Trying to explain what diabetes insipidus is can be challenging
enough, without having it confused with "the other
diabetes"-sugar diabetes (diabetes mellitus). Both share the word
"diabetes" in the name, and both involve thirst and frequent
urination, although in DI, urination is more frequent and in much
greater volumes than the more common sugar diabetes, and the urine is
subsequently extremely dilute and a very pale yellow color or almost
clear. But beyond that, there's not much else in common. Some people
with DI refer to their condition as either "central DI" or
"nephrogenic DI" (depending on what's applicable), because it
avoids the confusion caused when people not familiar with DI hear the
word diabetes.
The more you know about both diabetes insipidus and diabetes
mellitus, the better able you are to explain your condition to
others-from family members to primary care physicians or emergency
technicians.
A good starting place is to know the meaning of the words themselves.
Diabetes is derived from the Greek verb diabainein, which means to stand
with legs apart, as in urination. Diabetes mellitus means, literally,
honey-sweet urine (back when doctors would sometimes actually taste
people's urine to make a diagnosis). Diabetes insipidus means bland or
insipid urine.
There are four forms of DI: central DI (also referred to as pituitary
or neurogenic DI), nephrogenic DI, gestational DI and dipsogenic DI. DI
is caused by the lack of the antidiuretic hormone (vasopressin) or the
kidney's inability to respond to this hormone.
Sugar diabetes, or diabetes mellitus, comes in two different forms:
adult-onset diabetes and insulin-dependent diabetes. Sugar diabetes is
caused by lack of the hormone insulin. Not only are DI and sugar
diabetes separate conditions, but the diagnostic tests and treatments
are different, as well.
The table below sums up the major differences.
| |
Central DI |
Nephrogenic DI |
Diabetes
Mellitus |
| How common is the condition? |
Uncommon |
Uncommon |
Common |
| What causes the condition? |
The pituitary is unable to secrete vasopressin or the hypothalamus is
unable to make vasopressin. |
The kidneys are unable to respond to the diuretic hormone
vasopressin. It is acquired (as in lithium-induced nephrogenic DI) or
may be inherited, usually by male children. |
Not enough of the hormone insulin is secreted, or the body's cells do
not respond to it. Heredity, stress, obesity, pregnancy and drugs can
also lead to diabetes mellitus. |
| What do these hormones do in our bodies? |
Vasopressin is a diuretic hormone that controls water metabolism. It
is made in the hypothalamus (a part of the brain) and is stored and
secreted by the posterior pituitary gland (also in the brain). |
It causes the kidney to reabsorb water. Water that is not absorbed is
released to the bladder as urine. |
Insulin is
made in the pancreas, where it controls carbohydrate metabolism. It
controls sugar (glucose) levels in the body. |
| How do I know
if I have this condition? |
Sudden or gradual urination of large amounts of
clear, or almost colorless urine (polyuria), accompanied by excessive
thirst (polydipsia). Dehydration can occur if fluid balance is not
maintained. |
Sudden or gradual urination of large amounts of clear, colorless
urine (polyuria), accompanied by excessive thirst (polydipsia).
Dehydration can occur if fluid balance is not maintained. |
Excessive urination (polyuria), excessive thirst (polydipsia),
excessive appetite (polyphagia). You may experience a sudden or gradual
change with no symptoms. Other symptoms include tiredness, weight gain
or loss, and skin infections that do not heal. |
| How is the condition diagnosed? |
Water deprivation test/vasopressin test.
Also, MRI to determine if the post pituitary bright spot is present. |
Water deprivation test/vasopressin test. |
Fast blood sugar-24hr. post-prandial test. Glucose tolerance test. |
| How is the condition managed? |
Balance fluid intake and urine output. Replace antidiuretic hormone,
vasopressin (usually with synthetic hormone: desmopressin), find, if
possible, underlying injury to pituitary gland that is causing the
condition. |
Balance urine output with fluid intake. Treatment with thiazide and
potassium-sparing diuretics. Low-sodium diet (500-600 mg/day or less for
adults; 300 - 500 mg/day for children). |
Correct sugar/insulin intake. Prevent progression of disease. Change
the diet. Oral medication. |
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