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Diabetes Insipidus

January 24, 2022

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Diabetes insipidus (DI) is a rare condition that leads to excessive urination (passing a lot of clear urine) and excessive thirst. The antidiuretic hormone (ADH) or vasopressin (AVP) is released by the pituitary gland and helps the kidneys balance the amount of water in the body.  If ADH is low or the kidneys do not respond to ADH, the body cannot hold on to water, resulting in large amounts of clear urine. This, in turn, results in dehydration and increased thirst.  

DI is not related to diabetes mellitus (type 1 and type 2 diabetes), which is when your levels of blood sugar (glucose) are too high. In diabetes mellitus, the high concentrations of glucose cause excessive urination. 

Endocrine Connection 

The amount of water in the body is a balance between how much liquid you drink and how much urine you make. The hypothalamus, which is part of the brain, senses how much water is in the body and increases or decreases the production of ADH to maintain the amount of water in the body. If you do not drink enough water, your brain and pituitary will make more ADH. ADH will make the kidneys hold on to water, and urine becomes more concentrated. In DI, you are not making enough ADH (central DI), or the kidneys do not respond to ADH (nephrogenic DI). As a result, the kidneys let too much water to pass in the urine. This results in dehydration, high blood sodium levels, and increased thirst. It can be a serious condition if you are not able to drink enough water. 

There are several types of DI, including: 

Central DI: Damage to the pituitary gland or hypothalamus from head injury, surgery, tumors, or inflammation leads to a lack of ADH.

Nephrogenic DI: The pituitary releases enough ADH in the blood, but the kidneys cannot respond to it. This can result from drugs such as lithium, high blood calcium, low blood potassium, or different genetic problems.

Gestational DI: During pregnancy, an enzyme that comes from the placenta breaks down ADH, resulting in DI or making DI worse.

Your doctor will run several tests to make the diagnosis of DI and find the cause:

  • Urine tests and blood tests at the same time.
  • A water deprivation test might be needed. During this test, you will be closely monitored and have several blood and urine tests while you are asked not to drink any liquids for several hours.
  • Additional blood tests to see how your pituitary gland and/or kidneys are working.
  • A brain and pituitary MRI scan if central DI is diagnosed.
  • Genetic tests.

General symptoms of diabetes insipidus are:

  • Increased thirst and drinking large amounts of fluids.
  • Frequent urination of large amounts of light-colored urine.
  • Waking up several times during the night to urinate.

The goal of treatment for all types of DI is to relieve thirst and to decrease the amount of urine being made.  

Central DI is usually treated with synthetic ADH, called desmopressin or DDAVP. This can be given as an injection, nasal spray or tablets. In mild cases, drinking more water can be enough.  

Taking too much desmopressin or drinking lots of fluids while taking desmopressin may cause low sodium levels in the blood, which can lead to headache, nausea, confusion, seizures or, in rare cases, death. Centarl DI can be difficult to manage if the sense of thirst is not normal. 

Nephrogenic DI can be treated with a combination of measures that include: diet (low salt, low protein), diuretic medications (hydroclorthiazide, amiloride, acetazolamide) and non-steroidal antiinflammatory drugs (indomethacin) 

Long-term outlook depends on the type of DI. Usually, adults do not have serious problems unless they do not have access to water or other fluids. 

  • Is my frequent urination due to DI?
  • What is causing my DI?
  • What are my options for treatment?
  • What are the risks and benefits of each treatment option?
  • How long will I need treatment?
  • How often will I need check-ups and blood tests?
  • How much water or other fluids should I drink every day?
  • Do I need to make changes in my diet?

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Editor(s): Eleni Dimaraki, M.D., MS, Anne Klibanski, M.D., Ramon Martinez, M.D., Janet Schlechte, M.D., Nicholas Tritos, M.D., DSc
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