Diabetes Insipidus

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What is diabetes insipidus?

Diabetes insipidus is a rare disorder that causes the body to make too much urine. While most people make 1 to 3 quarts of urine a day, people with diabetes insipidus can make up to 20 quarts of urine a day. People with this disorder need to urinate frequently, called polyuria. They may also feel thirsty all the time and drink lots of liquids, a condition called polydipsia.

Are diabetes insipidus and diabetes mellitus the same?

Diabetes insipidus is not the same as diabetes mellitus. Although both conditions can increase thirst, intake of liquids, and urination, they are not related.

  • In diabetes mellitus, the level of glucose in your blood, also called blood sugar, is too high. Your kidneys try to remove the extra glucose by passing it in your urine.
  • In diabetes insipidus, your blood glucose levels are normal, but your kidneys can’t properly concentrate urine.

How common is diabetes insipidus?

Diabetes insipidus is rare, affecting about 1 in 25,000 people worldwide.1

Who is more likely to have diabetes insipidus?

People of all ages can develop diabetes insipidus. You are more likely to develop the condition if you1,2

  • have a family history of diabetes insipidus
  • had brain surgery or a major head injury
  • take medicines that can cause kidney problems, including some bipolar disorder medicines and diuretics
  • have metabolic disorders (high blood calcium or low blood potassium levels)

What are the complications of diabetes insipidus?

The main complication of diabetes insipidus is dehydration, which happens when your body loses too much fluid and electrolytes to work properly. If you have diabetes insipidus, you can usually make up for the large amount of fluids you pass in your urine by drinking more liquids. But if you don’t, you could quickly become dehydrated.

Symptoms of dehydration may include

  • thirst
  • dry mouth
  • feeling dizzy or light-headed when standing
  • feeling tired
  • difficulty performing simple mental tasks
  • nausea
  • fainting

Seek care right away

Severe dehydration can lead to seizures, permanent brain damage, and even death. Seek care right away if you feel

  • confused
  • dizzy
  • sluggish

What are the symptoms of diabetes insipidus?

The main symptoms of diabetes insipidus are

  • needing to urinate often, both day and night
  • passing large amounts of light-colored urine each time you urinate
  • feeling very thirsty and drinking liquids very often
An older man drinks a tall glass of water.People with diabetes insipidus often feel thirsty all the time and drink lots of liquids.

What causes diabetes insipidus?

Diabetes insipidus is usually caused by problems with a hormone called vasopressin that helps your kidneys balance the amount of fluid in your body. Problems with a part of your brain that controls thirst can also cause diabetes insipidus. Specific causes vary among the four types of diabetes insipidus: central, nephrogenic, dipsogenic, and gestational.2

Central diabetes insipidus

In central diabetes insipidus, your body doesn’t make enough vasopressin, also called “antidiuretic hormone.” Vasopressin is produced in your hypothalamus, a small area of your brain near the pituitary gland. When the amount of fluids in your body falls too low, the pituitary gland releases vasopressin into your bloodstream. The hormone signals your kidneys to conserve fluids by pulling fluids from your urine and returning fluid to your bloodstream. But if your body can’t make enough vasopressin, the fluid may get flushed out in your urine instead.

Causes of central diabetes insipidus include

Nephrogenic diabetes insipidus

In nephrogenic diabetes insipidus, your body makes enough vasopressin but your kidneys don’t respond to the hormone as they should. As a result, too much fluid gets flushed out in your urine. Causes include

Dipsogenic diabetes insipidus

In this type of diabetes insipidus, a problem with your hypothalamus causes you to feel thirsty and drink more liquids. As a result, you may need to urinate often. Causes include

  • damage to your hypothalamus from surgery, infection, inflammation, a tumor, or a head injury
  • some medicines or mental health problems

Gestational diabetes insipidus

Gestational diabetes insipidus is a rare, temporary condition that can develop during pregnancy. This type of diabetes insipidus occurs when the mother’s placenta makes too much of an enzyme that breaks down her vasopressin. Women who are pregnant with more than one baby are more likely to develop the condition because they have more placental tissue.3 Because the liver plays a role in curbing the enzyme that breaks down vasopressin, diseases and conditions that affect liver function also increase risk. Examples include preeclampsia and HELLP syndrome.

How do health care professionals diagnose diabetes insipidus?

Your health care professional will do a physical exam and ask questions about your health history, including your family’s health. Other tests and procedures may include

  • Urinalysis. A urinalysis can show if your urine is too diluted, or watery. It can also show if the level of glucose in your blood is too high, which is caused by diabetes mellitus, not diabetes insipidus.
  • Blood tests. A blood test can measure sodium levels and the amount of certain substances in your blood, which can help diagnose diabetes insipidus and, in some cases, determine the type.
  • Water deprivation test. This test can help health care professionals diagnose diabetes insipidus and identify its cause. The test involves not drinking any liquids for several hours. A health care professional will measure how much urine you pass, check your weight, and monitor changes in your blood and urine. In some cases, the health care professional may give you a man-made version of vasopressin or other medicines during the test.
  • Magnetic resonance imaging (MRI). An MRI uses magnets and radio waves to make pictures of your brain tissues. Your health care professional may order this test to look for damage to your hypothalamus or pituitary gland that could cause diabetes insipidus.
  • Stimulation tests. During these tests, you are given an intravenous solution that stimulates your body to produce vasopressin.4,5 A health care professional then measures your blood level of copeptin, a substance that increases when vasopressin does. Results can indicate if you have diabetes insipidus or a different condition called primary polydipsia, which can cause you to drink lots of liquids.

How do health care professionals treat diabetes insipidus?

The main way to treat diabetes insipidus is to drink enough liquids to prevent dehydration. But doing so can disrupt your regular lifestyle, including your sleep. Your health care professional may refer you to a specialist, such as a nephrologist or an endocrinologist for more specific treatments. Other treatments vary by cause.

Central diabetes insipidus

Health care professionals most often treat central diabetes insipidus with a man-made hormone called desmopressin, which replaces the vasopressin your body is not making.2,6 You can take this medicine as a nasal spray, a pill, or a shot.

Nephrogenic diabetes insipidus

In some cases, nephrogenic diabetes insipidus may go away after treating its cause. For example, switching medicines or taking steps to balance the amount of calcium or potassium in your body may be enough to resolve the problem. Your health care professional may also prescribe a class of diuretic medicines called thiazides to help reduce the amount of urine your kidneys make.2,7 Other treatments can include nonsteroidal anti-inflammatory drugs or other types of diuretics.

Dipsogenic diabetes insipidus

Researchers haven’t found an effective way to treat dipsogenic diabetes insipidus. Sucking on ice chips or sugar free candies to moisten your mouth and increase saliva flow may help reduce your thirst. If you wake up many times at night to urinate, your health care professional may suggest you take a small dose of desmopressin at bedtime. Your health care professional may also monitor your blood levels of sodium, which can drop too low if you have this condition.

Gestational diabetes insipidus

Health care professionals treat gestational diabetes insipidus with desmopressin, which is safe for both mother and baby. An expectant mother’s placenta does not destroy desmopressin as it does vasopressin. Gestational diabetes insipidus usually goes away after the baby is born, but may return if the mother becomes pregnant again.

Most people with diabetes insipidus can prevent serious problems and live a normal life if they follow their health care professional’s recommendations and keep their symptoms under control.

How do eating, diet, and nutrition affect diabetes insipidus?

Researchers have not found that eating, diet, and nutrition play a role in causing or preventing diabetes insipidus. To reduce symptoms, your health care professional may suggest you eat a diet that is low in salt and protein to help your kidneys make less urine. In some cases, these changes alone may be enough to keep your symptoms under control, particularly if you have nephrogenic diabetes insipidus.2,7

Clinical Trials for Diabetes Insipidus

The NIDDK conducts and supports clinical trials in many diseases and conditions, including kidney diseases. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.

What are clinical trials for diabetes insipidus?

Clinical trials—and other types of clinical studies—are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about disease and improve health care for people in the future.

Find out if clinical studies are right for you.

Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials.

What clinical studies for diabetes insipidus are looking for participants?

You can view a filtered list of clinical studies on diabetes insipidus that are open and recruiting at www.ClinicalTrials.gov. You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe. Always talk with your health care provider before you participate in a clinical study.

References

Last Reviewed September 2021
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This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

The NIDDK would like to thank:
Joseph Verbalis, M.D., Georgetown University