Diabetes insipidus is caused by the deficiency or impaired action of antidiuretic hormone (ADH), which acts on the kidneys to regulate the production of urine. Symptoms of diabetes insipidus include extreme thirst (even after drinking) and excessive urine production that can lead to dehydration.

This condition can be caused by damage to areas of the brain responsible for the production, storage, and release of ADH, also called vasopressin. It can also occur due to a kidney defect that prevents the kidneys from responding to ADH.

Diabetes insipidus is treated by an endocrinologist and involves managing fluid intake in addition to the use of medications to help relieve symptoms.

woman in yellow shirt drinking glass of water

Common symptoms

The main symptoms of diabetes insipidus include:

Uncontrollable thirst;
Excessive urine production;
Getting up frequently at night to pee;
A preference for cold drinks.

Adults with this condition produce more than 3 liters of urine a day. With children it is more than 2 liters per day.

Over time, excessive fluid consumption results in decreased sensitivity to ADH, leading to lower production of ADH and worsening of symptoms.

Diabetes insipidus can also occur in babies and children, leading to excessive urination and fluid loss. For this reason it is important to pay attention to signs of this condition, such as diapers that are always wet or bedwetting in older children. Other signs include difficulty sleeping, fever, vomiting, constipation, delays in growth and development, and weight loss.

Diabetes insipidus vs diabetes mellitus

Diabetes insipidus is different from diabetes mellitus because the hormones that are affected in these two conditions are different.

Diabetes insipidus involves dysfunction of the ADH hormone that controls the amount of urine produced in the body.

Diabetes mellitus, on the other hand, involves high levels of glucose in the blood due to low insulin production or insulin resistance.

Confirming a diagnosis

The diagnosis of diabetes insipidus is made by an endocrinologist based on an evaluation of symptoms, medical history, and lab results.

A doctor may order a 24 hour urine test as well as blood tests to check sodium and potassium levels, which can be altered with this condition.

A doctor may also order a water deprivation test, in which a person is admitted to the hospital to undergo a total fluid restriction and is monitored for signs of dehydration while measuring the amount of urine they produce.

An MRI (magnetic resonance imaging) of the brain may also be done to evaluate for any brain damage that could be causing the condition.

Possible causes

Causes of diabetes insipidus depend on the type of the condition, and can be classified as:

Head trauma;
Brain surgeries or infections, brain tumors, or cerebral aneurysm;
Autoimmune or genetic disorders;
Blockage in the blood vessels supplying the brain;
Polycystic kidney disease or severe kidney infections;
Altered levels of potassium in the blood;
Conditions like sickle cell disease, multiple myeloma, amyloidosis, and sarcoidosis;
Post-kidney transplant or kidney cancer.

In addition, the use of medications like lithium, rifampin, gentamycin, or contrast dye can also trigger diabetes insipidus due to their effects on the kidneys.

Main types

The main types of diabetes insipidus are:

1. Central diabetes insipidus

Central diabetes insipidus is caused by damage to the area of the brain called the hypothalamus, resulting in the inability to produce ADH, or the pituitary gland, which is responsible for the storage and release of ADH into the body.

When levels of ADH are diminished, the kidneys are unable to regulate the production of urine, leading to excessive urination of up to 3 to 30 liters per day.

This type of diabetes insipidus is usually the result of trauma, tumors, infection, or brain surgery.

2. Nephrogenic diabetes insipidus

Nephrogenic diabetes insipidus occurs when the concentration of ADH in the blood is normal, but the kidneys are unable to properly respond to it.

This type of diabetes insipidus can be caused by kidney disease or rare and serious genetic defects that present in childhood.

3. Gestational diabetes insipidus

Gestational diabetes insipidus is a rare condition that can happen around the third trimester of pregnancy due to an enzyme produced by the placenta that attacks and destroys maternal ADH, causing symptoms of diabetes insipidus.

In this case, the condition resolves itself following delivery, with levels returning to normal by around 4 to 6 weeks postpartum.

4. Dipsogenic diabetes insipidus

Dipsogenic diabetes insipidus, also called primary polydipsia, can occur from damage to the mechanism in the hypothalamus that controls thirst.

This type of diabetes insipidus can also be associated with mental health disorders like schizophrenia.

Treatment options

Treatment of diabetes insipidus is managed by an endocrinologist or pediatric endocrinologist and varies based on the cause of the condition, with the goal being to reduce the amount of urine produced by the body.

Treatment will depend on the severity of the disease and the type of diabetes insipidus being treated, and may include:

1. Controlling fluid intake

In mild cases of central diabetes insipidus, a doctor may recommend simply limiting fluid intake, while being sure to drink at least 2.5 liters per day to avoid dehydration.

Central diabetes insipidus is considered mild if the individual produces only 3 to 4 liters of urine in 24 hours.

2. Hormone replacement therapy

In the most serious cases of central or gestational diabetes insipidus, a doctor may recommend hormone replacement with a medication called desmopressin or DDAVP. This medication can be inhaled, taken orally, or administered through an IV.

Desmopressin is a more potent version of the ADH hormone produced naturally in the body, and is more resistant to being broken down. It has the exact same effect as natural ADH, however, preventing the kidneys from producing urine when levels of water in the body are too low.

3. Diuretics

Diuretics may also be indicated, especially in severe cases of nephrogenic diabetes insipidus. In these cases, the most commonly used diuretic is hydrochlorothiazide, which reduces the rate that blood is filtered through the kidneys. This results in decreased urine production and excretion by the body.

In addition, a doctor should recommend a low-sodium diet to help reduce the amount of urine produced by the kidneys, along with drinking at least 2.5 liters of water per day to prevent dehydration.

In the case of nephrogenic diabetes insipidus caused by the use of certain medications, your doctor may recommend suspending use of that particular medication or prescribe a different treatment.

4. Anti-inflammatories

Anti-inflammatories, such as ibuprofen, may be indicated for treatment of nephrogenic diabetes insipidus. In these cases, they are used in combination with diuretics to help decrease urine volume.

Long term use of anti-inflammatories can lead to problems like worsening kidney function, stomach irritation, and stomach ulcers.

To prevent these stomach issues, your doctor may recommend medications like omeprazole or esomeprazole, for example.

5. Psychiatric medication

Cases of diabetes insipidus caused by mental health disorders are treated by a psychiatrist who can prescribe specific medications on a case by case basis.

6. Antibiotics

Treatment of diabetes insipidus caused by an infection typically involves treating the underlying infection first. In these cases, a doctor can prescribe the use of specific antibiotics based on the type of infection.

Possible complications

Complications of diabetes insipidus can include dehydration or electrolyte imbalances in the body due to excessive loss of fluids and electrolytes through urination, such as sodium, potassium, calcium, and magnesium. Symptoms may include:

Dry mouth;
Headache;
Dizziness;
Confusion or irritability;
Excessive tiredness;
Muscle cramps and pain;
Nausea or vomiting;
Loss of appetite.

These symptoms require immediate medical attention at the closest emergency department.