Causes, Symptoms, And Treatment Of Diabetes Insipidus
Diabetes insipidus is a rare condition causing a water imbalance in the body, leading to excretion of larger than normal amounts of urine and increased thirst even after drinking plenty of fluids. Although most individuals have heard of diabetes mellitus, typically as either type 1 or type 2 diabetes, this is not the same as diabetes insipidus. There is currently no cure for this form of diabetes; however, treatment options are available to satisfy thirst and decrease the amount of urine output to prevent dehydration and electrolyte imbalances.
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Causes
There are two main types of diabetes insipidus. Although they are both related to an antidiuretic hormone called vasopressin, they each have separate causes. Central diabetes insipidus, also known as neurogenic or vasopressin-sensitive diabetes, occurs when the brain’s pituitary gland does not secrete enough of the hormone vasopressin or does not produce it at all. Nephrogenic diabetes insipidus is caused when there are normal production levels of vasopressin, but there is an impaired response to the hormone from the kidneys.
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How It Occurs
Diabetes insipidus occurs when the body fails to regulate how it handles fluids. In healthy individuals, excess body fluids are excreted from the bloodstream by the kidneys. The bladder temporarily stores the liquid waste, or urine, until it is ready to be discharged. Normal functioning kidneys conserve fluid and make less urine when the body is dehydrated or when sweating a lot, such as during exercise. Vasopressin is a hormone produced in the hypothalamus and is stored in the pituitary gland. It governs how much fluid is excreted by the kidneys. Diabetes insipidus occurs when there are imbalance levels of vasopressin in the body.
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Damage To The Pituitary Gland
When an individual has sustained damage to their pituitary gland, it can cause them to develop a form of diabetes insipidus called central diabetes insipidus. Individuals affected by central diabetes insipidus are unable to regulate their water balance inside of the body properly. The pituitary gland is located behind the bridge of an individual's nose and at the base of their brain. This main gland is responsible for the secretion of a hormone called anti-diuretic hormone into the rest of the individual's body. However, if the pituitary gland becomes damaged as a result of a tumor, previous surgery, illness, or head injury, it may cause it to malfunction. This malfunction may manifest as an inability to produce sufficient amounts of anti-diuretic hormone. In addition, any of these factors can cause an individual's pituitary gland to have difficulty storing and releasing the anti-diuretic hormone, which can also result in the development of central diabetes insipidus. This type of diabetes insipidus may also be caused by an inherited genetic disease with adverse effects on the patient's pituitary gland.
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Kidney Tubules Defect
An individual affected by a kidney tubules defect can develop a form of diabetes insipidus referred to as nephrogenic diabetes insipidus as a result of their defect. A healthy individual has a set of kidneys that contain small structures called tubules. The kidney tubules are responsible for the reabsorption of water from the urine when the body doesn’t have enough, and the excretion of water from the blood when the body has too much. In healthy individuals, the tubules perform this function as a response mechanism to differing levels of the hormone called anti-diuretic hormone. However, individuals affected by a kidney tubules defect have kidneys with tubules that do not know how to respond to varying levels of anti-diuretic hormone appropriately. A kidney tubules defect can be a result of an inherited genetic mutation in the individual's DNA, or it can be more of a chronic kidney disorder. In addition, nephrogenic diabetes insipidus that has precipitated from a kidney tubule defect can be the result of certain types of medications, including some antivirals and lithium.
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Primary Polydipsia
An individual who has primary polydipsia can develop a type of diabetes insipidus called dipsogenic diabetes insipidus as a complication. Primary polydipsia is the medical term used to describe an individual who experiences a sensation of extreme thirst on a consistent basis, all day and every day. As a result of this continuous sensation, the patient inappropriately consumes an excessive amount of fluids. Drinking excessive amounts of fluids leads to an abnormally large volume of very diluted urine to be excreted. When the hypothalamus is unable to regulate an individual's thirst properly, the water balance in the body cannot be adequately controlled or managed. This type of condition can be caused when the thirst regulating mechanism the hypothalamus is responsible for becomes physically and or functionally damaged. Certain mental illnesses have been known to trigger primary polydipsia that leads to the development of dipsogenic diabetes insipidus. Most mental illnesses that result in primary polydipsia are different forms of schizophrenia.
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Polyuria
Polyuria, or an excessive output of urine, is the main symptom of diabetes insipidus. In most cases, polyuria causes an increased thirst that does not seem to be quenched no matter how much an affected individual drinks. This contributes to urine output, which is already a common symptom of diabetes insipidus. The need to urinate frequently can be disruptive to sleep and other daily schedules such as working or sitting in a classroom for several hours during the day.
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Other Symptoms
Depending on how severe the condition is, patients with diabetes insipidus may lose as much as sixteen quarts of urine a day, whereas a healthy adult typically only loses around three quarts. Losing too much water can cause muscle weakness or pain, lethargy, and irritability. Affected children and infants may experience inconsolable crying, unexplained fussiness, vomiting, diarrhea, fever, weight loss, delayed growth, or an electrolyte imbalance. Thus, individuals should seek treatment at the first sign of increased urine output and excessive thirst.
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Adjustments In Consumption Of Sodium And Water
Diabetes insipidus patients may be advised by their physician to make adjustments in consumption of sodium and water as a part of their treatment regimen for the disorder. Different forms of diabetes insipidus have various recommendations on water and sodium in an individual's diet. Those affected by central diabetes insipidus are typically recommended to consume a diet low in salt. This low-salt diet helps decrease an excessive intake of water. Individuals affected by nephrogenic diabetes insipidus are also recommended to change to a diet low in sodium. In these cases, the low sodium functions to decrease the volume of diluted urine the kidneys are making and excreting. However, with a low salt diet, these patients will have to make sure to drink enough water so they do not become dangerously dehydrated. Individuals affected by primary polydipsia with dipsogenic diabetes insipidus will be advised to decrease their fluid intake significantly. For these patients, a reduction in the consumption of fluids often cannot be managed without the help of medication.
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Treatment With Hormones
Individuals affected by the central form of diabetes insipidus may require treatment with hormones when other treatment methods are unable to manage the disorder effectively. Desmopressin is a lab-created hormone that mimics the naturally occurring vasopressin hormone in healthy individuals. Those affected by hormone deficiency precipitated diabetes insipidus can take desmopressin to help replace the deficient or missing vasopressin in their bodies. Desmopressin is available in several different forms, including injections, oral tablets, or nasal sprays. This synthetic form of vasopressin helps reduce the amount of urine output from the patient's kidneys. Because the bodies of diabetes insipidus patients make varying but small amounts of natural vasopressin, each individual may need to take differing amounts of desmopressin to meet their goal of proper water balance. The general goal for patients taking desmopressin is an output of around two liters of urine every twenty-four hours. Desmopressin is taken on average between one and three times daily to achieve this goal.