Living with Diabetes Insipidus

Diabetes insipidus has nothing to do with the type 1 and type 2 diabetes related to blood sugar. Diabetes insipidus (DI) is a disorder that is caused by an imbalance of a hormone called vasopressin which is secreted by the pituitary gland, which controls kidney function. The patient will experience excessive thirst and the production of a large amount of urine.

The word “diabetes” comes from the Greek word diabainein which means siphon. It literally describes the running through or siphoning of water through the individual with diabetes insipidus. The term “siphon” can also relate to the “sugar” diabetes that most people are familiar with, because the patients often experience extreme thirst and frequent urination.

Diabetes insipidus can manifest in infants as well as adults. The symptoms in babies and children may be extreme fussiness, and an excessive amount of urination constant thirst. If you have an infant that is always fussy and needing to drink, and you are constantly changing wet diapers your infant may have this disorder. As a parent, if you notice extreme intake of water and output of urine, suspect that something is wrong and seek help from your pediatrician.

For adults and children the symptoms can be similar. There may be fever, nausea, vomiting and diarrhea. The skin may be cool and dry to touch, rather than the normal warm and dry. There may be muscle cramps from the depletion of electrolytes that causes extreme pain in the extremities. Often, patients with DI complain of dry mouth, excessive thirst, fever, headache, tiredness, and muscle weakness. These people may have significant weight loss; have the appearance of eyes sunken into their heads due to dehydration. They may also have low blood pressure related to the loss of hormones and electrolytes that keep kidney function within normal limits. Part of the kidneys function is to regulate blood pressure.

An electrolyte imbalance is almost always associated with diabetes insipidus. The minerals, sodium, calcium and potassium are three forms of electrolytes that are part of the internal pump that maintains fluid balance within the body. When these electrolytes get out of balance, physical symptoms of fatigue, body aches and pains will manifest. The urine output related to diabetes insipidus can range from 0.5 gallons per day to 3 or more gallons per day, depending on the severity of the disorder. In children, this disorder can be a reason for bed wetting in children.

Normally the fluid is stored in the bladder and excreted in urine, however in much less quantities than noted in patients with diabetes insipidus. We normally only lose part of our liquid waste through urine, because we also lose water and salts through perspiration. The hormone ADH (antidiuretic hormone-also called vasopressin) is released into blood circulation when necessary to regulate the fluid-electrolyte balance of the body. ADH is produced in the hypothalamus of the brain and then stored in the pituitary gland. This process between the ADH system combined with the electrolytes creates a sort of sodium/potassium pump, which regulates fluid-electrolyte balance. When this pump gets disrupted you have a condition known as diabetes insipidus.
If you see any of the signs and symptoms in yourself or anyone in your family, get to the doctor as soon as possible. Since the signs and symptoms of DI so closely resemble those of diabetes mellitus (DM) I and II, your doctor may need to determine which form of diabetes you have. A simple way to tell is to deprive the patent of water for approximately 3 to 4 hours before the test. During this time the doctor will check your weight, and your urine and blood. Then every hour for several hours your blood, urine and weight will be checked for weight loss, and fluid and electrolyte loss.

Once a diagnosis is made, and diabetes insipidus is confirmed, your doctor can determine how mild or severe your condition is. If the symptoms are only slight you might not have to do anything, but your doctor may want you to come into the office to be checked fairly frequently for urine and blood work. If your DI is more severe, your doctor can order a nasal spray that contains a drug that counteracts the fluid shift in the body. This medication is called desmopressin, which acts like ADH in the body. Since this is a medication to slow down the production of urine, you must not drink as much as you did when your DI was out of control. Drinking too much may make you feel sick, weak and make you feel dizzy
.
In some cases the desmopressin won’t work because the problem is within the kidneys and not the ADH. In this case the diuretic hydrochlorothiazide is used to maintain fluid and electrolyte balance. In most cases this drug is used to increase urine output, but in the case of diabetes insipidus hydrochlorothiazide will decrease urine output in nephrogenic (kidney related) DI.

For self care, the patient must maintain the proper fluid balance to prevent dehydration. The doctor will help determine the amount of water you need. It is important to keep bottles of water available, when water is not accessible, so you can drink when you need to up to the prescribed cut off point. It is vital to life, that everyone with this disorder wear a medical alert bracelet, or have a medical alert card on their person, to speak for them in an emergency, and have contact numbers of family and physician.

Be sure to talk with your family and friends to inform them of your condition. Learn all you can about your illness to be informed to be a responsible for your health. It may be a delicate dance between you and your attending physician to help you be as healthy as you can be. It helps to talk with other people who have the same challenges you do, so finding a support group might be very helpful. You can find a support group through the Google directory, which can make a big difference in how you cope with this disorder.

Source: Mayo Clinic information page