Diabetes Insipidus

Diabetes insipidus is a condition characterized by the inability of the kidney to conserve water resulting in extreme thirst and frequent urination dilute which is usually odorless and dilute.  The normal kidney passes out 1 to 2 quarts of urine in a day but People with diabetes insipidus releases about 3 to 20 quarts of urine in a day leading them to have a strong urge for drinking water almost every time. This condition can affect people of all ages and can become a serious problem when the fluid intake is low compared to the fluid lost in the urine. DIABETES  INSIPIDUS VS. MELLITUS Diabetes mellitus is a chronic condition whereby there is an increase in blood glucose level due to absent or insufficient insulin production in the body. It could also result in resistance of the body’s receptors to insulin. This type is called type II diabetes mellitus.  Diabetes insipidus is a clinical condition that haves nothing to do with blood glucose level but is characterized by the kidney’s inability to balance the body’s fluid. People with diabetes insipidus usually have normal body glucose levels unlike people with diabetes mellitus. TYPES OF DIABETES INSIPIDUS There are 4 types of diabetes insipidus and they include:

• Central diabetes insipidus 

• Nephrogenic diabetes insipidus

• Dipsogenic diabetes insipidus 

• Gestational diabetes insipidus

• Central Diabetes Insipidus

Central diabetes insipidus occurs when the hypothalamus or pituitary gland is damaged leading to severe disruptions in the production, storage, and release of antidiuretic hormone or vasopressin which leads the kidney to produce too much fluid in the body increasing the rate of fluid production.  Injury to the hypothalamus or pituitary gland can be as a result of:

• Surgery complications
• Infection
• Inflammation
• Tumor
• Injury to the head
• In some rare cases genetic complications or defects.

• Nephrogenic Diabetes Insipidus

Nephrogenic diabetes insipidus happens when there is an inability of the kidney to respond to the action of vasopressin, leading to the continuous removal of fluid from the bloodstream.  This could be caused by:

• Chronic kidney diseases or infection
• Increase in the calcium blood level
• The decrease in the potassium blood level
• Medications containing lithium
• Blockage of the urinary tract
• Gene defects or mutations, etc.

• Dipsogenic Diabetes Insipidus

Dipsogenic diabetes insipidus is also called primary polydipsia. It is characterized by the mass production of diluted urine caused by injury to the thirst regulatory mechanism of the hypothalamus.

• Gestational Diabetes Insipidus

This is a rare condition that happens mostly during pregnancy which is the hormone that reduces the kidney’s sensitivity to vasopressin. This condition however goes away after the mother delivers. RISK FACTORS The risk factors include:

• Genetic factors or mutations; this is most common in nephrogenic diabetes insipidus and sometimes central diabetes insipidus.
• Complications of surgery. 
• Injury or accidents involving the head.
• Medications containing lithium or anti-viral medication such as foscarnet could cause nephrogenic diabetes insipidus.
• Pregnancy

DIABETES INSIPIDUS COMPLICATIONS Complications of diabetes insipidus include;

• Dehydration

This is one of the primary complications of diabetes insipidus and it can lead to dry mouth, changes in skin elasticity, general body weakness, frequent thirst, dry skin, dizziness, and sluggishness. etc.

• Electrolyte imbalance

Due to the frequent excretion of body fluid that occurs in diabetes insipidus, there tends to be an electrolyte in the blood. Such electrolyte includes sodium and potassium.  This electrolyte imbalance may lead to vomiting, loss of appetite, lack of focus or confusion, general body weakness, and muscle cramps.

• Increased heart rate
• Low body temperature
• Decrease in weight 
• Fatigue
• Frequent headaches
• The decrease in blood pressure

DIAGNOSIS OF DIABETES INSIPIDUS When diagnosing diabetes insipidus, you will be checked based on the following;

• Your medical and family history to check if its cause is genetic or inherited.
• You will undergo a physical examination which includes checking your skin appearance for signs of dehydration.
• Urinalysis will be carried out. This procedure involves testing your urine sample which is collected in a special container. 

This aims to show how to dilute or concentrated your urine is. It can also show the amount of glucose concentration which helps to differentiate between diabetes insipidus and diabetes mellitus.

• You will be taken to the lab for a blood test. The blood test helps to ascertain your blood sodium level and distinguish between the presence of diabetes insipidus and diabetes mellitus.
• You will undergo a fluid depreciation test. This test measures the changes in your body weight and checks for urine concentration whilst restricting fluid intake.
• You will also undergo some scans such as magnetic resonance imaging. This scan aims to take images of the body’s internal tissues without using an X-ray. It is mostly carried by an experienced or specially trained technician or a radiologist.

DIABETES INSIPIDUS TREATMENT Treatment is usually based on the type of diabetes insipidus and the underlying cause. They include:

• Hormonal Treatment

This involves the use of artificial hormones which could be administered orally by pills or intravenously through injections. Examples of hormonal treatment include; desmopressin, etc.

• The Use of Drugs and Medications

Medications could be used in the treatment of nephrogenic diabetes insipidus. It could also be administered diuretics along with aspirin or ibuprofen. It is necessary to drink water only when thirsty while taking these medications.

• Use of ice chips or sour candies to moisten the dry mouth and increase saliva flow which in turn reduces the desire to drink.
• Taking enough water to prevent dehydration.
• In gestational diabetes insipidus, the expecting mother can be administered desmopressin.

PROGNOSIS  People with diabetes insipidus can live a normal life and keep their symptoms under control with proper medication and treatment. There is no cure yet for diabetes insipidus.

Symptoms

DIABETES INSIPIDUS SYMPTOMS

The symptoms of diabetes insipidus include the following:

• Extreme thirst.

• The massive production of diluted.

• Urge for cold drinks or substances.

• Frequent urge to urinate mostly at night.

In children, symptoms may include;

• Heavy or wet diapers.

• Bedwetting.

• Fever.

• Stunted growth.

• Weight loss.

• Vomiting.

Causes

DIABETES INSIPIDUS CAUSES

Diabetes insipidus is primarily caused by an injury or damage to the hypothalamus and pituitary gland which affects the production and action of anti-diuretic hormone or vasopressin on the kidney in the regulation of body fluid. 

Anti-diuretic hormone or vasopressin is a hormone that aids in maintaining or regulating how fast or slow the body fluids are excreted. It is produced by the hypothalamus and stored in the pituitary gland to be released when needed. Hence, people with diabetes insipidus cannot properly balance body fluids levels.

Another cause of diabetes insipidus is the inability of the kidney cells to respond to the level of vasopressin in the blood.

It could also be caused by an autoimmune reaction of the immune system fighting cells that produce that produces vasopressin. Research is still been carried out to find out more causes of diabetes insipidus.

FAQ

• Does diabetes insipidus cause weight gain?

Since diabetes insipidus affects the appetite, it can affect the weight of people having this condition. Weight is usually lost especially in children and also affect their growth

• What is the mortality rate of diabetes insipidus?

Most people hardly die from diabetes insipidus as long as they can effectively tackle the loss of water from their bodies. The risk of death is higher in infants and elderly people which is because they may have issues relating their thirst to people around

• Can diabetes insipidus go away without treatment?

Without treatment, the condition only gets worse. Effective adherence to treatment can help manage the constant thirst and frequent urination that comes with this condition.

• Can diabetes insipidus be prevented?

Currently, there is no specific preventive method for diabetes insipidus but certain measures can be taken, which include; constant monitoring of your urine output, checking and treating underlying brain tumors and kidney diseases

• How much water should a diabetic insipidus drink?

You may be advised by your doctor on the amount of water to drink every day at least a minimum of 2.5 liters of water