What is Diabetes Insipidus?
Diabetes insipidus is a health problem characterized by frequent thirst and more frequent urination in larger volumes than usual, even reaching 20 liters in one day.
Even though they have similar symptoms to diabetes mellitus, these two conditions actually have very significant differences.
Both diabetes insipidus and diabetes mellitus cause symptoms of more frequent drinking and urination.
However, diabetes insipidus has no relationship with blood sugar levels, unlike diabetes mellitus.
The process of diabetes insipidus also has nothing to do with diet or lifestyle like diabetes mellitus.
This type of diabetes is one of the health problems that can be said to be rare. At least, this disease only attacks one in 25 thousand people.
Symptoms of Diabetes Insipidus
Generally, people with diabetes insipidus will experience the following symptoms.
- Always feel thirsty even though you have drunk a lot.
- Frequent urination in larger volumes.
- Urine is pale or colorless.
- Often waking up at night just to urinate or actually wetting the bed while sleeping.
- Difficulty concentrating and becoming more irritable.
Meanwhile, diabetes insipidus that attacks babies and children tends to be more difficult to recognize, especially in children who cannot communicate well.
However, babies and children who show diabetes usually experience the following symptoms:
- Body temperature increases or experiences hyperthermia.
- Difficulty defecating or constipation.
- Insomnia.
- Bedwetting.
- Easily irritated and cranky.
- Weight loss for no reason.
- Growth becomes slower.
Causes of Diabetes Insipidus
Antidiuretic hormone or ADH is a hormone that plays a role in limiting the excretion of body fluids in the form of urine depending on the level of body fluid requirements.
When the body needs more fluids, this hormone will start working and the body can produce less urine.
Diabetes insipidus can occur when the body lacks the hormone ADH or when the performance of this hormone is disrupted.
This means that all conditions that cause a lack or disruption of the performance of this hormone can lead to diabetes insipidus.
The causes of diabetes insipidus can be seen from the type:
1. Cranial Diabetes Insipidus
Also called central diabetes insipidus, cranial diabetes insipidus occurs due to damage to the pituitary gland or hypothalamus.
This part functions to make the hormone ADH, while the pituitary gland is responsible for storing this hormone.
Damage to the pituitary gland or hypothalamus will result in disruption of ADH production. The causes could be:
- Serious head injury.
- Brain tumor.
- Operations on the brain or pituitary gland.
- The presence of genetic disorders, such as Wolfram syndrome.
- The presence of an infection in the brain, such as meningitis or encephalitis.
- Brain damage occurs due to lack of blood flow or oxygen, such as during a stroke or drowning.
However, one-third of all cases of cranial diabetes insipidus have no known cause.
It is thought that this is due to an autoimmune problem, a condition where the body’s immune system experiences problems and attacks healthy cells that make the hormone ADH.
2. Nephrogenic Diabetes Insipidus
This type of diabetes insipidus occurs due to abnormalities in the structure of the kidney organ, so that the organ is unable to respond optimally to the ADH hormone.
This problem can occur due to genetic disorders that occur from birth or congenital nephrogenic diabetes insipidus.
Not only that, this type of diabetes insipidus can also occur due to other health problems that arise after a person is an adult or acquired nephrogenic diabetes insipidus. For example:
- The effects of long-term lithium use.
- Blockage in the urinary tract.
- Excessive calcium levels in the body or hypercalcemia.
- Excessive potassium levels in the body or hypokalemia.
- Chronic kidney disease.
3. Gestational Diabetes Insipidus
Dipsogenic diabetes insipidus is caused by problems with the transmission of signals from the brain related to thirst.
This makes sufferers always feel thirsty and drink more, even more than their body’s daily needs.
No different from cranial diabetes insipidus, this type of diabetes insipidus also occurs because:
- Head injury.
- Inflammation or infection.
- Brain tumor.
- Had brain surgery.
In addition, dipsogenic diabetes insipidus or primary polydipsia is also believed to be associated with the consumption of certain drugs or mental disorders, such as schizophrenia.
4. Gestational Diabetes Insipidus
Gestational diabetes insipidus occurs only in pregnant women. This health problem occurs when the placenta produces an enzyme that causes damage to the hormone ADH.
Not only that, the increased production of prostaglandin hormones also causes the kidneys to become less sensitive to the ADH hormone.
This condition is considered rare and can improve after the mother gives birth. However, it is still necessary to be vigilant because this health problem can recur in subsequent pregnancies.
Diagnosis of Diabetes Insipidus
In order to get a more accurate diagnosis, the doctor will ask several questions related to the symptoms and medical history of the sufferer and family.
Next, a physical examination will be carried out to determine if there are any signs of dehydration, such as dry skin.
If necessary, the doctor will recommend that the sufferer undergo further examinations, such as:
1. Urine Examination
This examination is carried out to see the level of concentration and dilution of urine.
The doctor will ask the patient to collect urine for one day so that it can be known how much urine comes out in 24 hours.
2. Blood Test
This examination is carried out to determine blood sugar levels and electrolyte levels.
Blood tests can help doctors determine whether complaints of drinking and urinating more frequently are indeed caused by diabetes insipidus or diabetes mellitus.
By examining ADH levels in the blood, doctors can also determine the type of diabetes insipidus experienced by the sufferer.
3. Water Deprivation Examination
This test is done to measure sodium levels in the blood, body weight, and urine volume after the sufferer has not drunk for some time.
The doctor may also measure the level of ADH in the blood or provide additional ADH in synthetic form during the examination.
4. Antidiuretic Hormone Examination
This examination is carried out to find out how the sufferer’s body reacts after receiving an ADH hormone injection.
The antidiuretic hormone procedure will be performed after the patient undergoes a water deprivation examination.
If ADH hormone injections can help reduce urine production, the sufferer has diabetes insipidus due to ADH deficiency.
Meanwhile, if the sufferer continues to urinate more even though they have received hormone injections, the problem could originate from the kidneys or nephrogenic diabetes insipidus.
5. MRI
If the sufferer is suspected of having cranial diabetes insipidus due to damage to the pituitary gland or hypothalamus, the doctor will perform an MRI to obtain a more accurate diagnosis.
Through this examination, the doctor can find out the cause of the damage.
Complications of Diabetes Insipidus
If not detected and not treated properly, diabetes insipidus can lead to quite serious complications, including:
1. Electrolyte imbalance
Electrolytes are minerals such as sodium, calcium, magnesium, potassium, and bicarbonate that are found in the blood.
All of these minerals have an important role in maintaining fluid balance in the body as well as playing a role in cell function.
If the body experiences electrolyte deficiency, the symptoms that appear are:
- The body experiences fatigue.
- Headache.
- Muscle cramps.
- Nausea and vomiting.
- Loss of appetite.
2. Dehydration
The body of a person with diabetes insipidus is unable to maintain normal body fluid levels.
As a result, sufferers are very susceptible to dehydration, which is characterized by the following conditions:
- Mouth and lips feel dry.
- Dry, wrinkled skin that loses its elasticity.
- Headache.
- Easily angered and appears confused.
Mild dehydration can be treated by consuming oralit. However, severe dehydration needs to be treated immediately in the hospital to get additional fluids through an IV.
Children can also show various symptoms if they have diabetes insipidus. So, What Are the Symptoms of Diabetes Insipidus in Children?
Diabetes Insipidus Treatment
Treatment for diabetes insipidus depends on the underlying cause.
Treatment is done to help reduce the frequency of urination and control the signs and symptoms that appear.
1. Treatment of Cranial Diabetes Insipidus
Cranial diabetes insipidus is said to be mild if the sufferer urinates 3 to 4 liters a day. This condition does not require special treatment.
However, symptoms can be reduced by drinking at least 2.5 liters of water every day to prevent dehydration.
Meanwhile, people with severe cranial diabetes insipidus will be treated by administering drugs that function similarly to antidiuretic hormone or ADH.
This drug, called desmopressin, aims to control urine production, prevent dehydration, and maintain body fluid levels.
It should be noted that excessive consumption of desmopressin can result in fluid retention and lower sodium levels in the blood.
This condition is certainly very dangerous, so it is recommended not to take the drug without a doctor’s prescription.
2. Treatment of Nephrogenic Diabetes Insipidus
Treatment for nephrogenic diabetes aims to reduce urine production in the kidneys.
Usually, doctors will advise sufferers to eat low-salt foods and drink more water to prevent dehydration.
If the condition is caused by lithium use, the doctor will stop using the drug and prescribe another drug to replace it.
Meanwhile, to help relieve the symptoms that appear, the doctor can prescribe several other drugs to help reduce urine production so that the frequency of urination will also be reduced.
3. Treatment of Dipsogenic Diabetes Insipidus
Unfortunately, there is no specific treatment method to overcome the problem of dipsogenic diabetes insipidus.
However, sufferers can consume candy to help increase saliva production so that the desire to drink can be reduced.
Meanwhile, for sufferers who often wake up at night to urinate, doctors will usually prescribe desmopressin in low doses.
Then, for cases of dipsogenic diabetes insipidus that occur due to certain mental problems, the doctor will refer the sufferer to a mental health expert so that the mental health problem can be treated first.
4. Treatment of Gestational Diabetes Insipidus
People with gestational diabetes insipidus will be treated with the drug desmopressin during pregnancy.
After giving birth, this condition usually improves on its own, so treatment or consumption of desmopressin is no longer necessary.
When to See a Doctor?
Immediately see a doctor if you feel thirsty more often and urinate excessively because it could be a sign of diabetes insipidus.
Have your child checked if he or she has urinated more than 10 times in one day, especially if accompanied by many other symptoms.