Diabetes Insipidus, Causes, Diagnosis, Treatment, Prevention, Complications
Diabetes insipidus is a condition characterized by always feeling thirsty and frequently urinating in large quantities, even up to 20 liters a day. Although the name and main symptoms are similar to diabetes mellitus, the two conditions are actually very different. Diabetes insipidus and diabetes mellitus both cause symptoms of frequent drinking and frequent urination. However, unlike diabetes mellitus, diabetes insipidus is not related to blood sugar levels. The process of the emergence of this condition is also not related to diet or lifestyle like diabetes mellitus in general.
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| Diabetes Insipidus, Causes, Diagnosis, Treatment, Prevention, Complications |
Compared to diabetes mellitus, diabetes insipidus is a relatively rare disease.
Causes and Symptoms of Diabetes Insipidus
Diabetes insipidus occurs due to interference with the antidiuretic hormone which helps regulate body fluid levels. This disorder causes excessive urine production so that sufferers often urinate in large quantities.
Some conditions that can cause interference with the antidiuretic hormone are genetic disorders, brain tumors, and drug side effects. In addition, diabetes insipidus can also be caused by kidney problems.
Diabetes insipidus is characterized by an excessive amount of urine. Generally, a person emits 1-2 liters of urine or urinates 4-7 times a day. However, in people with diabetes insipidus, the amount of urine that comes out each day can reach 3-20 liters and urination can occur every 15-20 minutes.
Treatment and Prevention of Diabetes Insipidus
Treatment of diabetes insipidus depends on the cause of the hormonal disorder experienced by the sufferer. Some of the actions that doctors can take are:
- Advise the patient to drink a lot to avoid dehydration
- Prescribing medications, such as desmopressin, vasopressin, or hydrochlorothiazide
Patients are also advised to undergo a diet low in protein and low in salt to help reduce urine production. In addition, patients are advised to always drink enough, and monitor the amount and frequency of daily urine.
In most cases, diabetes insipidus cannot be prevented. What's more, this condition is often associated with other diseases whose occurrence is difficult to predict, such as genetic disorders and tumors.
Even so, patients can still prevent dehydration and control symptoms that arise due to diabetes insipidus by making the following efforts:
- Adequate fluid intake by drinking at least 2.5 liters of water per day
- Reduce salt and protein intake according to doctor's advice
- Wash your hands regularly and eat cooked food to prevent diarrhea
Causes of Diabetes Insipidus
Antidiuretic hormone (ADH) is a hormone that functions to limit the disposal of body fluids in the form of urine based on the level of body fluid needs at that time. If the body is in need of more fluids, ADH will work and the body will produce less urine.
Diabetes insipidus can occur when the body lacks ADH or when ADH work is disrupted. In other words, any condition that causes a deficiency or disturbance of these hormones can trigger diabetes insipidus.
The following are the causes of diabetes insipidus by type:
Cranial diabetes insipidus
Cranial diabetes insipidus or central diabetes insipidus results from damage to the hypothalamus or pituitary gland. The hypothalamus is the part of the brain that produces ADH, while the pituitary gland is the organ where ADH is stored.
Damage to the hypothalamus or pituitary gland causes impaired ADH production. Some of the causes of damage to the hypothalamus or the pituitary gland itself are:
- Brain tumor
- Severe head injury
- Brain or pituitary gland surgery
- Genetic disorders, such as Wolfram syndrome
- Brain infection, such as encephalitis or meningitis
- Brain damage due to lack of blood flow or oxygen, for example due to stroke and drowning
Of all cases of cranial diabetes insipidus, there is one third that has no known cause (idiopathic). This condition is thought to occur as a result of an autoimmune disease, which is a condition when the body's immune system is disturbed and attacks healthy cells that produce ADH.
Nephrogenic diabetes insipidus
Nephrogenic diabetes insipidus occurs due to abnormalities in the structure of the kidneys so that the kidneys cannot respond properly to ADH. This condition can be caused by a genetic disorder that is present at birth (congenital nephrogenic diabetes insipidus).
Nephrogenic diabetes insipidus can also be caused by other diseases that develop after adulthood (acquired nephrogenic diabetes insipidus), such as:
- Side effects of long term use of lithium
- Urinary blockage
- Hypercalcemia (excess calcium levels)
- Hypokalemia (excess potassium levels)
- Chronic kidney disease
Dipsogenic diabetes insipidus
Dipsogenic diabetes insipidus is caused by a problem with the brain sending the thirst signal. This disorder causes sufferers to always feel very thirsty so they will drink excessively.
As in cranial diabetes insipidus, disturbances in the sending of thirst signals in the brain can occur due to the following conditions:
- Head injury
- Infection or inflammation
- Brain tumor
- Brain surgery
In addition to the conditions above, dysgenic diabetes insipidus or what is also called primary polydipsia is thought to be related to the use of certain drugs, or mental disorders, such as schizophrenia.
Gestational diabetes insipidus
Gestational diabetes insipidus is a type of diabetes insipidus that only occurs in pregnant women. This condition can occur because the placenta produces enzymes that can damage ADH.
Gestational diabetes insipidus can also occur due to increased production of prostaglandins, which are compounds that stimulate uterine muscle contractions. Increased production of these compounds can cause the kidneys to become less sensitive to ADH.
Gestational diabetes insipidus is rare and usually resolves after delivery. However, this condition can recur in subsequent pregnancies.
Symptoms of Diabetes Insipidus
Symptoms that are commonly experienced by people with diabetes insipidus include:
- Always feeling very thirsty even though you drink a lot of water
- Frequent urination in large quantities, both during the day and at night
- Urine is pale or colorless
- Frequently waking up at night to urinate, or even wetting the bed while sleeping
- Tired, irritable, and difficult to concentrate in carrying out daily activities
While in infants and children, diabetes insipidus can be difficult to recognize, especially if they can't communicate well.
However, children with the condition generally show the following symptoms:
- High body temperature or hyperthermia
- Constipation
- Hard to sleep
- Bedwetting while sleeping
- Fussy or irritable
- Lost appetite
- Vomit
- Sudden weight loss
- Always feeling tired and exhausted
- Growth is slower than children his age
When to See a Doctor
Check with your doctor if you always feel very thirsty and urinate too often in large quantities. These complaints may indicate diabetes insipidus.
Check with your child to the doctor if he urinates more than 10 times a day, especially if he has other symptoms, such as frequent bed wetting, feeling thirsty, or having trouble sleeping. These symptoms can also indicate other diseases. Therefore, it is important to see a doctor to confirm the diagnosis.
Diagnosis of Diabetes Insipidus
The doctor will ask about the symptoms experienced by the patient, as well as the patient's and family's medical history. Next, a physical examination will be carried out to look for signs of dehydration, such as dry skin.
To confirm the diagnosis, the doctor will carry out further tests, including:
Urine test
A urine test or urinalysis aims to see the level of dilution and concentration of urine. The doctor can also ask the patient to collect urine in 1 day so that it counts how much urine is excreted in 24 hours.
Blood test
Blood tests aim to measure blood sugar and electrolyte levels. Blood tests can help doctors distinguish whether complaints of frequent drinking and frequent urination in patients are caused by diabetes insipidus or diabetes mellitus.
Through testing ADH levels in the blood, doctors can also determine the type of diabetes insipidus the patient is suffering from.
Water deprivation test
The water deprivation test aims to measure body weight, sodium levels in the blood, and the amount of urine, after the patient has not drank for some time. The doctor will also measure the ADH level in the blood or give synthetic ADH during this test.
Antidiuretic hormone test
The antidiuretic hormone (ADH) test aims to determine the patient's body reaction after being given an ADH injection. This procedure is carried out after a water deprivation test.
If ADH injections can reduce the amount of patient's urine production, it can be concluded that the patient has cranial diabetes insipidus due to ADH deficiency. However, if the patient continues to produce a lot of urine, it can be suspected that the problem originates from the kidneys (nephrogenic diabetes insipidus).
Magnetic resonance imaging (MRI)
If you suspect that you have cranial diabetes insipidus due to damage to the hypothalamus or pituitary gland, your doctor will order an MRI to investigate further. Through an MRI, the doctor can see the cause of the damage.
Treatment of Diabetes Insipidus
The method of treating diabetes insipidus depends on its type. Treatment is carried out aims to reduce the amount of urine produced by the body and control the symptoms that appear.
Treatment of cranial diabetes insipidus
Cranial diabetes insipidus is considered mild if the patient excretes 3–4 liters of urine a day. This condition does not require special treatment. However, patients can relieve their symptoms by consuming a lot of water, at least 2.5 liters per day so they don't become dehydrated.
Patients with severe cranial diabetes insipidus are generally treated with desmopressin, a drug that acts like antidiuretic hormone (ADH). Desmopressin aims to control urine production, maintain body fluid levels, and prevent dehydration.
It is important to remember that excessive use of desmopressin can cause fluids in the body to accumulate and blood sodium levels to become low. These conditions can harm the patient. Therefore, the use of this drug must be in accordance with the recommendations and supervision of a doctor.
Another drug is vasopressin, which is a drug to reduce urine production.
Treatment of nephrogenic diabetes insipidus
Doctors will advise patients to eat low-salt foods so that urine production in the kidneys is reduced. Patients will also be advised to drink lots of water to avoid dehydration.
If the patient's condition is caused by taking lithium, the doctor will ask the patient to stop using the drug, then prescribe another drug as a replacement. If the drug is given by another doctor, the patient is advised to consult with that doctor so that the drug can be stopped and replaced.
To relieve symptoms, the doctor will prescribe hydrochlorothiazide. In some patients with nephrogenic diabetes insipidus, these drugs can reduce urine production so that the patient's frequency of urination decreases.
Treatment of dysgenic diabetes insipidus
There is no specific treatment method for dysgenic diabetes insipidus. However, patients can suck on candy to help increase saliva production so that the desire to drink can be reduced.
In patients who frequently wake up at night to urinate, doctors may prescribe desmopressin in low doses.
In dysgenic diabetes insipidus which is caused by a mental disorder, the doctor may refer the patient to a psychologist or psychiatrist so that mental disorders can be treated first.
Treatment of gestational diabetes insipidus
In patients with gestational diabetes insipidus, doctors will give desmopressin during pregnancy. After giving birth, gestational diabetes insipidus will heal on its own so that the patient does not need desmopressin anymore.
Diabetes Insipidus Complications
If not detected early or not treated properly, diabetes insipidus can cause the following complications:
Disorders of electrolyte balance
Electrolytes are minerals such as calcium, sodium, potassium, magnesium and bicarbonate in the blood. This mineral content functions to maintain fluid balance in the body and plays a role in cell functions. If there is a lack of electrolytes, the body will experience symptoms in the form of:
- Tired
- Headache
- Muscle cramp
- Nauseous
- Vomit
- Loss of appetite
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 complaints:
- Dry mouth and lips
- Dry skin, wrinkles, and not supple
- Dizziness or headache
- Confused and irritable
Mild dehydration can be treated with ORS. If it is classified as severe, the patient needs to be hospitalized to get fluids through an IV.
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