Description:
Diabetes insipidus, is a debilitating and rare disease, with a prevalence of 1 out of 25,000 people. Often referred to as “water diabetes,” it is a condition characterized by frequent and heavy urination, excessive thirst and an overall feeling of weakness. It’s caused by a defect in the pituitary gland or in the kidneys.
While the names diabetes insipidus and diabetes mellitus sound similar, they’re not related. Diabetes mellitus — which can occur as type 1 or type 2 — is the more common form of diabetes.
There are four types of DI, each with a different set of causes.
* Central DI (CDI) is due to a lack of the hormone vasopressin (antidiuretic hormone). This can be due to damage to the hypothalamus or pituitary gland or genetics.
* Nephrogenic diabetes insipidus (NDI) occurs when the kidneys do not respond properly to vasopressin.
* Dipsogenic DI is due to abnormal thirst mechanisms in the hypothalamus while gestational DI occurs only during pregnancy. Diagnosis is often based on urine tests, blood tests, and the fluid deprivation test.
* Diabetes mellitus is a separate condition with an unrelated mechanism, though both can result in the production of large amounts of urine.
There’s no cure for diabetes insipidus, but treatments are available to relieve your thirst and normalize your urine output.
Symptoms:
The most common signs and symptoms of diabetes insipidus are:
* Extreme thirst
* Excretion of an excessive amount of diluted urine
Depending on the severity of the condition, urine output can be as much as 16 quarts (about 15 liters) a day if you’re drinking a lot of fluids. Normally, a healthy adult will urinate an average of less than 3 quarts (about 3 liters) a day.
Other signs may include needing to get up at night to urinate (nocturia) and bed-wetting.
Infants and young children who have diabetes insipidus may have the following signs and symptoms:
* Unexplained fussiness or inconsolable crying
* Trouble sleeping
* Fever
* Vomiting
* Diarrhea
* Delayed growth
* Weight loss
Causes:
Diabetes insipidus occurs when your body can’t regulate how it handles fluids. Normally, your kidneys remove excess body fluids from your bloodstream. This fluid waste is temporarily stored in your bladder as urine, before you urinate.
When your fluid regulation system is working properly, your kidneys conserve fluid and make less urine when your body water is decreased, such as through perspiration.
The volume and composition of your body fluids remain balanced through a combination of oral intake and excretion by the kidneys. The rate of fluid intake is largely governed by thirst, although your habits can increase your intake far above the amount necessary. The rate of fluid excreted by your kidneys is greatly influenced by the production of anti-diuretic hormone (ADH), also known as vasopressin.
Your body makes ADH in the hypothalamus and stores the hormone in your pituitary gland, a small gland located in the base of your brain. ADH is released into your bloodstream when your body starts to become dehydrated. ADH then concentrates the urine by triggering the kidney tubules to release water back into your bloodstream rather than excreting as much water into your urine.
The way in which your system is disrupted determines which form of diabetes insipidus you have:
* Central diabetes insipidus. The cause of central diabetes insipidus in adults is usually damage to the pituitary gland or hypothalamus. This damage disrupts the normal production, storage and release of ADH.
The damage is commonly due to surgery, a tumor, an illness (such as meningitis), inflammation or a head injury. For children, the cause may be an inherited genetic disorder. In some cases the cause is unknown.
* 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 the antiviral medications cidofovir and foscarnet (Foscavir), also can cause nephrogenic diabetes insipidus.
* Gestational diabetes insipidus. Gestational diabetes insipidus is rare and occurs only during pregnancy and when an enzyme made by the placenta — the system of blood vessels and other tissue that allows the exchange of nutrients and waste products between a mother and her baby — destroys ADH in the mother.
* Primary polydipsia. This condition — also known as dipsogenic diabetes insipidus or psychogenic polydipsia — can cause excretion of large volumes of dilute urine. Rather than a problem with ADH production or damage, the underlying cause is intake of excessive fluids.
Prolonged excessive water intake by itself can damage the kidneys and suppress ADH, making your body unable to concentrate urine. Primary polydipsia can be the result of abnormal thirst caused by damage to the thirst-regulating mechanism, situated in the hypothalamus. Primary polydipsia has also been linked to mental illness.
In some cases of diabetes insipidus, doctors never determine a cause.
Diagnosis:
Since the signs and symptoms of diabetes insipidus can be caused by other conditions, your doctor will perform a number of tests. If your doctor determines you have diabetes insipidus, he or she will need to determine which type of diabetes insipidus you have, because the treatment is different for each form of the disease.
Some of the tests doctors commonly use to diagnose and determine the type of diabetes insipidus and in some cases, its cause, include:
* Water deprivation test. This test confirms the diagnosis and helps determine the cause of diabetes insipidus. Under medical supervision, you’ll be asked to stop drinking fluids for a time so that your doctor can measure changes in your body weight, urine output and the concentration of your urine and blood when fluids are withheld.
Your doctor may also measure blood levels of ADH or administer synthetic ADH during this test. The water deprivation test is performed under close supervision in children and pregnant women to make sure no more than 5 percent of body weight is lost during the test.
* Urinalysis. Urinalysis is the physical and chemical examination of urine. If your urine is less concentrated — meaning the amount of water is high relative to other excreted substances — it could be due to diabetes insipidus.
* MRI (Magnetic resonance imaging.) An MRI of the head is a noninvasive procedure that uses a powerful magnetic field and radio waves to construct detailed pictures of brain tissues. Your doctor may want to perform an MRI to look for abnormalities in or near the pituitary gland.
Genetic screening
If your doctor suspects an inherited form of diabetes insipidus, he or she will look at your family history of polyuria and may suggest genetic screening.
Treatment:
The primary treatment for diabetes insipidus involves drinking enough liquid to prevent dehydration. Depending on what type of diabetes insipidus you have, treatment for constant thirst and frequent urination will vary.
Since its introduction in 1972, desmopressin has been the most widely used drug for the treatment of diabetes insipidus. Desmopressin is a synthetic, man-made hormone that comes as an injection, nasal spray or pill. It works by replacing the vasopressin that a patient’s body would normally produce, which can control the amount of urine your kidneys make. Desmopressin helps a patient to manage her symptoms, but it does not cure the disease.
Desmopressin can cause a low level of sodium in the blood. This is rare, but can be serious and possibly life-threatening. Drinking too much water or other fluids increases your risk of having low sodium levels in your blood. It’s important to follow your doctor’s directions if you are using this drug and limit your fluids as instructed. Signs of low levels of sodium in the blood include: loss of appetite, severe nausea, vomiting, severe headache, mental and mood chances, muscle weakness, cramps and spasms, shallow breathing and loss of consciousness.
Health care providers commonly prescribe diuretics to help patients’ kidneys remove fluid from the body. On the the other hand, there’s a class of diuretics called thiazides that help to reduce urine production and help patients’ kidneys concentrate urine. Patients with nephrogenic diabetes insipidus would use these. Thiazide diuretics are sometimes combined with amiloride to prevent hypokalemia, or low potassium levels in the blood. Amiloride works to increase the amount of sodium and decrease the amount of potassium.
Aspirin or ibuprofen is sometimes used to help reduce urine volume as well. Do not use these drugs on a regular basis because of the risk of overdose. Symptoms of a ibuprofen overdose to look out for include: a ringing in the ears, blurred vision, headaches, confusion, dizziness, drowsiness and skin rashes.
Home remedies and Natural Treatment:
1. Change Your Diet:
A diet containing nutrient-dense whole foods with plenty of water-heavy fruits and vegetables can be helpful for people with diabetes insipidus. (10) Some examples of water-based, hydrating foods to consume regularly include: cucumbers, zucchini, dark leafy green vegetables (such as spinach and kale), red cabbage, red peppers, blueberries, watermelon, kiwi, citrus fruit, pineapple and strawberries. Starchy vegetables like sweet potatoes, squash, bananas and avocados are also great options. You may also find that coconut water is hydrating and helps to balance your electrolytes.
While you focus on adding these nourishing foods into your diet, try to avoid eating processed foods that are typically high in sodium and other chemicals that are used as preservatives. Removing caffeine from your diet may also be helpful, which includes carbonated soft drinks.
2. Avoid Dehydration:
It’s vital for diabetes insipidus patients to drink enough liquids to replace their urine losses and to relieve excessive thirst. You need to drink extra water to compensate for fluid loss, especially after being active or exercising. Research shows that without enough water present in the body, dehydration and deficits can cause cardiovascular complications, muscle cramping, fatigue, dizziness and confusion.
Make sure to always carry water with you wherever you go. Wearing a medical alert bracelet will alert professionals of your condition and advise them of your need for fluids.
3. Keep Your Electrolytes Balanced:
The major electrolytes found within the body include calcium, magnesium, potassium, sodium, phosphate and chloride. These nutrients help to stimulate nerves throughout the body and balance fluid levels. You can keep your electrolytes balanced by avoiding packaged or processed foods because of their sodium content. Sodium is an electrolyte that plays a significant role in the body’s ability to retain or release water. So if your diet is very high in sodium, the kidneys excrete more water. This can cause complications balancing other electrolytes. It’s also important to drink enough water throughout the day and to increase your water intake after exercise, when you are sick or any time you are losing fluids. (12)
4. Keep Your Mouth Moist:
Sucking on ice chips or sour candies can help to moisten your mouth and increase saliva flow, reducing your desire to drink. This can be especially helpful later in the evening when you don’t want to consume as much water and be up in middle of the night to use the bathroom.
5. Check Your Medications:
Some medications can impact your electrolyte balance, a complication of diabetes insipidus. These include antibiotics, diuretics, hormonal pills, blood pressure medications and cancer treatments. Cancer patients who are receiving chemotherapy usually experience the most serious forms of electrolyte imbalances. Laxatives and diuretics also change potassium and sodium levels within the blood and urine. It’s also possible to develop electrolyte imbalances due to hormonal interactions from antidiuretic hormone medications, aldosterone and thyroid hormones. Even high levels of physiological stress can impact hormones to the point that fluid and electrolyte levels can become thrown out of balance.
If you begin experiencing the signs and symptoms of diabetes insipidus, be sure to consider whether a new medication or supplement can be causing fluid or electrolyte imbalances.
Risk factors:
Nephrogenic diabetes insipidus that’s present at or shortly after birth usually has a genetic cause that permanently alters the kidneys’ ability to concentrate the urine. Nephrogenic diabetes insipidus usually affects males, though women can pass the gene on to their children.
Complications:
Dehydration:
Except for primary polydipsia, which causes you to retain too much water, diabetes insipidus can cause your body to retain too little water to function properly, and you can become dehydrated. And this dehydration can cause:
* Dry mouth
* Changes in skin elasticity
* Low blood pressure (hypotension)
* Elevated blood sodium (hypernatremia)
* Fever
* Headache
* Rapid heart rate
* Weight loss
* Electrolyte imbalance
Diabetes insipidus can also cause an electrolyte imbalance. Electrolytes are minerals in your blood — such as sodium and potassium — that maintain the balance of fluids in your body. Electrolyte imbalance can cause symptoms, such as:
* Fatigue or lethargy
* Nausea
* Loss of appetite
* Muscle cramps
* Confusion
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.
Resources:
https://en.wikipedia.org/wiki/Diabetes_insipidus
https://www.mayoclinic.org/diseases-conditions/diabetes-insipidus/symptoms-causes/syc-20351269
https://draxe.com/diabetes-insipidus/
