Diabetes Insipidus

What is diabetes insipidus?

Diabetes insipidus occurs when your body doesn’t make enough antidiuretic hormone (ADH). Or your kidneys don’t respond to it. ADH is a hormone that helps keep the right amount of water in your body. It does this by controlling how much urine your kidneys put out. ADH is made by a small section of your brain located in the upper part of your pituitary gland called hypothalamus. ADH is released by the posterior part of the pituitary gland. Normally, it's released into the bloodstream when your body's sodium concentration is high, or your total fluid level is low. This keeps you from losing too much water (dehydration). If you are a bit dehydrated, ADH should increase.

Diabetes insipidus is not related to the more common type of diabetes (diabetes mellitus).

What causes diabetes insipidus?

There are several types of diabetes insipidus:

• Central. This is when the hypothalamus or pituitary gland in the brain doesn’t make or send out enough ADH. It can happen if the hypothalamus or pituitary gland are damaged or there is something compressing them. That can be caused by a head wound, including surgery on the pituitary gland. It can also be caused by a genetic problem or other diseases.

• Nephrogenic. This is when the kidneys don’t respond to normal levels of ADH. It can be caused by medicines like lithium, or rare genetic disorders. It can also be caused by kidney disease or low potassium or high calcium levels in the blood.

• Gestational. This occurs only in pregnant women and is very rare. In this type, an enzyme made by the placenta destroys ADH in the mother.

What are the symptoms of diabetes insipidus?

Common symptoms may include:

• Being very thirsty

• Urinating a lot

• Dehydration

These symptoms may look like other health problems. Always see your healthcare provider for a diagnosis.

How is diabetes insipidus diagnosed?

Your healthcare provider will take your health history and give you a physical exam. You may also need the following tests:

• Urine tests

• Blood tests to see how your hypothalamus, pituitary gland, and kidneys react to dehydration. This is called a formal water deprivation test.

• CT scan or MRI of the pituitary. You may need this to see if you have a structural problem in the hypothalamus or pituitary gland.

How is diabetes insipidus treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment for diabetes insipidus depends on what is causing it:

• All types. You need to have a specific amount of fluid to prevent dehydration and keep a normal sodium concentration. .

• Central and gestational types. Treatment may include taking modified ADH medicines or medicines to stimulate ADH production.

• Nephrogenic diabetes insipidus. Other medicines may be used.

What are possible complications of diabetes insipidus?

If you don’t drink enough fluids, you can get dehydrated. You can also have an electrolyte imbalance. This means not having the right balance of minerals in your body.

Dehydration can cause:

• Dry skin

• Dry mouth, nose, and sinuses

• Sluggishness

• Confusion

• Fever

• Fast heart rate

• Eyes that look sunken

• Weight loss and weakness, especially when standing

Electrolyte imbalance can cause:

• Tiredness

• Headache

• Muscle pains

• Feeling very tired

• Being grouchy (irritable)

• Irregular heartbeat

Living with diabetes insipidus

It’s important to follow your healthcare provider’s directions about medicines and fluid intake to prevent problems.

When should I call my healthcare provider?

If your symptoms get worse or you have new symptoms, call your healthcare provider right away.

Key points about diabetes insipidus

• Diabetes insipidus occurs when your body doesn’t make enough antidiuretic hormone (ADH), or your kidneys don't react to it. It is a rare disease that causes you to urinate often.

• It is not related to the more common type of diabetes (diabetes mellitus).

• Symptoms may include extreme thirst and urine production, and dehydration. This leads to high normal sodium level imbalance

• You may need to have blood tests and urine tests.

• Treatment depends on what is causing the disease. It may include replacing ADH with medicines.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.