16618 Diabetes Insipidus

Overview

Diabetes insipidus is a rare condition that makes the body produce large amounts of very watery urine and feel extremely thirsty. It happens when the body cannot balance fluids properly. It is not the same as diabetes mellitus (often called just diabetes), which is about blood sugar.

No. Diabetes insipidus is rare. Most doctors will see very few cases in their career.

It can affect anyone at any age. Some types are more common in adults, while others may first appear in childhood. It affects both men and women.

Symptoms

Common symptoms

• Feeling extremely thirsty even after drinking
• Producing large amounts of pale, watery urine (often more than 3 to 4 litres a day)
• Waking up many times during the night to urinate
• Preferring cold or iced drinks

Symptoms in children

• Bedwetting in a child who was previously dry at night
• Poor weight gain or slow growth
• Irritability or crying that only calms when given water
• Very wet diapers more often than usual

Symptoms in older adults

• Confusion or drowsiness
• Signs of dehydration, such as a dry mouth, sunken eyes, or low blood pressure
• Feeling dizzy or weak, which can lead to falls
• Worsening kidney function

Causes

Main causes

• Central diabetes insipidus: the brain does not make enough vasopressin, the hormone that tells the kidneys to hold onto water
• Nephrogenic diabetes insipidus: the kidneys do not respond to vasopressin properly
• Gestational diabetes insipidus: a rare temporary form that happens during pregnancy
• Primary polydipsia: drinking very large amounts of water, which disrupts the body's fluid balance

Risk factors

• Head injury or brain surgery
• Certain medicines, such as lithium
• Family history of diabetes insipidus
• Kidney disease or sickle cell disease
• Pregnancy

When to see a doctor

See a doctor urgently if:

• Symptoms that appear suddenly and are getting worse
• Signs of severe dehydration
• Vomiting so you cannot drink enough fluids

Book a routine appointment if:

• You have been very thirsty and urinating a lot for more than a few days
• You need to get up many times at night to urinate
• A child is bedwetting again or drinking constantly

Diagnosis

Your doctor will ask about your symptoms and may do several tests. The aim is to find out why your body is losing too much water.

Tests that may be done

• Urine test to check how diluted or concentrated your urine is
• Blood test to check sodium levels and kidney function
• Water deprivation test, where you are asked not to drink for a few hours while doctors measure your body's response
• MRI scan of the brain to look for problems with the pituitary gland or hypothalamus

What to expect at your appointment

The tests may take several hours. Your doctor will explain each step and supervise you carefully during the water deprivation test so you stay safe.

Treatment

Treatment depends on the type of diabetes insipidus you have. The main goal is to replace or mimic the missing hormone, treat the underlying cause, and make sure you stay well hydrated.

Self-care at home

• Carry water with you at all times and sip regularly
• Wear a medical alert bracelet saying you have diabetes insipidus
• Tell family, friends, teachers, or coworkers so they can help in an emergency
• Weigh yourself daily, if advised by your doctor, to check for rapid fluid changes

Medical treatments

For central diabetes insipidus, treatment usually involves a synthetic form of the body's antidiuretic hormone, given as a pill, spray, or injection. For nephrogenic diabetes insipidus, the focus is on treating the underlying cause and using medicines that help the kidneys respond better. Your doctor will always prescribe the treatment that is safest and most suitable for you.

When is surgery considered?

Surgery is not a treatment for diabetes insipidus itself. However, if a brain tumour or another structural problem is causing the condition, surgery may be needed to remove it.

Living with this condition

Living with diabetes insipidus means keeping a balance. You need enough fluids, but not too much, and you may need to plan around frequent bathroom visits and thirst. Most people learn to manage this well with their healthcare team.

Lifestyle tips

• Plan for bathroom breaks at work, school, or on trips
• Carry a refillable water bottle
• Avoid alcohol, which can increase fluid loss
• Tell your airline or travel company about your condition so you can access water on flights

Diet and exercise

There is no special diet for diabetes insipidus, but eating regular meals and drinking according to thirst is important. During exercise, drink extra fluids before, during, and after activity, and let someone know about your condition.

Mental health and emotional wellbeing

Living with a chronic condition like diabetes insipidus can feel frustrating or worrying, especially if it interrupts your sleep or daily routine. It is normal to feel this way. Talk to your doctor or a counsellor if the condition is affecting your mood or mental health.

Prevention

Most types of diabetes insipidus cannot be prevented. Some cases caused by head injury or certain medicines can be avoided by protecting your head and reviewing medicines with your doctor.

Complications

If left untreated

• Severe dehydration
• High sodium levels in the blood (hypernatraemia)
• Seizures
• Brain damage or coma in very severe cases
• Kidney problems over time

Long-term outlook

With the right treatment, most people with diabetes insipidus are able to live a normal, active life. It may take time to find the best plan, but the condition can be well managed with your healthcare team.

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