Diabetes insipidus is associated with increased urination and a constant feeling of thirst. The chances of cure depend on the manifestation of the syndrome. For 2 types characterize the classification of diabetes insipidus.
What is diabetes insipidus?
Diabetes insipidus (diabainein, Greek: to flow through, insipidus, Latin: insipid, tasteless) is known in German as Wasserharnruhr. Despite the same main term, diabetes insipidus has only similarities in symptomatology with diabetes mellitus, which is known as diabetes. In diabetes insipidus, the regulation of water balance is disturbed. The body excretes too much water, so that the patient constantly feels thirsty and has to drink a lot. Nevertheless, there is a constant risk of dehydration. Diabetes insipidus occurs in two forms. The more common type is diabetes insipidus centralis, in which the hormone vasopressin is not produced or is insufficiently produced in the brain. This neurotransmitter restrains water excretion in the kidney. In diabetes insipidus renalis (renalis, Latin for affecting the kidney), the kidney does not respond to vasopressin. The consequence of increased water excretion characterizes both forms of diabetes insipidus.
Causes
Diabetes insipidus can also have two different causes according to its two manifestations. In diabetes insipidus centralis, there is damage to the hypothalamus. This is a brain region located above the pituitary gland that produces a variety of hormones. Various diseases can affect the nerve tissue of the central core area so that it can no longer perform its function adequately. Tumors and circulatory disorders as well as strokes or meningitis are the most common underlying diseases that trigger diabetes insipidus. Very rarely, this subtype appears to be genetic. Diabetes insipidus renalis results from diseases that cause damage to the kidney. Often these are poisonings, including side effects of medications, but also inflammation of the renal pelvis or high blood pressure. Severe pregnancy is also considered a possible cause of renal diabetes insipidus.
Symptoms, complaints, and signs
Diabetes insipidus results in a number of different complaints, but all of them have a very negative impact on the quality of life of the affected person and usually also make the patient’s everyday life much more difficult. If the disease is not treated, it often leads to a severe lack of fluids and thus to dehydration. Likewise, this can also lead to deficiency symptoms, which generally have a very negative effect on the health of the affected person. Patients suffer from increased thirst and therefore have to visit the toilet more frequently. When urinating, the patient may also experience burning or stabbing pain. In some cases, the thirst of the affected person is so strong that it can lead to sleep problems and thus to irritability or other psychological upsets. Often, the affected person’s daily work routine also suffers significantly from the disease, and social discomfort may also occur. The patient’s skin is often dry and may also flake. Diabetes insipidus can also cause constipation or diarrhea. Usually, the disease can be well limited, so that the life expectancy of the affected person is not reduced by it.
Diagnosis and course
Diabetes insipidus is noticeable by a violent feeling of thirst. When this symptom is present, the physician will first want to rule out diabetes mellitus (diabetes) by determining blood glucose. This is because the two very different diseases have this symptom in common. If the blood glucose is in the normal range, the physician will try to detect diabetes insipidus with a water balance. In the process, fluid intake and urine excretion are precisely determined. In parallel, the doctor takes blood and urine tests twice a day. If the urine is diluted and the mineral concentration in the blood is increased at the same time, the diagnosis of diabetes insipidus is confirmed. To distinguish between the two variants of the clinical picture, the patient is now given the hormone vasopressin as a medication. If the symptoms then disappear, the patient has diabetes insipidus centralis. If the body does not respond, the patient suffers from diabetes insipidus renalis.Easily treatable is the first form, but more complicated and prone to complications is renal diabetes insipidus.
Complications
Due to diabetes insipidus, the patient suffers from a greatly increased excretion of urine, which in extreme cases can be up to 25 liters per day. This severely restricts the patient’s daily life and in many cases leads to psychological complaints and depression. The affected person also suffers from an increased sense of thirst, although many try to reduce their fluid intake. Sleep disturbances and cramps also occur. The patient’s quality of life is greatly reduced. Young children, in particular, can suffer from severe discomfort and sequelae if the body suffers from persistent dehydration. In most cases, the treatment of diabetes insipidus is causal and is based on the underlying disease. Often the symptoms can be limited with the help of medication and regress. In this case, no further complications occur for the patient. If the disease is caused by a tumor, it can either be surgically removed or irradiated. The further course of the disease depends to a large extent on the spread and type of tumor. In most cases, however, a positive course of the disease results and the patient’s life expectancy is not limited.
When should one go to the doctor?
A rarely occurring form of diabetes, diabetes insipidus can be recognized by an unusually high volume of urine per day. Anyone who secretes three to twenty or more liters of urine daily without having taken in adequate amounts of fluid should definitely see a doctor. The doctor must first determine whether one of the two forms of diabetes insipidus is the cause of the unusually high urine output. It is possible that a tumor in the area of the hypothalamus or the pituitary gland is the trigger for the unusual symptoms. Kidney disease, surgical sequelae in the area of the brain or other trauma can also be the cause of diabetes insipidus. The next step is to treat any secondary symptoms of diabetes insipidus. First and foremost, the treating physician must remedy the hormone deficiency that was probably causative for the disease. In addition, as a result of polyuria, there may already be disturbances in the electrolyte balance and dehydration. Since the disturbances in diabetes insipidus are serious, self-treatment or reduction of the drink dose is a wrong choice. Without medical help, such a large urine output, along with all the subsequent consequences, can be fatal. Without prompt diagnosis and cause-related or symptomatic treatment, no patient can survive diabetes insipidus unscathed. Water balance must be maintained because it is essential for survival.
Treatment and therapy
Diabetes insipidus requires correction of the mineral balance in the blood as the first immediate measure. Further therapy depends on the type of disease. Purely symptomatic, drug administration of artificial vasopressin helps in diabetes insipidus centralis. Another option is medication that can stimulate the secretion of vasopressin in the brain. The patient should always be careful not to drink too much. Furthermore, the doctor must clarify what the damage to the hypothalamus consists of. If there is a brain tumor, the surgeon must remove it and the patient must undergo chemotherapy. The treatment of diabetes insipidus renalis starts from the mineral balance. Thus, the physician strives to lower the blood concentration of sodium and calcium. The key here is a low-salt diet. Some diuretic drugs (thiazide diuretics) indirectly reduce the excretion of pure water. This occurs through an increased excretion of sodium via the kidney, which retains water in the body. The damaged kidney receives further support from a low-protein diet. It spares the organ and can, but only in mild cases, restore the disturbed function. The bundle of measures maintains an unstable balance between water and minerals. Therefore, the patient must check his or her weight regularly, because water retention is a consequence of therapy for renal diabetes insipidus in cases of maladjustment.
Outlook and prognosis
The prognosis of diabetes insipidus depends on the underlying disease. In general, however, it is good. Thus, in some cases, even a complete cure is possible.This is particularly the case if the cause of diabetes insipidus is, among other things, elevated calcium levels caused by certain drugs or brain tumors. The resulting diabetes insipidus then also disappears completely when the corresponding medication is discontinued or the tumor is successfully treated. Some forms of diabetes insipidus cannot be cured, but they can be well controlled by hormone replacement therapy with desmopressin. Thus, with a well-controlled therapy, even people with a hereditary or chronic deficiency of vasopressin due to other causes can lead a completely normal life. However, it is also important to restrict fluid intake during this therapy, as otherwise the body may even become overhydrated. Without treatment, however, diabetes insipidus can lead to death from dehydration (exsiccosis) because the body loses up to 25 liters of fluid per day by excreting large amounts of urine. Even drinking large amounts of water alone cannot stop fluid loss. An agonizing urge to urinate and a strong feeling of thirst also lead to sleep disturbances, which in turn promote the development of mental illnesses. In addition to the direct consequences of diabetes insipidus, the respective underlying diseases also determine the further course.
Prevention
Preventing diabetes insipidus means preventing hypertension and arteriosclerosis in advance. The general measures for this are identical to the prophylaxis of cardiovascular disease. However, this can only influence some factors that promote diabetes insipidus. People cannot protect themselves against most of the causes of urinary retention. Admittedly, preventive examinations at the doctor are useful for early detection of this disease as well. Because the sooner treatment begins, the better the chances of recovery from diabetes insipidus.
Follow-up care
In diabetes insipidus, the patient is primarily dependent on early detection of the disease so that further complications and discomfort can be prevented. The earlier the disease is detected in this process, the better the further course of this disease usually is. The follow-up measures depend on the exact underlying disease of diabetes insipidus, so that no general prediction can be made. In general, the patient with this disease should pay attention to a healthy lifestyle with a healthy diet. Very sweet or very fatty foods should be avoided so as not to aggravate the symptoms. Sporting activities can also have a positive effect on the further course of diabetes insipidus. The treatment itself is also carried out by taking certain supplements that bring the body’s mineral balance back into order. The doctor should always be consulted. Accumulations of water in the body should also be regularly examined in diabetes insipidus and treated by a doctor. Contact with other affected persons is also useful, as this often leads to an exchange of information. Whether there is a reduction in life expectancy as a result of the disease cannot be universally predicted.
Here’s what you can do yourself
Diabetes insipidus, also known as water urine retention, has nothing to do with diabetes mellitus type 2 or type 1 (diabetes). The leading symptom is an abnormally increased excretion of water by the kidneys, leading to a constant feeling of thirst. Due to the excessive fluid excretion, electrolyte balance is disturbed, which can result in considerable secondary damage. Everyday behavior should be aimed at balancing the electrolyte balance and include measures suitable for preventing arteriosclerosis and high blood pressure. Supportive measures include lowering the sodium and calcium concentration in the blood, so that an extremely low-salt diet is recommended. Parallel to the above measures and the above self-help, it should be medically clarified what the causes of the urinary retention are. For example, a brain tumor may affect the body’s control hormone center, the hypothalamus and pituitary gland, due to space stress, so that too little vasopressin is produced in the tiny glands, which would stop the excessive urine production. Depending on the diagnosis, immediate medical treatment or surgery becomes urgent to prevent a critical progression of the disease.Affected persons who often wake up at night due to frequent urination and hardly have a chance to sleep through the night should be particularly attentive during the day, as their ability to concentrate and alertness is often impaired by daytime sleepiness. Driving in particular requires attention and frequent breaks to prevent dangerous microsleep.
