
It may also be called psychogenic or primary polydipsia.
The cause behind this form of DI is usually a behavioral disorder or a mental illness. People feel the need to drink more fluids than normal every day and this creates the foundation for disease development. There are no direct treatments that are effective for this form of DI, so those that are suffering from it must be careful to avoid water intoxication.
There are times when a malfunction in the hypothalamus may also lead to this condition. Not only does the hypothalamus control ADH levels through the pituitary gland, but it is also responsible for the thirst mechanisms that people experience.
Most efforts to treat dipsogenic diabetes involve treating the underlying medical condition that causes it. If the behavioral disorder or mental illness can be controlled effectively, then the disease may slowly resolve itself over time. Treatments also tend to be similar to the nephrogenic version of DI because the overall goal is to find a way for urine to become concentrated once again.
Are You Experiencing the Signs and Symptoms of DI?
Diabetes insipidus can affect anyone of any age. Age is a risk factor for development, but the genetic variations that create the disease can be present from birth. The biggest risks of DI are becoming too dehydrated and having excessive urination that interrupts daily living activities. Children may also experience pain, diarrhea, and vomiting when DI is present.
Some people can manage their diabetes insipidus symptoms on their own just by making sure there are enough fluids around. They may pack a backpack full of water bottles, be near convenience stores, or fill large containers with tap water in case of an emergency. Others can control their DI symptoms through hormone replacements or other medications. A lucky few will have their symptoms resolve.
Use the information here to ask questions about diabetes insipidus if you see the signs and symptoms of it at your next medical appointment. Do not self-diagnose. This will just create more stress and anxiety, which can enhance the symptoms. Keep fluid intakes at healthy levels and follow any treatment plan as instructed and diabetes insipidus can become one more challenge that has been defeated.