What Is Diabetes Insipidus?


Diabetes Insipidus is a fairly rare condition with symptoms always feeling thirsty and at the same time often urinating in very large quantities. If it is very severe, the sufferer can excrete urine as much as 20 litres a day. Diabetes insipidus itself is different from diabetes mellitus. Diabetes mellitus is a long-term disease characterized by blood sugar levels above normal. Diabetes insipidus, on the other hand, is not related to blood sugar levels.

Causes of Diabetes Insipidus
The occurrence of diabetes insipidus is caused by a disruption in the antidiuretic hormone (ADH) which regulates the amount of fluid in the body. This hormone is produced by the hypothalamus, which is a special tissue in the brain. This hormone is stored by the pituitary gland after it is produced by the hypothalamus.

The pituitary gland will release this antidiuretic hormone when the water content in the body is too low. 'Antidiuretic' means opposite to 'diuresis'. 'Diuresis' means urine production. This antidiuretic hormone helps maintain water in the body by reducing the amount of fluid wasted through the kidneys in the form of urine.

What causes diabetes insipidus is the production of antidiuretic hormone which is reduced or when the kidneys no longer respond as usual to antidiuretic hormones. As a result, the kidneys emit too much fluid and cannot produce concentrated urine. People who experience this condition will always feel thirsty and drink more because they try to compensate for the amount of fluid lost.

Diabetes insipidus itself is divided into two main types, namely:
  • Diabetes cranial insipidus . This type of diabetes insipidus is the most common. Because the body does not have enough antidiuretic hormones from the hypothalamus. This condition can be caused by damage to the hypothalamus or to the pituitary gland. Damage that occurs can be caused by infection, surgery, brain injury, or brain tumors.
  • Diabetes insipidus nephrogenic . This type of diabetes insipidus occurs when the body has enough antidiuretic hormone to regulate urine production, but the kidney organ does not respond to it. This condition may be caused by damage to kidney function or as a hereditary condition. Some drugs used to treat mental illness, such as lithium, can also cause this type of diabetes insipidus.
If you experience symptoms of diabetes insipidus, such as always feeling thirsty and urinating more than usual, you should immediately see a doctor. Maybe you don't experience diabetes insipidus, but it's better to know the cause.

Adults urinate 4-7 times a day, while young children do it up to 10 times a day. This is because the bladder of children is smaller. The doctor will do several tests to find out the exact cause and diagnosis of the condition experienced.

Treatment of Diabetes Insipidus
In cranial diabetes insipidus, treatment may not be necessary in mild cases. To compensate for the amount of liquid wasted, you need to consume more water. There is a drug that functions to mimic the role of antidiuretic hormone named desmopressin. If you really need it, you can take this medicine.

Whereas in nephrogenic diabetes insipidus, the drug used to treat it is thiazide diuretic. This drug serves to reduce the amount of urine produced by kidney organs.

Complications of Diabetes Insipidus
The low amount of water or fluid in the body is called dehydration. This is one of the complications caused by diabetes insipidus. If dehydration is quite mild, you can drink ORS to treat it. But hospital treatment will be needed if dehydration is severe.

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Symptoms of Diabetes Insipidus

The main symptom of diabetes insipidus is always feeling thirsty and often urinating in large quantities. You will always be haunted by feeling thirsty even though you have drunk a lot of water.

The amount of urine released by people with diabetes insipidus every day is around 3-20 liters, ranging from mild cases of diabetes insipidus to the most severe cases. Urination experienced by sufferers of this condition can be 3-4 times per hour.

Symptoms that appear above can interfere with your daily activities and your sleep patterns. The result will be fatigue, irritability, and difficulty concentrating on daily activities.

Diabetes insipidus in children may be more difficult to recognize, moreover the child cannot communicate well. Symptoms in children suffering from diabetes insipidus are:
  • Bedwetting at bedtime.
  • Easily irritated or angry.
  • Crying excessively.
  • High body temperature or hyperthermia.
  • Weight loss without obvious reasons.
  • Loss of appetite.
  • Feel fatigue and fatigue.
  • Slower growth.
Be sure to see your doctor immediately if you experience the two main symptoms of diabetes insipidus, which is always feeling thirsty and often urinating in large quantities.


Causes of Diabetes Insipidus

The hypothalamus, the tissue in the brain that controls mood and appetite, is an organ that produces antidiuretic hormones. This hormone will be stored in the pituitary gland until needed. The pituitary gland itself is under the brain, and is behind the bridge of the nose. This gland will release antidiuretic hormone when the body's water content decreases to stop urine production in the kidneys.

Diabetes insipidus occurs when the antidiuretic hormone is disrupted in regulating the body's water content. As a result, the body produces a lot of urine and removes a lot of water.

The following is a further explanation of the two types of diabetes insipidus.

Cranial Diabetes Insipidus

This is a condition when the body does not produce enough antidiuretic hormone and causes a lot of wasted water in the urine. Below are some of the most common causes of this type of diabetes insipidus, namely:
  • About 16 percent of cranial diabetes insipidus cases are caused by severe head injuries that damage the hypothalamus or the pituitary gland.
  • About 20 percent of cranial diabetes insipidus cases are caused by complications due to brain surgery that damage the hypothalamus or the pituitary gland.
  • About 25 percent of cranial diabetes insipidus cases are caused by brain tumors that damage the hypothalamus or pituitary gland.
The following are some of the less frequent causes of cranial diabetes insipidus.
  • Brain cancer.
  • Lack of oxygen in the brain for example due to stroke.
  • An infection that damages the brain, such as encephalitis and meningitis.
  • Wolfarm syndrome is a rare genetic disorder that can cause loss of vision.
About 1 in 3 cases of cranial diabetes insipidus are unknown.

Nephrogenic Diabetes Insipidus

This is a condition when the antidiuretic hormone is produced in accordance with the levels needed by the body. But the kidneys are not sensitive or do not respond to this hormone.

The antidiuretic hormone normally sends signals to the nephron tissue in the kidney. Nephrons are small structures that control how much water is absorbed by the body and how much water is released in the form of urine. For people who suffer from nephrogenic diabetes insipidus, the process of sending this signal is interrupted. As a result, people who experience it will always feel thirsty because urine is wasted in large quantities. Nephrogenic diabetes insipidus itself is divided into two types:
  • Congenital nephrogenic diabetes insipidus or known as congenital nephrogenic diabetes insipidus. Congenital nephrogenic diabetics are born with this condition. There are two types of mutations or genetic changes that cause congenital nephrogenic diabetes insipidus, namely AVPR2 and AQP2. AVPR2 genetic mutations can only be transmitted from mother to son. This type of mutation occurs in 9 out of 10 sufferers. Whereas the AQP2 genetic mutation occurs in 1 in 10 cases of congenital nephrogenic diabetes insipidus and can affect both men and women.
  • Acquired nephrogenic diabetes insipidus . This type of diabetes insipidus sufferers is not born with this condition. The most common factor causing acquired nephrogenic diabetes insipidus is the side effect of lithium. Lithium itself is a drug used to treat bipolar disorder. If consumed in the long term, kidney organ cells can be damaged and then no longer can respond to antidiuretic hormones. Nearly 50 percent of people will experience nephrogenic diabetes insipidus if they take this drug in the long term. Be sure to do a kidney check every three months while you are taking lithium. Other causes of this condition besides lithium are:
    • Pyelonephritis or kidney infection . Kidney organs are damaged due to infection.
    • Urinary tract obstruction. The inhibition of one or both urinary tracts that connect the kidney organs to the bladder, such as kidney stones.
    • Hyperkalemia . Excess amount of calcium in the blood which can damage the kidneys.
    • Hypokalemia. The amount of potassium in the blood is small, even though all cells in the body need potassium to function properly.

Diabetes Insipidus Diagnosis

Diabetes insipidus has symptoms similar to type 1 diabetes and type 2 diabetes, such as thirst and frequent urination. The doctor will ask about the symptoms you are experiencing and maybe do some tests to make sure you are suffering from which conditions.

A referral to a hormone disruption specialist may be given to do these tests:
  • Water deprivation test . In this test you are required not to consume fluids for several hours to see your body's reaction. If your condition is normal, you will only urinate a little and concentrate more concentrated. But if you have diabetes insipidus, you will urinate in large quantities.
  • Blood tests and urine tests . Blood tests are performed to determine the levels of antidiuretic hormones in the blood. In addition to blood, urine tests will also be done to find out some other elements, such as glucose, calcium, and potassium. Urine from diabetic insipidus will be very runny. If glucose levels are high, then what is suffered is type 1 diabetes or type 2 diabetes.
  • Antidiuretic hormone test . This test will show your body's reaction to the antidiuretic hormone given by injection to find out what type of diabetes insipidus is suffered. This procedure is done after a water deprivation test, if the hormone given helps you stop producing urine, it means you have cranial diabetes insipidus due to a lack of antidiuretic hormone. But if you keep producing a lot of urine, you have kidney problems or nephrogenic diabetes insipidus.
  • MRI . If a hormone specialist suspects you have cranial diabetes insipidus because of damage to the hypothalamus or pituitary gland, MRI is performed to investigate further. The doctor will see abnormalities in the hypothalamus or pituitary gland, for example whether there is a tumor.

Treatment of Diabetes Insipidus

Treatment of diabetes insipidus depends on the type suffered. Treatment is aimed at reducing the amount of urine produced by the body and controlling the symptoms that arise.

Treatment of Cranial Diabetes Insipidus

If you produce 3-4 liters of urine in one day (24 hours), this condition is considered as mild cranial diabetes insipidus. This condition does not require special treatment. You can relieve the symptoms that arise by increasing your water consumption to avoid dehydration. Doctors will recommend at least 2.5 liters a day.

If your condition is severe enough and is caused by a low production of antidiuretic hormones, consuming plenty of water is not enough to relieve the symptoms that appear. The following are some medications that might be used to treat the condition experienced.
  • Desmopressin . This drug functions like an antidiuretic hormone. This drug will stop urine production. Desmopressin is an artificial antidiuretic hormone and has a stronger function than the original hormone. This drug can take the form of a nasal spray or tablet. Possible side effects are headaches, abdominal pain, nausea, nosebleeds, or runny or stuffy nose. To find out more about this medicine, ask your doctor or pharmacist.
  • Thiazide diuretic . This drug works to make urine become more concentrated by reducing its water content. Side effects that may occur due to this drug are dizziness when standing, indigestion , skin becomes more sensitive, and for men, experience erectile dysfunction.
  • Anti- inflammatory drugs Non- teroid drugs . If this group of drugs is combined with thiazide diuretics, this drug can reduce the amount of urine released by the body.
Treatment of Nephrogenic Diabetes Insipidus

If your condition is caused by drugs such as lithium and tetracycline, hormone specialist doctors will ask you to stop taking it and look for a replacement drug. If not recommended by a doctor, do not stop taking the medication that your doctor has prescribed.

If the kidney organs are disrupted and cannot respond to antidiuretic hormones, causing nephrogenic diabetes insipidus, you will be advised to drink plenty of water to avoid dehydration. The desmopressin drug cannot overcome this condition.

Reducing salt intake will also help the kidneys to store water and reduce urine volume. Be sure to consult a doctor before changing your diet. To reduce the amount of urine production from kidney organs, a combination of thiazide diuretics and non-steroidal anti-inflammatory drugs will be prescribed in severe nephrogenic diabetes insipidus.


Complications of Diabetes Insipidus
If diabetes insipidus is not detected early or is not treated properly, this condition can cause several complications as below.

Electrolyte Imbalance
Electrolytes are minerals such as calcium, sodium, chlorine, potassium, magnesium, and bicarbonate. This mineral content serves to maintain the balance of water in the body and plays a role in cell functions. Symptoms that might occur due to this condition are:
  • Exhausted or running out of energy.
  • Headache.
  • Pain in the muscles.
  • Easy to get angry.
  • Nausea and loss of appetite.
Dehydration
Dehydration is the most common effect when the body cannot maintain enough fluid in the body due to diabetes insipidus. Symptoms that arise from dehydration include:
  • Dry mouth and lips.
  • Dizziness or headache.
  • Low blood pressure (hypotension).
  • Fever.
  • Confusion and irritability.
  • Fast heart rate.
  • Weight loss.
For mild dehydration, it can be treated with ORS. As for severe conditions, you may need to be hospitalized to get fluids through an IV.

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