Diabetes Insipidus
Also known as: DI, Arginine vasopressin deficiency, Arginine vasopressin resistance, Water diabetes
Diabetes insipidus is a rare condition in which the kidneys cannot hold on to water, so you pass very large amounts of dilute urine and feel constantly thirsty. Despite the name, it has nothing to do with blood sugar or the far more common diabetes mellitus. It happens either because the brain does not make enough of the water-conserving hormone vasopressin (central diabetes insipidus) or because the kidneys do not respond to it (nephrogenic diabetes insipidus). As long as you can drink enough to keep up, the condition is manageable, but it can quickly lead to dangerous dehydration if fluid intake is restricted, for example during illness or surgery. Treatment depends on the type and is often very effective.
At a Glance
- Common symptoms
- Passing very large volumes of pale, dilute urine, often many liters per day, Intense, persistent thirst, especially a craving for cold water, Waking repeatedly at night to urinate or, in children, bedwetting
- Main treatments
- Desmopressin, a synthetic form of vasopressin given as a tablet, nasal spray, or injection, for the central type, Treating the underlying cause, such as a pituitary tumor or electrolyte imbalance, For the nephrogenic type: a low-salt, lower-protein diet and thiazide diuretics, which paradoxically reduce urine output
- Category
- Endocrine · Rare; affects people of all ages, most often after pituitary surgery or head injury
- See a doctor if
- You are urinating far more than usual and cannot quench your thirst
Symptoms
Causes
- Damage to the hypothalamus or pituitary from surgery, tumors, head injury, or inflammation (central type)
- Inherited gene mutations affecting vasopressin production or kidney response
- Long-term lithium use and certain other medications (nephrogenic type)
- High calcium or low potassium levels that impair kidney concentrating ability
- Chronic kidney disease or urinary tract obstruction
- Pregnancy, when an enzyme from the placenta breaks down vasopressin (usually temporary)
Risk Factors
- Recent brain or pituitary surgery, or radiation to the head
- Traumatic brain injury
- A family history of diabetes insipidus
- Long-term treatment with lithium
- Conditions that raise blood calcium, such as overactive parathyroid glands
Diagnosis
- Measurement of 24-hour urine volume and urine concentration (osmolality)
- Blood tests for sodium, glucose, calcium, and potassium to rule out other causes of excess urination
- A supervised water deprivation test, often with a dose of synthetic vasopressin to distinguish central from nephrogenic types
- Copeptin blood testing, a newer marker that reflects vasopressin levels
- MRI of the brain and pituitary when a central cause is suspected
Treatment
- Desmopressin, a synthetic form of vasopressin given as a tablet, nasal spray, or injection, for the central type
- Treating the underlying cause, such as a pituitary tumor or electrolyte imbalance
- For the nephrogenic type: a low-salt, lower-protein diet and thiazide diuretics, which paradoxically reduce urine output
- Reviewing medications with your doctor if lithium or another drug is responsible (never stop a prescribed medicine on your own)
- Nonsteroidal anti-inflammatory drugs in some nephrogenic cases, under medical supervision
- Supportive: always keeping water available and drinking to thirst, since thirst is your main protection against dehydration
- Supportive: wearing a medical alert bracelet so emergency staff know you need fluids
Prevention
- Most cases cannot be prevented, but complications can be
- Carry water and never let fluid intake be restricted without medical supervision
- Have kidney function and electrolytes checked regularly if you take lithium
- Tell any surgeon or hospital team about your diagnosis before procedures
- Take desmopressin exactly as prescribed to avoid both dehydration and water overload
When to See a Doctor
- You are urinating far more than usual and cannot quench your thirst
- A child suddenly starts wetting the bed or drinking excessively
- You develop confusion, severe headache, rapid heartbeat, or fainting, especially if you have been unable to drink (emergency)
- You have diabetes insipidus and become ill with vomiting or diarrhea
- You feel bloated, nauseous, or confused after taking desmopressin, which can signal low sodium
Frequently Asked Questions
Related Conditions
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