Diabetes insipidus is a fairly rare condition, with symptoms of always feeling thirsty and at the same time often urinating in very large quantities. If it is very severe, the sufferer can excrete as much as 20 liters of urine in a day.
Diabetes insipidus 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 disturbance in the antidiuretic hormone (ADH) which regulates the amount of fluid in the body. This hormone is produced by the hypothalamus, a special tissue in the brain. This hormone is stored by the pituitary gland after being produced by the hypothalamus.
The pituitary gland will secrete this antidiuretic hormone when the water level in the body is too low. ‘Antidiuretic’ means the opposite of ‘diuresis’. ‘Diuresis’ itself means urine production. This antidiuretic hormone helps retain water in the body by reducing the amount of fluid that is wasted through the kidneys in the form of urine.
What causes diabetes insipidus is reduced production of antidiuretic hormone or when the kidneys no longer respond normally to antidiuretic hormone. As a result, the kidneys excrete too much fluid and cannot produce concentrated urine. People who experience this condition will always feel thirsty and drink more because they are trying to compensate for the amount of fluid lost.
Diabetes insipidus itself is divided into two main types, namely:
- Cranial diabetes insipidus. This type of diabetes insipidus is the most common. Because the body does not have enough antidiuretic hormone from the hypothalamus. This condition can be caused by damage to the hypothalamus or to the pituitary gland. The damage can be caused by infection, surgery, brain injury, or a brain tumor.
- Nephrogenic diabetes insipidus (NDI). This type of diabetes insipidus occurs when the body has enough antidiuretic hormone to regulate urine production, but the kidneys don’t respond to it. This condition may be caused by impaired kidney function or as a hereditary condition. Some medications 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 see a doctor immediately. You may not have diabetes insipidus, but it would be 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 children’s bladders are smaller. The doctor will perform several tests to determine the exact cause and diagnosis of the condition.
Diabetes Insipidus Treatment
In cranial diabetes insipidus, treatment may not be necessary in mild cases. To compensate for the amount of fluid wasted, you need to consume more water. There is a drug that works to mimic the role of the antidiuretic hormone called desmopressin. If necessary, you can take this drug.
While in nephrogenic diabetes insipidus, the drug used to treat it is a thiazide diuretic. This drug works to reduce the amount of urine produced by the kidneys.
Complications of Diabetes Insipidus
Low amount of water or fluids in the body is called dehydration. This is one of the complications caused by diabetes insipidus. If the dehydration that occurs is quite mild, you can drink ORS to overcome it. However, hospitalization will be required if the dehydration is severe enough.
Symptoms of Diabetes Insipidus
The main symptoms of diabetes insipidus are feeling thirsty and urinating frequently. You will always feel thirsty even though you have drunk a lot of water.
The amount of urine excreted by people with diabetes insipidus every day is about 3-20 liters, ranging from mild cases of diabetes insipidus to the most severe cases. Pee experienced by sufferers of this condition can be as much as 3-4 times per hour.
The symptoms that appear above can interfere with daily activities and your sleep patterns. As a result, you will feel tired, irritable, and difficult to concentrate in carrying out daily activities.
Diabetes insipidus in children may be more difficult to recognize, especially if the child is not yet able to 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 for no apparent reason.
- Loss of appetite.
- Feeling tired and fatigued.
- Slower growth.
Be sure to see a doctor right away if you experience two of the main symptoms of diabetes insipidus, namely feeling thirsty and urinating frequently.
Causes of Diabetes Insipidus
The hypothalamus, the tissue in the brain that controls mood and appetite, is the organ that produces antidiuretic hormone. 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 level decreases to stop urine production in the kidneys.
Diabetes insipidus occurs when the antidiuretic hormone is disturbed in regulating the body’s water levels. As a result, the body produces a lot of urine and excretes large amounts 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 results in a large amount of water being lost in the urine. Below are some of the most common causes of this type of diabetes insipidus, namely:
- About 16 percent of cases of cranial diabetes insipidus are due to a severe head injury that damages the hypothalamus or pituitary gland.
- About 20 percent of cases of cranial diabetes insipidus are due to complications from brain surgery that damage the hypothalamus or pituitary gland.
- About 25 percent of cases of cranial diabetes insipidus are caused by a brain tumor that damages the hypothalamus or pituitary gland.
Here are some of the less common causes of cranial diabetes insipidus.
- Brain cancer.
- Lack of oxygen to the brain, for example due to a stroke.
- The occurrence of infections that damage the brain, such as encephalitis and meningitis.
- Wolfarm syndrome is a rare genetic disorder that can cause vision loss.
About 1 in 3 cases of cranial diabetes insipidus has no known cause.
Diabetes insipidus Nefrogenik
This is a condition when antidiuretic hormone is produced in accordance with the levels required by the body. But the kidneys are not sensitive or do not respond to this hormone.
Antidiuretic hormone normally sends a signal to the nephron tissue in the kidney. Nephrons are tiny structures that control how much water is absorbed by the body and how much water is excreted in the form of urine. For people with nephrogenic diabetes insipidus, this signaling process is impaired. 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 , also known as congenital nephrogenic diabetes insipidus. People with congenital nephrogenic diabetes are born with this condition. There are two types of mutations or genetic changes that cause congenital nephrogenic diabetes insipidus, namely AVPR2 and AQP2. The AVPR2 genetic mutation can only be passed from mother to son. This type of mutation occurs in 9 out of 10 patients. While the genetic mutation AQP2 occurs in 1 in 10 cases of congenital nephrogenic diabetes insipidus and can affect both men and women.
- Acquired nephrogenic diabetes insipidus . People with this type of diabetes insipidus are not born with this condition. Themost commoncausative factor for acquired nephrogenic diabetes insipidus is the side effect of lithium. Lithium is a drug used to treat bipolar disorder. If consumed in the long term, kidney organ cells can be damaged and then no longer able to respond to antidiuretic hormone. Nearly 50 percent of people will develop nephrogenic diabetes insipidus if they take this drug long term. Be sure to have your kidneys checked 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. Blockage of one or both urinary tracts that connect the kidneys 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 low, even though all cells in the body need potassium to function properly.
Diagnosing Diabetes Insipidus
Diabetes insipidus has symptoms similar to those of type 1 diabetes and type 2 diabetes, such as thirst and frequent urination. Your doctor will ask about your symptoms and may do some tests to confirm which condition you have.
A referral to a hormone specialist may be given to perform these tests:
- Water deprivation test . In this test you are required not to drink fluids for several hours to see how your body reacts. If your condition is normal, you will urinate only a little and with a more concentrated concentration. But if you have diabetes insipidus, you will urinate in large amounts.
- Blood tests and urine tests . Blood tests are done to determine the level of antidiuretic hormone in the blood. In addition to blood, urine examination will also be carried out to determine several other elements, such as glucose, calcium, and potassium. Urine from people with diabetes insipidus will be very dilute. If glucose levels are high, then you have 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 you have. This procedure is done after a water deprivation test, if the hormone given helps you stop producing urine, you have cranial diabetes insipidus due to a lack of antidiuretic hormone. But if you continue to produce a lot of urine, it means you have kidney problems or nephrogenic diabetes insipidus.
- MRI. If a hormone specialist suspects that you have cranial diabetes insipidus due to damage to the hypothalamus or pituitary gland, an MRI is done to investigate further. The doctor will look for abnormalities in the hypothalamus or pituitary gland, for example if there is a tumor.
Diabetes Insipidus Treatment
Treatment for diabetes insipidus depends on the diabetes type you have. Treatment aims to reduce the amount of urine produced by the body and control the symptoms that appear.
Cranial Diabetes Insipidus Treatment
If you produce 3-4 liters of urine in one day (24 hours), this condition is considered mild cranial diabetes insipidus. This condition does not require special treatment. You can relieve symptoms that arise by increasing your water consumption to avoid dehydration. Doctors will recommend consuming at least 2.5 liters in one day.
If your condition is severe enough and is caused by low production of antidiuretic hormone, then drinking lots of water is not enough to relieve the symptoms that appear. Here are some medications that may be used to treat this condition.
- Desmopressin . This drug acts like an antidiuretic hormone. This medicine will stop the production of urine. Desmopressin is an artificial antidiuretic hormone and has a stronger function than the original hormone. This medication can be in the form of a nasal spray or tablet. Possible side effects include headache, stomach pain, nausea, nosebleeds, or a runny or stuffy nose. To know more about this drug, ask your doctor or pharmacist.
- Thiazide diuretic . This drug works to make urine 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, erectile dysfunction.
- Anti- Drug i nflamasi Non -s teroid . When this group of drugs is combined with thiazide diuretics, these drugs can decrease the amount of urine excreted by the body.
Nephrogenic Diabetes Insipidus Treatment
If your condition is caused by drugs such as lithium and tetracycline, a hormone specialist will ask you to stop taking them and look for replacement drugs. If not recommended by the doctor, do not stop taking the medicine that has been prescribed by the doctor.
If the kidneys are impaired and cannot respond to antidiuretic hormone, causing nephrogenic diabetes insipidus, then you will be advised to drink lots of water to avoid dehydration. The drug desmopressin cannot treat this condition.
Reducing salt intake will also help the kidneys retain water and reduce urine volume. Be sure to consult a doctor before changing your diet. To reduce the amount of urine produced by the kidneys, a combination of thiazide diuretics and non-steroidal anti-inflammatory drugs will be prescribed in severe nephrogenic diabetes insipidus.