Gear up for Sports!
Don’t Let DI Keep You Down
By Jackie Duda

Sweating, running, and engaging in high-energy activities might be the norm for most people. But for people with diabetes insipidus concerned about maintaining adequate hydration, there may be some concerns. How can you possibly stay active when you have to consume a higher than average fluid intake and visit the “loo” more often than most of your teammates? Is it realistic to even consider this?

The good news is you don’t necessarily have to rule out activities just because you feel permanently attached to your water bottle and your personal key to the restroom.

While there are going to be some foreseeable concerns, it is very possible to lead an active life despite having DI.

Matthew McCarty, a 33 year-old male from Atlanta, Georgia, hasn’t “thrown in the towel” on his love of jogging. Quite the contrary, McCarty, who has CDI, runs every other day at minimum. “I don’t participate in organized running activities, but I do engage in various local races, such as those offered through the Atlanta Track Club,” he said.

How is it possible to remain active in an outdoor sport while enduring the heat and humidity of the south? “I do perspire quite a lot and this seems to postpone the ‘break through.’ I just make sure to stay hydrated by drinking plenty of fluids and sticking to my established DDAVP schedule,” McCarty says.

McCarty learned he had CDI when he was diagnosed in August 1999. “I believe that I may have lived with the symptoms for several years prior. However, that August, I had brain surgery to remove a colloid cyst and the doctors were looking for DI. They had hoped it would be transient. It was not. While my thirst mechanism always seemed adequate, but DDAVP sure does make life more convenient,” he says.

“I just make sure to drink plenty of fluids (usually water) before and after I run, even if I don’t feel terribly thirsty,” McCarty adds. “If I’m in a race and water is available, I will usually grab a quick, small drink during the race, sometimes at each mile. Gatorade and Powerade drinks also work for me.”

What tips does he have for other people with DI who want to engage in running or jogging as their sport of choice? “Just stay hydrated and follow your doctor’s recommendation on medication. I don’t find it necessary to make myself bloated by over compensating. To me, lukewarm fluids appear more compatible and less shocking to the body so as to not slow me down or affect my performance on the track.”

Seventeen-year-old Chris Richards from Kent, England, also has CDI. A highly active sports enthusiast, Richards was diagnosed several years ago after suffering bouts of extreme exhaustion, “splitting headaches,” and unquenchable thirst. It is possible that he acquired the DI from a series of concussions that he suffered as a result of several rugby mishaps.

Richards’ frenetic pace with sports activities never seems to cease, and he doesn’t let his DI stop him from enjoying what he does best. He represents his school, Maidstone Grammar School, in rugby, cricket, hockey, and basketball. He plays golf at home and also participates in rugby tournaments for Kent’s “under 18” Southeast England and London schools. 

Richards describes his experience: “When I was first diagnosed, I felt that I would not be able to continue my involvement with sports. Even when using desmopressin tablets, which made me feel much better, I often felt dehydrated after engaging in sports. However, I have learned to control the situation to a stage where I was able to proceed to play for the England “Under 16” rugby team.”

To what does he attribute this success? “The most important thing to me is to ensure that I stay well hydrated and always keep a large bottle of water with me when playing. I especially make sure to drink plenty of water before going out, as no matter how much I drink during the sport, my body simply can’t catch up on what it’s lost.” He prefers water as his drink of “choice” rather than sports drinks, both before and during high levels of activity. Afterward however, while his body is “recovering,” he consumes some isotonic sports drinks. “While the rest of the team may be enjoying a nice cold beer, I’ve learned after experiencing several migraines that alcohol is no way to re-hydrate your body,” he says.

Richards also adds, “I realize that on a very hot day I am not going to be able to do as much as other people – it’s better to admit defeat and work out at the gym where it’s cool instead of getting dehydrated and quite ill!”

He has also discovered that DI doesn’t stop him from engaging in activities that he has always loved to do. “I now find that DI hardly affects my life. As long as I take my tablets regularly, drink plenty of water during sports and realize my limits, I feel fine. When I do feel dehydrated or at the first sign of head pain on a hot day, I don’t fight it and instead lie down in front of the television for a while,” he says.

Maggie Tapia, a 29-year-old dental assistant from Palmdale, California, was diagnosed with CDI in 1997 while hospitalized with asthma complications. Her pulmonologist noticed her excessive thirst and urination and asked the nurses to measure her daily input and output. It was nearly the same, down to the very last ounce. “That’s when I was referred to an endocrinologist,” says Tapia. “My MRI revealed that I didn’t produce a certain type of hormone and they prescribed my ‘miracle’ drug, DDAVP.”

Prior to her diagnosis, her life involved hauling extra “baggage” - a jug of water everywhere she went, parties, vacations, the theatre, and sleepovers, where she would need to wake every two hours to drink a pitcher of water and visit the bathroom. Since starting the DDAVP post-diagnosis, she found herself shedding tears of joy after experiencing a straight eight-hour stretch of sleep each night. “The DDAVP ‘spoiled’ me,” she says.

Tapia runs regularly, jet skis every weekend in the summer, and practices yoga. Rather than having to stop every 30 minutes in between sessions, she makes sure to take her medication regularly and drinks plenty of water. She prefers water to sports drinks, but also enjoys an occasional cantaloupe or watermelon to help replace lost fluids from excessive activity. Her advice to other DI patients who are just dying to get out and enjoy sports again?" Be patient. Try not to get frustrated, it's your way of life. consider how fortunate you are that physicians were able to create a medication for it. Not exactly a cure, but a way to help you lead a better, more active life," she says.

Kevin Meyers, M.B., B.Ch. a pediatric nephrologist and the Assistant Professor of Pediatrics at the Children’s Hospital of Philadelphia and University of Pennsylvania, recommends certain precautions for active patients with CDI who use DDAVP. “To have a regular normal output,” he says, “you first have to make sure you drink enough water when engaging in sports.”

Meyers also offers advice for parents of children who have NDI who want to participate in school sponsored or community sports activities. “Children with NDI put out a lot more fluid, so they must have unlimited access to water throughout the activity and go to the bathroom as needed,” he says.

He encourages parents to alert respective coaches of the child’s condition, emphasizing the importance of adequate water intake and their need to be able to go to the bathroom. “Since NDI patients’ kidneys aren’t helped by DDAVP because their kidneys do not recognize the hormone, they simply must let the fluid pass through as necessary, which means NDI patients need to be extra vigilant in water consumption and access to a bathroom at all times,” he says.

“There should be no real limitations or concerns with either form of DI in terms of sports involvement,” Meyers says. “It might be a little more difficult to engage in certain sports, both functionally and physically, so it could become self-limiting in terms of the medical condition.”

For those who participate in ball games for example, Meyers says to “scope out” locations beforehand, locate the facilities, and keep water handy at all times.

It is his belief that DDAVP isn’t necessarily diluted when swimming, unless, he cautions, “you’ve just sprayed it and jumped in the pool of course.” He also recommends examining your medicine’s recommendations to see if there are guidelines limiting the amount of time you should wait prior to diving in, or contact your doctor beforehand for advice.

“And if you’re participating in a sport that makes you sweat a great deal, you will have to drink more,” Meyers states. “It really boils down to having access to water at all times.”