Diabetes insipidus: symptoms, causes, and treatment

Definition

What is diabetes insipidus?

Diabetes insipidus is a disorder that causes an imbalance of fluids in the body. This condition can result in increased urination frequency and excessive thirst.

This disease can make sleepless nights disturbed and it is difficult to hold urine, to incontinence. Although the symptoms are similar to diabetes mellitus, the causes of this disease are different.

Diabetes mellitus is caused due to insulin problems and high blood sugar levels. Meanwhile, diabetes insipidus is affected by the work of your kidneys on urine. The two are not related.

This condition cannot be cured. However, there are various treatment options according to the cause of the disease. Treatment is done to relieve symptoms and reduce the risk of complications.

How common is this disease?

Diabetes insipidus is a rare condition. However, men experience diseases that attack kidney function more often than women. In addition, this condition can also occur at any age, including infants and children.

You can reduce your chances of getting this disease by reducing the risk factors.

Signs & symptoms

What are the signs and symptoms of diabetes insipidus?

There are various symptoms that can appear when a person is exposed to this disease. One of them is frequent urination and thirst. Why is that?

Urinating frequently

People with diabetes insipidus may urinate too often. Quoted from the Mayo Clinic, the kidneys usually filter around 120-150 liters of blood to produce 1-2 liters of urine every day.

Meanwhile, patients with this disease can pass 3-20 liters of urine daily. This condition causes them to urinate more frequently, which is about 3-4 times per hour. In addition, the urine they pass is generally thinner, looks faded, and has no smell.

It's easy to feel thirsty

If you have been feeling thirsty lately, you may need to be careful. The reason is, easily and often feeling thirsty can be a sign and symptom of diabetes insipidus.

This condition can occur because you excrete more urine. The more urine you pass, the more fluid your body needs. As a result, people with this condition can constantly feel thirsty, even after drinking lots of water.

Apart from the two symptoms above, there are several other signs of diabetes insipidus that are similar to kidney disease, such as:

• feeling weak, lethargic, and weak,
• lack of sleep due to frequent waking up at night to urinate,
• constipation,
• dry skin,
• hard to concentrate, as well
• frequent bed-wetting.

Characteristics of diabetes insipidus in children

This disease does not only affect adults, but babies and children can also experience it. So, what are the symptoms that parents need to be aware of?

• Fever.
• Vomiting and diarrhea.
• Unreasonable fuss or keep crying.
• Weight loss drastically.
• Late child growth.
• Dry skin and cold body.

There may be signs and symptoms not listed above. If you have concerns about a particular symptom, consult your doctor.

When should I see a doctor?

Tell your doctor right away if you urinate more than usual, feel excessively thirsty, or have other symptoms. Each person may experience different symptoms. Therefore, you need to discuss with your doctor to choose the type of examination and the most appropriate solution.

Cause

What causes diabetes insipidus?

Diabetes insipidus is a disorder of kidney function caused by problems with the pituitary gland or antidiuretic hormone. Antidiuretic hormone that does not work causes fluid imbalance in the body.

Normally, the antidiuretic hormone (ADH), known as vasopressin, is responsible for maintaining fluid balance in the body. This hormone is produced by the brain's hypothalamus gland which is responsible for supporting kidney function in absorbing and removing body fluids.

If the body is dehydrated, the pituitary gland will secrete the hormone ADH to the kidneys to retain fluids and reduce urine production. However, these hormones do not work, thus disrupting the amount of fluid in the body.

Here are some types of diabetes insipidus based on the cause.

1. Central diabetes insipidus

Central diabetes insipidus is caused by damage to the hypothalamus or pituitary gland. This causes the production, storage, and release of the hormone vasopressin to be disrupted. Damage can be caused by meningitis, tumors, head injuries, or brain surgery.

2. Nephrogenic diabetes insipidus

This condition can occur when the kidneys do not respond to vasopressin and continue to remove too much fluid from the bloodstream. These abnormalities in the kidney tubules can also be caused by genetic disorders and other conditions, such as:

• chronic kidney failure,
• low levels of potassium in the blood,
• too much calcium in the blood,
• blocked urinary tract, as well
• use of certain medications, such as lithium and demeclocyline.

3. Gestational diabetes insipidus

Gestational diabetes insipidus usually only occurs in pregnant women. This type of disease is caused by an enzyme produced by the baby's placenta that destroys the hormone ADH or vasopressin in the mother's body.

In some cases, this disease occurs because pregnant women produce more prostaglandins or hormones that reduce the sensitivity of the kidneys to vasopressin. Gestational diabetes is fairly mild and doesn't cause severe symptoms.

4. Primary polydipsia

Excessive fluid consumption can actually lead to primary polydipsia. This occurs due to damage to the body's mechanisms that respond to thirst.

The damage results in increased thirst and desire to drink. Increasing fluid intake ultimately suppresses vasopressin secretion and makes you urinate more frequently. There are several factors that cause damage to the nerves located in the hypothalamus, namely:

• ever had surgery,
• infection and inflammation, and
• tumors and injuries to the head.

Risk factors

What increases my risk for diabetes insipidus?

Regardless of age and gender, anyone can get diabetes insipidus. However, there are several factors that can increase a person's risk of this disease, namely as follows.

• Gender, men are more at risk than women.
• Genetic factors, parents with this disease can pass the genes to their children.
• Have had a head injury.
• History of tumor disease in the brain.
• Had surgery on the brain.
• Use of certain drugs, such as lithium.
• History of congenital diseases of the kidneys.
• History of certain diseases or infections.

Diagnosis

How to diagnose this condition?

In order to detect diabetes insipidus, the doctor will perform several tests, including kidney function tests. In addition, the doctor will also check the medical history of other family members. Here are some types of tests that are done to diagnose this condition.

1. Urine test

By collecting a patient's urine sample, the laboratory can see if the urine is dilute or concentrated. This test is also performed to show the glucose that differentiates diabetes insipidus from diabetes mellitus.

In addition, a urine test can also be used as a benchmark to measure the total amount of urine produced by the kidneys for 24 hours.

2. Blood test

The blood sample taken from the exam helps the doctor show the sodium level. The amount of sodium in the body will help the doctor determine the diagnosis and the type of disease.

3. Water deprivation test

This test is generally performed to measure changes in a patient's weight and urine concentration after limiting fluid intake. In healthy people, they will urinate less with a more concentrated urine concentration.

If you have diabetes insipidus, your urine volume may be heavier and more frequent, even if you have limited fluid intake.

After the deprivation test is done, the doctor may inject an antidiuretic hormone. This method is used to determine the type of diabetes insipidus. If the hormone that is being injected makes the kidneys reduce urine production, it means you have diabetes insipidus.

Meanwhile, if you still have a lot of urine, you may have kidney disease or nephrogenic diabetes insipidus.

4.MRI (magnetic resonance imaging)

This examination with magnetic technology and radio waves cannot be used to diagnose diabetes inspidus. MRI is done to show whether the hypothalamus or pituitary gland in the kidneys is problematic.

Thus, it is easier for the doctor to determine whether this disease is a possible cause of the appearance of symptoms in a patient.

Medicine & medication

What are my treatment options for diabetes insipidus?

Diabetes insipidus cannot be cured. This disease is permanent and will last for life. In fact, until now there is no drug that can cure diabetes insipidus.

However, there are a number of medications or treatments that can be done to relieve symptoms and reduce the risk of complications.

Types of treatment to treat diabetes insipidus also vary and can be adjusted according to the cause. Here are the therapies you can choose from:

1. Desmopressin therapy

For people with central, dipsogenic, and gestational diabetes insipidus who are already severe, doctors will usually recommend desmopressin therapy. This applies when increasing the water does not relieve the symptoms experienced.

This therapy, which works like ADH, helps the kidneys produce urine. There are two types of desmopressin drugs available, namely nasal sprays and tablets.

The use of nasal sprays is usually done just one to two times a day. This is because the drug can absorb quickly into the bloodstream. Therefore, this drug is not recommended when the patient has a cold.

Meanwhile, desmopressin in tablet form can be consumed more than twice a day. The reason is, this drug is not absorbed effectively by the intestines than through the nasal passages. In order to have the same effect, more desmopressin tablets need to be used.

This therapy is classified as safe with few side effects, such as headaches to nosebleeds. If used too often, the patient may feel bloated and lack of sodium in the blood (hyponatremia).

2. Diuretic therapy

Unlike the three other types of diabetes insipidus, nephrogenic diabetes cannot be controlled with desmopressin therapy. The treatment option for sufferers of this disease is diuretic therapy.

Generally, doctors will prescribe a combination drug, namely thiazide diuretics and non-steroidal anti-inflammatory drugs (NSAIDs). The two drugs are combined to reduce the amount of urine the kidneys produce.

Although thiazide is a type of drug that can increase urine production (is a diuretic), there are times when the use of this drug helps reduce the rate at which the kidneys filter blood. This means that the amount of urine excreted by the body will decrease.

Although safe, this drug also has side effects, such as dizziness, digestive problems, and erection problems. Treatment of diabetes insipidus with NSAID drugs, such as ibuprofen can support the performance of the diuretic drug thiazide.

However, long-term use of NSAIDs can cause stomach ulcers, so additional drugs are needed, namely proton pump inhibitors (PPIs). This medicine helps reduce the risk of stomach problems.

3. Treat the cause

If your symptoms are caused by medication, your doctor will change your medication to an alternative. Meanwhile, diabetes insipidus which is caused by mental disorders will be treated first.

If the cause is a tumor, the doctor may consider whether the tumor needs to be removed or not.

Home remedies

What are some lifestyle changes or home remedies that can be done to treat diabetes insipidus?

While getting treatment from a doctor, there are several home remedies that can help you deal with diabetes insipidus, which are as follows.

Drink enough water when thirsty

One of the home remedies that diabetes insipidus patients should take is drinking adequate water when thirsty. This is done to prevent complications in the form of dehydration. Your doctor or endocrinologist will usually advise you to drink at least 2.5 liters of water per day.

If you are on desmopressin therapy, ask your doctor what fluid needs are right for you. The reason is, too much water intake can actually cause excess fluid buildup. As a result, your health condition can worsen due to the heavier workload of the kidneys.

Other handling

Apart from drinking enough water when thirsty, there are several other things to consider when suffering from diabetes insipidus:

• Take medication as directed by your doctor.
• Tell your doctor if there are changes in your condition.
• Immediately go to the nearest hospital if you have a high fever, diarrhea, or urinate more frequently.

If you have any questions, consult your doctor for the best solution to your problem.