Diabetes Insipidus is a disease that’s quite rare and is debilitating if not treated properly. The condition occurs in only 1 of 25,000 people. You might have heard it called “water diabetes,” as it is characterized by frequent urination, excessive thirst, and just plain weakness. Diabetes insipidus is caused by a defect in the pituitary gland or in the kidneys.
Insipidus means “without taste” in Latin so you can see where the name comes from. The urine passed by people with the condition of diabetes insipidus is odorless and has a relatively low sodium content.
The diabetes you are probably thinking of is Diabetes Mellitus and that one includes what you hear called “Type 1 Diabetes” and “Type 2 Diabetes”. The two diseases are totally unrelated even though both conditions result in frequent urination and excessive thirst.
Blood sugar levels are normal in people diagnosed with diabetes insipidus. The problem is their kidneys can’t adequately balance the amount of fluid in the body.
Like diabetes mellitus, the symptoms of diabetes insipidus can be bothersome and life-changing but the condition does not increase future health risks if managed properly. It’s extremely important to find the right treatment plan and that usually entails taking measures to avoid dehydration.
What Is Diabetes Insipidus?
Diabetes insipidus is a life altering condition that disrupts normal life due to increased thirst and large volumes of urine being passed, even during bedtime hours. It belongs to a group of hereditary or acquired polyuria and polydipsia diseases and it is associated with inadequate vasopressin or antidiuretic hormone secretion.
Formed in the hypothalamus, Vasopressin, which includes arginine vasopressin (AVP) and antidiuretic hormone (ADH), is a peptide hormone. It travels to the posterior pituitary where it releases into the blood. You really need to fully understand the role of vasopressin in order to fully understand the cause of diabetes insipidus and how it affects your kidneys and fluid balance.
Daily, your kidneys filter anywhere from 120 quarts – 150 quarts of blood and this ends up producing as much as 2 quarts of urine. Urine is made up of waste and extra fluid. It travels from your kidneys to the bladder and through tubes called ureters.
Your body regulates the amount of fluid by balancing the liquids and removing the extra fluid. When you become thirsty, you drink something and that controls your liquid intake while the process of urination removes most fluid. People also lose fluid by sweating or diarrhea.
The hypothalamus is a gland at the base of the brain and its job is to produce vasopressin. Vasopressin is stored in the pituitary gland and released into the bloodstream as needed. Vasopressin signals your kidneys to absorb less of the fluids in your bloodstream which results in the production of less urine.
However, when the body does have too much fluid, the pituitary is the gland that releases small amounts of vasopressin as needed. This causes the kidneys to remove more fluid and thereby produce more urine. Issues with the release of vasopressin lead to Diabetes Insipidus.
There are actually four different types of Diabetes Insipidus. They are Gestational, Central, Dipsogenic, and Nephrogenic. Each type of diabetes insipidus has a different cause.
Causes and Risk Factors by Type
Gestational Diabetes Insipidus
Gestational diabetes insipidus can occur when an enzyme produced by the placenta breaks down the mother’s vasopressin. In some cases, a pregnant woman produces more prostaglandin which reduces chemical sensitivity to vasopressin. Often, the symptoms of gestational diabetes insipidus go unnoticed. The great news is the condition typically is no longer an issue after the mother delivers the baby.
Diabetes insipidus can develop at any age and the prevalence is equal among males and females. Nephrogenic diabetes insipidus that’s present at birth, or shortly after, is usually genetic and tends to affect males. However, women can pass the gene to their children.
Central Diabetes Insipidus
Central diabetes insipidus (also known as neurogenic diabetes insipidus) is the most common form of diabetes insipidus. This type occurs in males and females and doesn’t discriminate based on age either. Inadequate synthesis or release of vasopressin causes it and that is quite often due to a head injury, an infection, a tumor that damages the hypothalamus or posterior pituitary gland or surgery. The kidneys actually, in this case, remove too much fluid leading to an increase in urination.
Dipsogenic Diabetes Insipidus
Dipsogenic diabetes insipidus (also known as primary polydipsia) is a problem with the thirst mechanism which is located in the hypothalamus. The result is an abnormal thirst and liquid intake. That suppresses vasopressin and increases urine output.
Conditions that damage the hypothalamus or pituitary gland cause it, such as surgery, inflammation, a head injury or a tumor. Certain mental health problems and even some medications may predispose a person to this type of diabetes insipidus.
Nephrogenic Diabetes Insipidus
Nephrogenic diabetes insipidus results from the failure of the kidneys to respond to vasopressin thereby removing too much fluid from a person’s bloodstream. Gene changes that have been inherited or have mutated preventing the kidneys from responding normally to vasopressin are the cause of the issue.
Chronic kidney disease, high levels of calcium in the blood, low potassium levels in the blood, urinary tract blockage and even certain medications (like lithium) can be the causde of nephrogenic diabetes insipidus.
Common Signs And Symptoms
The most common signs and symptoms of diabetes insipidus include an excessive amount of diluted urine and unusual thirst. Your body regulates fluid by removing extra fluid from the body and balancing liquid intake. As mentioned earlier, thirst is usually the body’s way of controlling liquid intake. Urination on the other hand removes most fluid.
Normally, a healthy adult will urinate an average of less than 3 liters a day. With diabetes insipidus, depending on the severity, you can output as much as 15 liters a day of urine when you’re drinking a lot of fluids. Because of this, people who have diabetes insipidus almost always have to get up in middle of the night to urinate (called nocturia). They may even struggle with wetting the bed.
Infants and young children with diabetes insipidus may have trouble sleeping, unexplained fussiness, inconsolable crying, fever, vomiting, diarrhea, excessively wet diapers, constipation, weight loss and even delayed growth.
The main complication of diabetes insipidus is dehydration which occurs when fluid loss is greater than liquid intake and can be dangerous. Signs of dehydration include thirst, fatigue, dry skin, confusion, sluggishness, dizziness, and nausea. You can experience seizures, brain damage and, believe it or not, even death if the dehydration is severe enough.
Another common complication is an imbalance of electrolytes. Electrolytes are nutrients or chemicals (such as sodium and potassium) present in your body and they have many important functions. Everything from regulating your heartbeat to allowing your muscles to contract so you can move.
Electrolytes are found within bodily fluids i.e. urine, blood and sweat. When you have an imbalance, you may experience spasms, anxiety, muscle aches, twitches, frequent headaches, excessive thirstiness, fever, confusion, joint pain, digestive issues, fatigue, irregular heartbeats, and changes in appetite or body weight.
Conventional Treatment
The primary treatment for diabetes insipidus involves simply drinking enough liquids to prevent becoming dehydrated. Depending on what type you have, treatment for constant thirst and frequent urination will vary.
The most widely used drug for the treatment of diabetes insipidus is desmopressin. The drug was actually introduced in 1972. Desmopressin is a man-made hormone that comes either as an injection, nasal spray or a pill. The drug works by replacing the vasopressin that your body would normally produce. Desmopressin will help you manage your symptoms, but it is not a cure.
Rarely, desmopressin can cause a low level of sodium in the blood. This can be serious and possibly life-threatening. Drinking an excessive amount of water or other fluids increases your risk of having low sodium levels in your blood so you have to be careful.
It’s important to follow your doctor’s directions if you are using this drug and limit your fluids as instructed by your healthcare provider. Some of the signs of low levels of sodium in the blood include severe nausea, loss of appetite, vomiting, severe headache, muscle weakness, mental and mood chances, cramps and spasms, shallow breathing and even loss of consciousness.
Health care providers commonly prescribe diuretics to help your kidneys remove fluid from the body. On the other hand, there’s a class of diuretics called thiazides which help to reduce urine production and help the kidneys concentrate urine. Patients with nephrogenic diabetes insipidus would be appropriate for the use of thiazides. These diuretics are sometimes combined with amiloride to prevent hypokalemia (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. However, you should NOT use these drugs on a regular basis because of the risk of overdose. Symptoms of an ibuprofen overdose include blurred vision, a ringing in the ears, confusion, headaches, skin rashes, dizziness, and drowsiness.
5 Natural Treatments For Diabetes Insipidus
1. Change Your Diet
A diet that can be helpful for those dealing with diabetes insipidus is one that contains nutrient-dense whole foods with plenty of water-heavy fruits and vegetables. Some examples of hydrating foods to consume regularly include cucumbers, zucchini, dark leafy green vegetables (such as spinach and kale), red peppers, red cabbage, watermelon, blueberries, citrus fruit, kiwi, strawberries, and pineapple.
Starchy vegetables like sweet potatoes, bananas, squash, and avocados are great options as well. Coconut water is hydrating and helps to balance your electrolytes.
While making every effort to add these nourishing foods into your diet, you will want to avoid processed foods typically high in sodium and other chemicals. Removing caffeine from your diet may also be helpful so you’ll probably want to cut out those carbonated soft drinks.
2. Avoid Dehydration
It’s extremely important that you drink enough liquids to replace the urine losses and to relieve your excessive thirst. You need to drink extra water to compensate for fluid loss especially after exercising or being really active. Without enough water present in the body, dehydration and deficits can cause cardiovascular complications, dizziness, muscle cramping, confusion and fatigue.
You will absolutely want to always be sure to carry water with you wherever you go. Wearing a medical alert bracelet will alert professionals of your condition and advise them of your potential need for fluids.
3. Keep Your Electrolytes Balanced
The major electrolytes found within the body include magnesium, calcium, sodium, potassium, phosphate and chloride. These nutrients help to stimulate the nerves throughout the body and balance your fluid levels. One thing that will help you keep your electrolytes balanced is avoiding packaged or processed foods.
This is due to their sodium content. Sodium is an electrolyte that plays a very important part in your body’s ability to retain or release water. Therefore, if your diet is very high in sodium, the kidneys excrete more water which can cause complications balancing other electrolytes. Remember to drink enough water throughout the day and you’ll definitely want to increase your water intake after exercise, when you are sick or any time you are losing fluids.
4. Keep Your Mouth Moist
Ice chips or sour candies can help to moisten your mouth and increase saliva flow, thereby reducing your desire to drink. This is a great tip to remember late in the evening when you don’t want to consume so much water that you’ll be up all night using the bathroom.
5. Check Your Medications
Some medications can impact your electrolyte balance and these include diuretics, antibiotics, blood pressure meds, hormonal pills, and cancer treatments. Patients being treated for cancer with chemotherapy usually experience serious forms of electrolyte imbalances.
Laxatives and diuretics also alter the levels of potassium and sodium in the blood and urine. It’s quite possible to develop an imbalance of electrolytes as a result of hormonal interactions from antidiuretic hormone medications, aldosterone and thyroid hormones.
Fluid and electrolyte levels can become thrown out of balance when high levels of physiological stress impact hormones. You will definitely want to consider whether a new medication or supplement can be causing fluid or electrolyte imbalances if you experience the symptoms of diabetes insipidus.
Precautions
A major complication of diabetes insipidus is dehydration which, as mentioned earlier, can be extremely dangerous. You can prevent dehydration by increasing the amount of fluids that you take in. Seek care immediately if you experience the signs of dehydration, such as confusion, dizziness or sluggishness.
Diabetes Insipidus Final Thoughts
Diabetes insipidus is a condition that disrupts normal life due to increased thirst and passing of large volumes of urine, even at night when you are trying to get that much-needed sleep. The condition is associated with antidiuretic hormone secretion or inadequate vasopressin.
Issues with the release of vasopressin lead to this rare disorder that occurs when the kidneys pass an abnormally large volume of urine that is insipid aka dilute and odorless.
The four types of diabetes insipidus are gestational, central, dipsogenic, and nephrogenic and each of them has a different cause.
Extreme thirst and the excretion of an excessive amount of diluted urine are the most common signs and symptoms of diabetes insipidus. Your body regulates the fluids in your body by balancing liquid intake and output.
Two major complications of diabetes insipidus an electrolyte imbalance and dehydration. Desmopressin is a synthetic (man-made) form of vasopressin used to treat diabetes insipidus. You must drink enough water to stay hydrated, watch your medications (some may be altering fluid balance), and change your diet but this condition can be controlled.
