Diabetes Insipidus – What is it, Symptoms and Treatments!

Diabetes Insipidus – What it is, Symptoms and Treatments  that many are unaware of. Additionally,  Diabetes Insipidus (die-uh-BEE-teze in-SIP-uh-dus) is an uncommon disorder that causes an imbalance of water in the body. This imbalance leads to intense thirst even after drinking fluids (polydipsia) and excreting large amounts of urine (polyuria).

Although the names Diabetes Insipidus and Diabetes Mellitus sound similar, they are not related. diabetes mellitus – which can occur as either type 1 or type 2 – is the most common form of diabetes. There is no cure for Diabetes Insipidus , but treatments are available to relieve your thirst and normalize your urine output .

Causes of Diabetes Insipidus:  Diabetes  Insipidus  occurs when your body cannot regulate how it handles fluids. Normally, your kidneys remove excess body fluids from your bloodstream. This waste of fluid 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 body water is decreased, such as perspiration.

The volume and composition of your body fluids remain balanced through a combination of oral intake and kidney excretion . The rate of fluid intake is largely governed by thirst, although your habits can increase your intake far above the required amount. 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 the pituitary gland, a small gland located at the base of the brain. ADH is released into your bloodstream when your body starts to get dehydrated. ADH then concentrates the urine by triggering the kidney tubules to release water back into the bloodstream, instead of excreting as much water in your urine. How 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 usually 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 is a defect in the renal tubules – the structures in the kidneys  that cause water to be excreted or reabsorbed. This defect makes their rivers unable to respond adequately to ADH. The defect may be due to an inherited (genetic) disorder or chronic kidney disease. Certain drugs, such as lithium or the antiviral drugs cidofovir and foscarnet (Foscavir), can also cause nephrogenic diabetes insipidus.
  • Insipidus of gestational diabetes. Diabetes Insipidus from gestational diabetes is rare and only occurs during pregnancy and when an enzyme made by the placenta – the system of blood vessels and other tissues that allow the exchange of nutrients and waste between mother and baby – destroys ADH in the mother.
  • Primary polydipsia. This condition – also known as dipsogene diabetes insipidus or psychogenic polydipsia – can cause the excretion of large volumes of dilute urine. Rather than a problem with ADH production or damage, the underlying cause is excessive fluid intake.

Prolonged excessive water intake alone 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 regulation mechanism located in the hypothalamus. Primary polydipsia has also been associated with mental illness. In some cases of Diabetes Insipidus , doctors never determine a cause.

Symptoms of Diabetes Insipidus:  The most common signs and symptoms of Diabetes Insipidus are:

  • extreme thirst
  • Excretion of an excessive amount of dilute urine

Depending on the severity of the condition, urine output can be up to 16 liters (about 15 liters) a day if you are drinking a lot of fluids. Normally, a healthy adult urinates an average of less than 3 liters (about 3 liters) a day.

Other signs may include needing to get up at night to urinate (nocturia) and wetting the bed. Babies and young children who have Diabetes Insipidus may have the following signs and symptoms:

  • Unexplained experience or inconsolable crying
  • trouble sleeping
  • Fever
  • vomit
  • Diarrhea
  • delayed growth
  • Weight loss

When to See a Doctor:  See your doctor right away if you notice the two most common signs of Diabetes Insipidus : excessive urination and extreme thirst.

Risk Factors for Diabetes Insipidus:  Nephrogenic  diabetes insipidus that is present at or shortly after birth usually has a genetic cause that permanently alters the kidneys ‘ ability  to concentrate urine.

Nephrogenic Diabetes Insipidus usually affects males, although females can pass the gene on to their children.

Complications of Diabetes Insipidus:  Dehydration: Except for primary polydipsia, which causes you to conserve too much water, Diabetes Insipidus can cause your body to contain too little water to function properly, and you can become dehydrated. Dehydration can cause:

  • Dry mouth
  • Changes in skin elasticity
  • Low blood pressure (hypotension)
  • High blood pressure (hypernatremia)
  • Fever
  • Headache
  • fast 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

Diagnosing Diabetes Insipidus:  Since the signs and symptoms of Diabetes Insipidus can be caused by other conditions, your doctor will perform a series of tests. If your doctor determines that you have Diabetes Insipidus , he or she will need to determine which type of Diabetes Insipidus you have, because treatment is different for each form of the disease. Some of the tests doctors often 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 will be asked to stop drinking fluids for a while so that your doctor can measure changes in your body weight, urine output, and the concentration of your urine and blood when fluids are retained. 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 on children and pregnant women to ensure that no more than 5% of body weight is lost during the test.
  • Urine analysis. Urinalysis is the physical and chemical examination of the urine. If your urine is less concentrated – meaning the amount of water is high relative to other substances excreted – it could be due to Diabetes Insipidus .
  • Magnetic resonance imaging (MRI). An MRI of the head is a non-invasive procedure that uses a powerful magnetic field and radio waves to build up detailed images of brain tissue. 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 review your family history of polyuria and may suggest genetic screening.

Diabetes Insipidus Treatments:  The treatment of  Diabetes Insipidus depends on the form of the condition you have. Treatment options for the most common types of Diabetes Insipidus include:

  • Central diabetes insipidus. As the cause of this form of Diabetes Insipidusis the lack of anti diuretic hormone (ADH), treatment is usually with a synthetic hormone called desmopressin. You can take desmopressin as a nasal spray, as oral tablets, or by injection. The synthetic hormone will eliminate increased urination. For most people with this form of the condition, desmopressin is both safe and effective. If the condition is caused by an abnormality in the pituitary gland or hypothalamus (such as a tumor), your doctor will first treat the abnormality. Desmopressin should be considered a medication that you take as needed. This is because, in most people, ADH deficiency is not complete and the amount made by the body can vary from day to day. Taking more desmopressin than necessary can result in too much water retention and low blood sodium levels. Symptoms of low sodium include lethargy, headache, nausea and, in severe cases, seizures. In mild cases ofCentral Diabetes Insipidus , you just need to increase your water intake.
  • Nephrogenic diabetes insipidus. This condition is the result of your kidneys  not responding properly to ADH, so desmopressin is not a treatment option. Instead, your doctor may prescribe a low-salt diet to help reduce the amount of urine your kidneys  produce. You will also need to drink plenty of water to prevent dehydration. The drug hydrochlorothiazide, used alone or with other medications, may improve symptoms. Although hydrochlorothiazide is a diuretic (usually used to increase urine output), in some cases it can reduce urine output for people with nephrogenic diabetes insipidus. If the symptoms of Diabetes Insipidusnephrogenic are due to medications you are taking, stopping these medications may help; However, do not stop taking any medication without talking to your doctor first.
  • Insipidus of gestational diabetes. Treatment for most cases of gestational diabetes insipidus is with the synthetic hormone desmopressin. In rare cases, this form of the condition is caused by an abnormality in the thirst mechanism. In these rare cases, doctors do not prescribe desmopressin.
  • Primary polydipsia. There is no specific treatment for this form of Diabetes Insipidus , other than decreasing the amount of fluid intake. However, if the condition is caused by mental illness, treating the mental illness can alleviate symptoms.
Useful links: 

Prevention of Diabetes Insipidus:  In general, most causes of Diabetes Insipidus are not preventable.

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