Causes And Risk Factors
There are four different types of diabetes insipidus central, nephrogenic, dipsogenic and gestational. Each type of diabetes insipidus has a different cause.
Central Diabetes Insipidus
Central diabetes insipidus is the most common form of diabetes insipidus. It occurs in both males and females equally and at any age. Inadequate synthesis or release of vasopressin causes it, often due to surgery, head injury, an infection or a tumor that damages the hypothalamus or posterior pituitary gland. The disruption of vasopressin causes the kidneys to remove too much fluid from the body, leading to an increase in urination.
Nephrogenic Diabetes Insipidus
Nephrogenic diabetes insipidus results from the failure of the kidneys to respond to vasopressin. This causes the kidneys to continue to remove too much fluid from a persons bloodstream. Nephrogenic diabetes insipidus can result from inherited gene changes or mutations that prevent the kidneys from responding normally to vasopressin. Chronic kidney disease, low potassium levels in the blood, high calcium levels in the blood, a blockage of the urinary tract and certain medications can cause nephrogenic diabetes insipidus.
Dipsogenic Diabetes Insipidus
Gestational Diabetes Insipidus
How Do Doctors Treat Diabetes Insipidus
Central or neurogenic DI and nephrogenic DI are treated differently.
Central DI
We treat central or neurogenic DI by giving medication to provide the vasopressin effects that the body needs. This medication comes in 2 forms, which are:
- Vasopressin given as an injection. The effects of the vasopressin injection last for only a few minutes.
- As a medication called desmopressin. The effects of desmopressin last for 8-24 hours. Desmopressin can be given as a nasal sniff , a pill or an injection. It is usually given about 2 times a day. When your child takes desmopressin, its a good idea to make sure your child has urinated before taking the next dose. This will help make sure your child doesnt become overloaded with fluid.
- We can also help treat DI by making sure children drink fluids only when they are thirsty and not just because they want or like a drink. This will help prevent them from becoming overloaded with fluid.
- Sometimes, it can be difficult to treat babies with central DI with desmopressin because they need to take in so much fluid to get the nutrition they need. They often do better when they are treated with hydrochlorothiazide, given as a pill or liquid and a diluted , low-protein formula until they are mostly taking solid foods. Hydrochlorothiazide works on the kidneys to help hold onto the water your babys body needs.
Nephrogenic DI
We treat nephrogenic DI in a few ways, such as:
- Following a low-protein diet
- Correcting imbalances in calcium and potassium
What Is The Difference Between Diabetes Mellitus And Diabetes Insipidus
There are two types of diabetes in dogs. Diabetes mellitus is also called sugar diabetes and results from a disruption of pancreas function and abnormal regulation of blood sugar. The term, meaning ‘sweetened with honey’, originated from the fact that the urine of these patients was ‘sweet’ due to high amounts of sugar excreted from the body.
Diabetes insipidus gets its name from the fact that the urine of these patients is dilute enough to be ‘tasteless’ or ‘insipid’. Diabetes insipidus is rare in dogs, and is characterized by excessive thirst/drinking and the production of enormous volumes of extremely dilute urine. Some dogs may produce so much urine that they become incontinent . The irony of this disease is that despite drinking large volumes of water, the dog can become dehydrated from urinating so much.
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Why Do Thiazides Decrease Polyuria In Diabetes Insipidus
I was reviewing the treatment of diabetes insipidus the other day, and was reminded of the paradoxical effect of thiazide diuretics on urine output in diabetes insipidus. How does this work? The traditional thinking is that thiazide-induced blockade of the Na-Cl cotransporter in the distal tubule leads to a decrease in GFR. This decrease is compensated by an increase in proximal tubule sodium and water uptake. Because less water and solute are then delivered to the collecting duct, less water is lost as urine. However, some studies suggest that chronic use of thiazides does not result in a decrease in extracellular fluid volume: cardiac output returns to normal several weeks after initiating therapy, and infusion of salt-free dextran does not increase blood pressure. Studies in rats with central DI have also shown that replacement of renal sodium losses does not prevent the antidiuretic effect of thiazides. Experiments by Kim et al. suggest that thiazides may serve to upregulate aquaporin channels and ENaC subunits. In rates with lithium-induced nephrogenic DI, HCTZ reversed lithium-induced downregulation of AQP2. It also caused an increase in the abundance of ENaC channels. While these results are specific to Li-induced renal effects, they may at least partially explain how a thiazide can serve to decrease polyuria in patients with diabetes insipidus.Continue reading > >
Natural Treatments For Diabetes Insipidus
Disclaimer: Results are not guaranteed*** and may vary from person to person***.
When you think of the word diabetes, what comes to mind?
Maybe you think of insulin injections, since type 1 diabetes occurs as a result of the body being unable to create insulin. Or perhaps you think of controlling high blood sugar through a low glycemic index diet?
What if I told you that the name diabetes has nothing to do with blood sugar control or insulin injections? Let me explain
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What Causes Diabetes Insipidus
Diabetes insipidus is usually caused by problems with a hormone called vasopressin that helps your kidneys balance the amount of fluid in your body. Problems with a part of your brain that controls thirst can also cause diabetes insipidus. Specific causes vary among the four types of diabetes insipidus: central, nephrogenic, dipsogenic, and gestational.2
How Do Eating Diet And Nutrition Affect Diabetes Insipidus
Researchers have not found that eating, diet, and nutrition play a role in causing or preventing diabetes insipidus. To reduce symptoms, your health care professional may suggest you eat a diet that is low in salt and protein to help your kidneys make less urine. In some cases, these changes alone may be enough to keep your symptoms under control, particularly if you have nephrogenic diabetes insipidus.2,7
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How To Treat Nephrogenic Diabetes Insipidus
The issue with this type of diabetes insipidus is that the body doesnt actually know what to do with the Vasopressin that is being produced. The kidneys dont respond as they should to the hormone, which means treating it with additional hormones wont be beneficial. Lifestyle changes are the most common method of treating this form of the disease.
A nutritionist will be brought onto the treatment team and a low-salt diet will be designed around your specific needs. Enough water will need to be consumed to avoid dehydration and caffeinated products will need to be eliminated from the diet in most instances.
Sometimes the drug hydrochlorothiazide will be prescribed to treat nephrogenic diabetes insipidus as well. This is because it will decrease urine outputs, even though it actually acts as a diuretic. It does not work in every person who takes it, however, so it is often ordered for severe symptoms only.
If symptoms are bothersome and cannot be reduced, then the drug indomethacin has been shown to be effective at improving symptoms. Thiazide diuretics may also be used.
If there are medications that may be causing the condition, the treatment team will need to weigh the advantages of taking the drugs to the disadvantages of dealing with diabetes insipidus. This is taken on a case by base basis. Do not stop any medications that have been ordered without first speaking with a doctor.
Are Diabetes Insipidus And Diabetes Mellitus The Same
Diabetes insipidus is not the same as diabetes mellitus. Although both conditions can increase thirst, intake of liquids, and urination, they are not related.
- In diabetes mellitus, the level of glucose in your blood, also called blood sugar, is too high. Your kidneys try to remove the extra glucose by passing it in your urine.
- In diabetes insipidus, your blood glucose levels are normal, but your kidneys cant properly concentrate urine.
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Diabetes Insipidus And Cushings Disease In Dogs
Dogs with Cushings disease can present with symptoms that are very similar to diabetes insipidus. This includes an increase in thirst and an increase in urination. Some dogs with these symptoms just have Cushings disease.
However, it is possible for diabetes insipidus to occur secondary to Cushings disease. The elevated levels of steroids can interfere with the release of ADH from the pituitary gland. Also, excess steroids in the blood can interfere with how ADH binds at the receptors in the kidneys.
The good news is that getting a dogs Cushings disease under control may help improve the signs associated with diabetes insipidus.
Diabetes Insipidus Vs Mellitus
Just because diabetes insipidus and diabetes mellitus have the term diabetes in it, both should not be related. Diabetes mellitus is a condition where blood sugar levels are above the normal range. While mellitus is more common and can be diagnosed with the help of a glucometer in seconds, diabetes insipidus can be diagnosed with a series of blood and urine tests that can take hours.
Under both conditions, the body experiences frequent urination and constant thirst, also known as polyuria and polydipsia. While diabetes management requires lifestyle modifications in diet and exercise, diabetes insipidus can be managed only with the help of fluid intake and medications.
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Diabetes Insipidus: Causes & Symptoms + 5 Natural Treatments
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. Its caused by a defect in the pituitary gland or in the kidneys.
The term insipidus means without taste in Latin, while diabetes mellitus involves the excretion of sweet urine. People with diabetes insipidus pass urine that is diluted, odorless and relatively low in sodium content.
Diabetes insipidus and diabetes mellitus are unrelated. Both conditions do cause frequent urination and constant thirst. People with diabetes insipidus have normal blood sugar levels, but their kidneys cannot balance fluid in the body.
Although the symptoms of diabetes insipidus can be bothersome and sometimes even life-changing, the condition doesnt increase future health risks when it is managed properly. Its important to find the right treatment plan, which typically involves taking measures to avoid dehydration.
Diabetes Insipidus Risk Factors
It is caused due to a lack of vasopressin or when it can not be used properly. These conditions can occur due to various reasons. The main risk factor is genetic inheritance. Specific changes in the genes inherited from your parents can cause diabetes insipidus. Although it only happens in 1-2% of cases.
An injury or surgery in the head near the pituitary gland can also be a factor for causing diabetes insipidus. Therefore, a person should always be careful with their head.
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What Is The Outlook For Children With Di
Children with central or neurogenic DI do well when they are treated appropriately with medication. If your child has idiopathic DI, he/she will need frequent examinations, including MRIs of the pituitary gland, to see if there is a cause that we havent been able to find.
The outcomes of children with a known reason for central or neurogenic DI depend on the cause of the DI. For example, if your child had a head injury, he/she should lead a normal life if the brain injury heals. However, your child will still need to take medication for DI. Sometimes, central or neurogenic DI from a head injury or after surgery slowly gets better on its own. This is because the nerve fibers from the hypothalamus that were cut off slowly grow back and store vasopressin again.
Children with nephrogenic DI often do quite well if their DI was caused by a medication that can be stopped or from a chemical abnormality that can be controlled. Children who are born with nephrogenic DI should be treated carefully to protect their kidneys as much as possible. They should also stay hydrated, even when they are sick, so their brain development is protected. This is especially true for young children.
Children with central or neurogenic DI do well when they are treated appropriately with medication. If your child has idiopathic DI, he/she will need frequent examinations, including MRIs of the pituitary gland, to see if there is a cause that we havent been able to find.
Diagnosis Of Central Diabetes Insipidus
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Water deprivation test
Doctors suspect diabetes insipidus in people who produce large amounts of urine. They first test the urine for sugar to rule out diabetes mellitus Diabetes Mellitus Diabetes mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar levels to be abnormally high. Urination and thirst are… read more . Blood tests show abnormal levels of many electrolytes, including a high level of sodium.
The water deprivation test is the best test to diagnose central diabetes insipidus. In a water deprivation test, urine production, blood electrolyte levels, and weight are measured regularly for a period of about 12 hours, during which the person is not allowed to drink. A doctor monitors the person’s condition throughout the course of the test. At the end of the 12 hoursor sooner if the person has a decrease in blood pressure, an increase in heart rate or a loss of more than 5% of body weightthe doctor stops the test and injects vasopressin. The diagnosis of central diabetes insipidus is confirmed if, in response to vasopressin, the person’s excessive urination stops, the urine becomes more concentrated, the blood pressure rises, and the heart beats more normally. The diagnosis of nephrogenic diabetes insipidus is made if, after the injection, the excessive urination continues, the urine remains dilute, and blood pressure and heart rate do not change.
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Who Is More Likely To Have Diabetes Insipidus
People of all ages can develop diabetes insipidus. You are more likely to develop the condition if you1,2
- have a family history of diabetes insipidus
- had brain surgery or a major head injury
- take medicines that can cause kidney problems, including some bipolar disorder medicines and diuretics
- have metabolic disorders
How To Treat Dispogenic Diabetes Insipidus
There are no specific treatments that will help to treat this version of diabetes insipidus. The overall goal is to decrease the amount of fluids that a person feels like they need to drink in order to feel satisfied. If there is an underlying mental illness that is causing this condition, then the focus of treatment will be on the mental illness instead of the symptoms of diabetes insipidus.
Some medications may be prescribed to reduce the feelings of thirst that are being felt. This is taken on a case by case basis and is usually only recommended in severe cases. Habit changes, correcting thinking pattern errors, and CBT therapy may all be examined as viable treatment options as well.
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Our Approach To Diabetes Insipidus
UCSF is an international leader in endocrinology care. Our team provides comprehensive consultations, evaluations and treatments for a wide range of hormone disorders, such as diabetes insipidus.
We treat this condition with a medication called desmopressin acetate, or DDAVP. The medication is similar to antidiuretic hormone, the hormone implicated in diabetes insipidus. We will adjust the dosage for each individual to find the right balance between controlling symptoms and avoiding complications. Our goal is to help our patients return to healthy, normal lives.
There Are Various Forms Of Diabetes Insipidus
- Neurogenic – the brain doesn’t produce enough of the hormone vasopressin. Some of the events that could cause this form of diabetes insipidus include head injury, infection , brain tumour, ruptured aneurysm or brain surgery. In about half of cases, the cause remains unknown .
- Nephrogenic – the kidneys aren’t sensitive to vasopressin and fail to respond. This comparatively rare form of diabetes insipidus is caused by an inherited disorder that affects the tubules, the tiny structures inside the kidneys that absorb water. Men are more prone to this condition than women. In adults nephrogenic diabetes insipidus can be caused by treatment with lithium and by hypercalcemia.
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What Are The Symptoms Of Diabetes Insipidus
The following are the most common symptoms of diabetes insipidus. However, each individual may experience symptoms differently. Symptoms may include:
- excessive thirst
- excessive urine production
- dehydration
The symptoms of diabetes insipidus may resemble other conditions or medical problems. Always consult your physician for a diagnosis.
Types Of Diabetes Insipidus
- Central diabetes insipidus. You get this when damage to your hypothalamus or pituitary gland affects how your body makes or puts out vasopressin. Your kidneys remove too much fluid from your body, and you pee more. This damage can result from:
- A tumor
- Inflammation
- Surgery
Some medications or mental health problems could make you more likely to get dipsogenic diabetes insipidus.
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