When speaking of diabetes, you probably are familiar with the term type 2 diabetes. Type 2 diabetes is indeed a condition that seems to be common in our society. You may see or at least know a person in your life that is diagnosed with type 2 diabetes. Those with type 2 diabetes have to get the right kind of diabetes care to ensure they lead a healthier life and lower the risk for many other health conditions such as heart diseases and disability. In this article, we will talk about another kind of diabetes which is diabetes insipidus that may seem new to you.
Diabetes insipidus is a rare disorder which is characterised by the body producing excessive urine. The urine can amount to 3 litres a day which is more than normal urine in humans (normal amount urine in a day is 800 to 2000 millilitres). In severe cases, the urine may be up to 20 litres a day. Diabetes insipidus is not related to the diabetes mellitus we all might be familiar with. This is because those with diabetes insipidus have normal blood sugar levels but the problem with the kidney causes the body unable to balance fluid and electrolytes in the body.
To understand how diabetes insipidus occurs, we have to know the basic kidney process. Kidneys are the size of the fist and humans will have one kidney on the left and one kind on the right side of the body, specifically side of the spine. It is located just below the ribcage. Healthy kidney filters blood and removes wastes with extra water to produce urine. The urine flows from the kidney to the bladder through the ureters (two thin tubes). Urine is often stored in the bladder before it is emptied through the way we urinate.
What happens in diabetes insipidus is there is a problem with the kidney as it is unable to concentrate the urine as normal. This itself creates a large amount of urine that is diluted. Amount of water that is excreted through urine is controlled by antidiuretic hormone (ADH) which is also known as vasopressin. ADH is produced by the hypothalamus in the brain and stored in the pituitary gland before being released into the body. Lack of ADH occurring in diabetes insipidus is known as central diabetes insipidus. Failure of kidneys to respond to ADH is known as nephrogenic diabetes insipidus.
Central diabetes insipidus occurs when there is damage to the hypothalamus or pituitary gland. It can be caused by many conditions such as head injury, genetic problems and surgery to the pituitary gland or hypothalamus area. Nephrogenic diabetes insipidus occurs when there are defects to the kidneys. It can be caused by certain medications and kidney disease itself such as polycystic kidney disease.
The 2 main symptoms of diabetes insipidus are extreme thirst (polydipsia) and frequent urination (polyuria). Extreme thirst will make a person drink liquid very often and still be feeling thirsty. Urine will be seen as light-coloured and in very large amounts. The need to urinate will be intense regardless of day or night. The issue with diabetes insipidus is dehydration as the latter. Symptoms of dehydration include dry mouth, feeling light-headedness, tiredness and fainting. Severe dehydration can lead to seizures and permanent brain damage. Besides dehydration, it is feared that electrolyte imbalances can cause dysfunction of the body.
The first way to diagnose diabetes insipidus is to eliminate the possibility of diabetes mellitus as it can give the similar symptoms of polydipsia and polyuria. This is done by testing blood sugar level. Urinalysis is then done to evaluate the urine in general. Next is to determine the vasopressin deficiency leading to the diabetes insipidus. Water deprivation test is the best test to check this. The test involves measuring urine and the body weight after several hours of not drinking any liquids. In some cases, vasopressin medications may be given during the test. Another test is the stimulation test that is done by giving intravenous solution to stimulate the production of vasopressin. Health professionals will then measure the blood level of copeptin, a substance that responds with vasopressin. Imaging tests may proceed after these tests. Imaging tests of MRI can help see for damages or abnormality to the hypothalamus or pituitary gland.
Treatment for diabetes insipidus aims to ensure the patient is well hydrated. Beside the hydration factor, health professionals may prescribe desmopressin in treating central diabetes insipidus. In nephrogenic diabetes insipidus cases, some cases may actually go away when the cause of the condition is well treated. In mild conditions, reducing salt and protein in diet can help the kidney to produce less urine. In severe cases, combination of thiazide diuretics and non-steroidal anti-inflammatory drug (NSAID) to reduce the urine production. Due to the fact that diabetes insipidus is considered a rare condition as only 1 in 25000 people are affected, treatment is best sought when treated by doctors.
