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WHAT IS DIABETES INSIPIDUS?

This is a metabolic disorder in which there is increased urinary output and water intake with increased thirst. The disease is often associated with frequency in urination coupled with the fact that the urine is colorless and watery in appearance, lacking the necessary concentration. Diabetes insipidus (DI) resembles diabetes mellitus because they share similar symptoms of frequency in urination and thirst. However, the treatment of these two diseases is completely different.

There are four different types of diabetes insipidus; each of them has different causes and so should be treated differently. The most common type is due to lack of a particular hormone called vasopressin. This hormone normally acts on the kidney to reduce urine output by increasing its concentration. This is as a result of the destruction of the posterior part of the pituitary gland where vasopressin is normally produced. It is therefore referred to as pituitary DI or neurogenic DI. The posterior pituitary may be destroyed by a lot of underlying diseases or it could be an inherited factor. The inherited one can be distinguished from the one caused by diseases through the onset of DI in early childhood or from family history. Pituitary DI cannot be cured but the signs and symptoms can be eliminated by placing the patient on certain drugs for life. A popular drug is desmopressin (a modified form of vasopressin) or DDAVP.

The second type is referred to as gestational DI. This can come as a result of vasopressin suppression during pregnancy. This can also be treated with DDAVP throughout the period of the pregnancy. The signs and symptoms of DI usually disappear two to three weeks after delivery and the drug treatment can stop. However DI may reoccur with subsequent pregnancies.

Nephrogenic DI is the third type. This is caused by the failure of the kidney to respond to the antidiuretic effect of normal amount of vasopressin. This may be as a result of the side effect of certain drugs, a kidney disease or heritable genetic defect. This type cannot be treated with DDAVP. Elimination of the offensive drug may or may not relieve the effect. The inherited type lasts for life although some forms of treatment are available to relieve the signs and symptoms.

The fourth subtype is called dipsogenic DI. This occurs when vasopressin is suppressed by excessive fluid intake which is as a result of the failure on the part of the brain that regulates thirst. It is usually difficult to differentiate this type of DI from pituitary DI since the two are as a result of brain disorders. A way of distinguishing the two is to observe the effects of DDAVP treatment. With dipsogenic DI, DDAVP treatment eliminates excessive urination but does not completely eliminates the increased fluid intake. This is unlike pituitary DI that eliminates the two .Treatment of dipsogenic DI with DDAVP may therefore result in water intoxication. Hence , DDAVP is not recommended for treating this type of DI. However, a small dose of DDAVP may be taken at bedtime to relieve nocturia.

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