What is Insipidus Diabetes: Causes, Symptoms, Diagnosis, Risk Factors

Insipidus diabetes or diabetes insipidus is a rare medical condition in which there is there is larger excretion of urine (polyuria) leading to an imbalance of fluids (water) inside the human body. It also causes intense feeling of thirst even after drinking lot of water (polydipsia). This problem is basically associated with kidney which starts to behave abnormally passing 3 to 20 quarts of urine as compared to 1 to 2 quarts or urine in a normal human being. The urine is dilute and free from any odour termed as insipid.

Some people may think that insipidus diabetes and diabetes mellitus are same and similar but they are very different in nature. However, both the conditions results in constant thirst and frequent urination and can be classified into type 1 and type 2 diabetes.

Diabetes mellitus is more related to inability of the body to burn down sugar leading to increased levels of sugar in blood while insipidus diabetes is related to inability of kidneys to maintain a proper balance of fluids in the body.

• The amount of fluid in the body of human beings is maintained by balancing thirst and urination. Urinations removes excess fluids while thirst helps in fulfilling demands of fluids. However, there are some more processes like breathing, sweating or diarrhea which also causes removal of fluids. Removal of fluids from the body by urination is governed by hormone vasopressin, also referred as antidiuretic hormone.
• Diabetes insipidus can be divided into four types: nephrogenic, central, gestational and dipsogenic. Each of them is associated with a different cause.
• The main concern in case of diabetes insipidus is the excess loss of water from the body as compared to liquid intake.
• There are many factors that help in diagnosis of insipidus diabetes including a physical exam, medical and family history, blood tests, urinalysis, magnetic resonance imaging (MRI) and a fluid deprivation test. A person needs to drink lots of water in case of insipidus diabetes to ensure right amount of fluids in the body.

Classification of insipidus diabetes into type 1 and type 2 diabetes is very much different from diabetes mellitus. Insipidus diabetes results due to issues with antidiuretic hormone (ADH) or its receptor resulting in frequent urination.

While it is impossible to cure Insipidus diabetes, it is possible to control its symptoms such as constant urination and thirst by using synthetic version of vasopressin (Desmopressin or DDAVP) which helps in leading a normal life.

If there is a problem with hypothalamus which releases anti-diuretic hormone (ADH) or with the pituitary gland in the brain insipidus diabetes is caused and this is the major cause. There are other causes.

Insipidus diabetes results from the inability of the body to maintain proper balance of fluids in the body. Kidneys are responsible for removing excess fluid from the blood which is stored in urinary bladder temporarily before being urinated out of the body. Under normal circumstances, kidney generates urine according to the amount of fluids present in body.

In our body, proper balance of fluids is maintained by the combination of removal of water through urine and intake of water when we are thirsty. The rate of excretion of fluids from kidneys is determined by a hormone known as anti-diuretic hormone (ADH), also referred as vasopressin.

This hormone is produced by hypothalamus and is stored in pituitary gland located close to the brain. In case of dehydration in body, brain triggers the release of ADH into blood stream which causes kidney tubules to reduce excretion of water circulating it back into the blood stream.

The root cause of insipidus diabetes and the location of the problem depends on the type of insipidus diabetes:

• Central Insipidus Diabetes: This type of insipidus diabetes results from any injury or harm to hypothalamus or pituitary gland. This damage can result from a tumour, surgery, inflammation, illness or even injury to head. The injury to pituitary gland affects the process of release, storage or production of ADH leading to insipidus diabetes. Central insipidus diabetes can also be genetic.
• Nephrogenic Insipidus Diabetes: This type of insipidus diabetes results from improper functioning of kidney tubules which determines the excretion and re-absorption of water. Thus, ADH is unable to influence kidney properly leading to insipidus diabetes. This type of insipidus diabetes can be genetic or can be caused due to intake of some drugs like cidofovir and foscarnet (Foscavir) or lithium.
• Gestational Insipidus Diabetes: This type of insipidus diabetes is very rare and occurs during pregnancy when certain enzymes in placenta starts to eat away ADH preventing them from reaching to kidney. Placenta is tissue with rich supply of blood vessels that nourishes a child in the mother’s womb. It occurs very rarely.
• Primary Polydipsia: This type of insipidus diabetes does not result from any damage or disruption of ADH or pituitary gland but from excessive intake of fluids. When a person takes excessive fluids regularly, ADH are unable to control secretion of fluids in kidney resulting in insipidus diabetes. This type of insipidus diabetes is also termed as psychogenic polydipsia or dipsogenic insipidus diabetes.

Other causes of insipidus diabetes:

• Increased amount of thirst can result due to any disruption in thirst-regulating mechanism regulated by hypothalamus. In few cases, it may also be associated with mental illness.
• There are some cases of insipidus diabetes where doctors cannot determine the cause.

Insipidus diabetes shows one or more of the following signs and symptoms:

• Increased thirst is the symptom of insipidus diabetes.
• Excessive discharge of fluids through dilute urine.

The release of fluids in case insipidus diabetes is usually between 3 to 16 quarts and can be can be as high as 15 liters in a day in case of extreme condition of insipidus diabetes. Under normal circumstances, amount of fluids discharged through body is less than 3 liters per day on an average.

It can also cause an urge to urinate at night (nocturia) or even bed-wetting.

Most common signs and symptoms of insipidus diabetes in case of young children and infants are as follows:

• Feeling of discomfort causing crying without any reason can be a sign of insipidus diabetes.
• Inability to sleep.
• Diarrhea.
• Fever.
• Loss of weight.
• Vomiting.
• Deferred growth.

It is strongly recommended to seek immediate attention from a doctor and expert if an individual experiences combination of extreme thirst and excessive urination which are the two most common indication of insipidus diabetes.

Your doctor would need answers of the following questions to diagnose the condition of insipidus diabetes:

• When was the first time you experienced symptoms of insipidus diabetes?
• What is change is volume or frequency of urination as compared to normal circumstances?
• How much water are you drinking in a whole day?
• Do you feel the urge to urinate at night or feel thirsty at night?
• Are you expecting a baby?
• Are you taking any medications or any treatments currently?
• Have you undergone any kind of medical treatment in the recent past?
• Have you undergone any surgery of your brain and have suffered any injury in your head?
• Is there anyone else in your family you know experiencing same problems or diagnosed with insipidus diabetes?
• Is there anything that relieves you from the symptoms of insipidus diabetes?
• Is there anything that make symptoms of insipidus diabetes worse?

In the meantime while you cannot see a doctor or are waiting for your turn, you must ensure that your body stay well hydrated by drinking enough water every time you feel thirsty. Also avoid yourself from getting dehydrated by keeping yourself away from spending time in hot atmosphere or physical exertion.

In case of nephrogenic insipidus diabetes occurring in infants right from the birth or just after the birth, the cause is mostly genetic. As a result, an off spring is born with a kidney that is unable to work efficiently and concentrate urine. Risk of occurrence of nephrogenic insipidus diabetes are much higher in case of men as compared to women but this disorder can be easily passed on to the children from the mother.

A doctor needs to perform multiple tests to confirm the diagnosis of insipidus diabetes as there are many other conditions that can result in similar symptoms. Once it is confirmed that a person is suffering from insipidus diabetes, the next step is to determine the type of insipidus diabetes as there are different treatment procedures for each type.

Following is the list of most commonly used tests for the diagnosis of insipidus diabetes and its types.

• Water Deprivation Test to Diagnose Insipidus Diabetes: Water deprivation test is one of the most prominent tests capable of diagnosing insipidus diabetes as well as its sub-type. Usually a person is kept away from drinking any fluids for some time under the supervision of doctor to monitor the change in weight, urination and the concentration of blood and urine in this state of the body. Sometimes, ADH levels in blood is also measured and also inject some synthetic ADH into your blood stream. In case of pregnant women and children, special care is taken to ensure that the body does not loss more than 5% of the initial body weight during the test.
• Urinalysis to Diagnose Insipidus Diabetes: Analysis of urine can also reveal the occurrence of insipidus diabetes as dilute urine is a clear indication of loss of excessive water from the body.
• Another way to Diagnose is Through Magnetic Resonance Imaging (MRI): In this MRI method, the doctor tries to determine any abnormalities in the head especially around pituitary gland using powerful magnetic field that generates radio waves.
• Genetic Screening for Diagnosing Insipidus Diabetes: In case the doctor is suspicious about insipidus diabetes being inherited, the doctor may want to look at your family medical history.

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