Is Diabetes Insipidus Life-Threatening?

Diabetes insipidus (DI) is an uncommon disease that manifests as a frequent urge for urination and extreme thirst. It has nothing to do with blood sugar levels. Although in both diabetes mellitus and insipidus, patients experience a large volume of urine production, the cause is completely different.

DI is caused by less production of antidiuretic hormone (ADH) in the body. This is also named vasopressin. It is produced by your brain that instructs your kidneys to retain water. This hormone helps your kidneys to keep the correct amount of water in the body. 

Normal people pass about one to two quarts of urine a day, whereas people with DI may pass 3-20 quarts of urine a day that makes them pee more often, sometimes every 15 minutes.

In DI, too much water is pulled from the blood by the kidneys, which causes the body to create a lot of urine and lead to extreme thirst. Therefore, this condition is also named watery diabetes.

You may have

• Polydipsia (severe thirst that can’t be satisfied)
• Polyuria (excessive peeing that is colorless)
• Dehydration
• Weight loss
• Failure to grow
• Getting up frequently in the night to pee
• Constipation
• Weak muscles
• Muscle pain 
• Irritability
• Bedwetting 

Types include:

Central diabetes insipidus (DI): It mostly occurs due to brain damage because of

• Brain surgery.
• Infection such as tuberculosis.
• Encephalitis (inflammation of the brain).
• Brain tumor.
• Radiation therapy.
• Blockage in the arteries leading to the brain.
• Autoimmune disease.
• Hereditary disease.
• A head or brain injury.

Nephrogenic DI: It causes

• Pyelonephritis (kidney disease).
• Hypokalemia (low potassium levels in the blood).
• Hypercalcemia (high calcium levels in the blood).
• Blockage of the urinary tract due to kidney stones.
• Certain medications such as lithium.

Dipsogenic DI: If the pituitary (a gland in your brain) doesn’t make enough antidiuretic hormone (ADH) that regulates the thirst mechanism, it may be due to

• Brain surgery.
• Infection.
• Inflammation.
• Tumor.
• Head injury.
• Certain medications used in mental illness such as lithium.

Gestational DI: This condition usually occurs in pregnancy and may resolve by itself.

Your doctor may check your medical history and family health history. The doctor may ask you about your daily fluid intake, diet, and bowel and bladder habits. After your physical examination, your doctor may order for

• Urine sample test to diagnose this condition.
• Blood tests to measure sodium (salt) and other electrolyte levels in the blood.
• Water deprivation test to calculate the amount of urine passed.
• Magnetic resonance imaging (MRI) of the brain to check the details of brain damage and to look for problems with the pituitary gland (a gland inside the brain).
• Computed tomography (CT) scans.

Treatment of diabetes insipidus (DI) usually depends on the cause of this condition. The following modalities may be tried:

• If you have mild DI, you may only need to increase your water intake.
• A man-made hormone called desmopressin (DDAVP, Minirin, others) may replace the missing antidiuretic hormone (ADH). You can take desmopressin as a nasal spray, oral tablets, or injection.
• Other medications may also be prescribed, such as Indocin and Tivorbex (indomethacin) and chlorpropamide may produce more ADH in the body.

In the nephrogenic DI, your doctor may prescribe a low-salt diet to help reduce the amount of urine your kidneys make. You'll also need to drink enough water to avoid dehydration.

Complications include:

• Mental disturbance
• Hyperactivity
• Attention-deficit hyperactivity disorder
• Poor growth
• Weight loss
• Frequent headaches
• Low blood pressure
• Fatigue
• Restlessness
• Brain damage
• Kidney damage