Diabetes Insipidus – Causes, Pathogenesis, Symptoms, Prevention, Cure, Ayurveda Understanding

By Dr Raghuram Y.S MD (Ay) & Dr Manasa, B.A.M.S

Diabetes Insipidus is a disease related to fluid imbalance in the body. It is marked by frequent thirst and desire to drink water in spite of having taken water sometime back. It also causes excessive urination.

Insipid means colorless and odorless. Diabetes insipidus is called so because it causes your body to make a lot of urine that is insipid.

It is a different condition from diabetes mellitus though both conditions have excessive urination and being excessively thirsty in common. If you have diabetes insipidus, the hormones which balance the liquids in your body do not work. This condition is found only one in every 25,000 people. On the other hand your body cannot use energy from the food in a way it should do in diabetes mellitus. This condition is more common than insipidus.

It is said to be incurable. Treatments are oriented towards relieving thirst and to decrease the urine output.
Read – Diabetes: Ayurvedic Treatment, Remedies, Prevention Tips

Symptoms

• Severe thirst
• Polyuria – excessive urination / voiding of large quantities of diluted urine
• Frequent urge to urinate during the night time and waking up many times at night for the same reason
• Liking / preference towards cold drinks
• Dehydration
• Weakness
• Muscle pains
• Irritability

Symptoms in infants and children

a. In infants –

• Slow growth
• Poor feeding
• Crankiness

b. In children –

• Drinking lot of water
• Frequent urination, sometimes even once in every hour
• Bedwetting which has developed recently
• Waking during night to urinate / pee
• Dehydration

c. Other symptoms common both in infants or young child

• Bed wetting
• Heavy and wet diapers, frequent need for diapers
• Difficulty in sleeping
• Fever
• Constipation
• Vomiting
• Weight loss
• Delayed growth

Dehydration and related symptoms include –

• Fatigue
• Dizziness
• Confusion
• Nausea
• Feeling sluggish

Pathogenesis of Diabetes Insipidus

This disease occurs when your body cannot balance the fluid levels properly.

Kidneys help in maintaining this fluid balance when the fluid regulation system is working properly in the body. Kidneys are responsible for removing the excessive fluids from your bloodstream. Excessive fluids are also expelled by the body through sweating, breathing or diarrhea.

Role of ADH or Vasopressin – Your body makes a hormone called vasopressin, also called as Anti-Diuretic Hormone or ADH in hypothalamus. It is stored in your pituitary gland. Vasopressin signals your kidneys to retain water which makes your urine more concentrated. It controls the fluid balance. It controls how fast or how slow the fluids should be excreted from the body.

When you feel thirsty or dehydrated, the vasopressin levels go up. The kidneys absorb more water. The urine gets concentrated. If you have had enough to drink, the levels of vasopressin will fall. The urine which comes out is clear and diluted.

When sufficient vasopressin is not formed in the body, the condition is called as central diabetes insipidus. If vasopressin is sufficiently formed but if your kidneys don’t respond to it, you would have nephrogenic diabetes insipidus.

Whatever form of diabetes insipidus it is, your kidneys cannot keep water. Even if you are dehydrated, they will put out a lot of pale urine.
Read – How Endocrine System And Hormones Are Governed By Tridosha?

Causes, Types

If you have diabetes insipidus your body cannot balance the fluid levels properly. Causes depend and vary on the type of diabetes insipidus that you are having –

1. Central Diabetes Insipidus – This is caused by damage to either pituitary gland or hypothalamus. This affects how your body makes or puts out vasopressin i.e. the damage affects the usual production, storage and release of ADH.  Consequentially the kidneys remove more fluid from your body. As a result there is excessive urination.

Damage to the above mentioned structures result from –

• Tumor
• Head injury
• Inflammation
• Infection
• Aneurysm
• Surgery
• Impact of some chronic illness etc.

This form of diabetes insipidus can also be caused by an inherited genital disease.

2. Nephrogenic Diabetes Insipidus – This type of the disease occurs when there is a defect at the level of tubules in the kidney. These are the structures located in your kidneys which are responsible for excretion or re-absorption of water. When these tubules are at defect your kidneys will be unable to respond to ADH / vasopressin properly and take too much fluid from your bloodstream.

It may be caused by –

• Chronic kidney disease
• Inherited disorder of kidney
• Blocked urinary tract
• High levels of blood calcium
• Low levels of blood potassium
• Effect of medicines / drugs like lithium, antiviral medicines etc.
  Read – High Potassium, Kidney Disease and Leaching of Vegetables

3. Gestational Diabetes Insipidus – It is a rare form of this disease. It occurs only during pregnancy. This occurs due to destruction / breakdown of ADH caused by an enzyme made by the placenta.

More prostaglandin is produced in some pregnant woman that makes the kidneys less sensitive to vasopressin. Most cases are mild and do not cause symptoms. It goes away after birth. It might come back in the next pregnancy.

4. Dipsogenic Diabetes Insipidus / Primary Polydipsia – In this condition large amount of diluted urine is produced. This happens when your body has trouble controlling thirst. Drinking excessive amounts of fluids may be the main underlying cause for this condition. It may also occur when there is damage to the thirst regulating mechanism in the hypothalamus. When you drink water, the liquid causes lowering of vasopressin and also cause excessive urination. This condition is also related to schizophrenia.

The causes for this condition include damage to pituitary or hypothalamus from –

• Tumor
• Head injury
• Inflammation
• Infection
• Surgery
• Some medications
• Mental health issues

5. Other causes – Sometimes there may not be any obvious cause for diabetes insipidus. In other people the disease may be caused due to an autoimmune reaction that causes the immune system to damage the cells making vasopressin.
Read – Hypothyroidism Causes, Symptoms, Ayurvedic Treatment, Remedies

Risk Factors

Nephrogenic diabetes insipidus – when present at birth or immediately after birth is associated with an inherited / genetic cause. This can permanently change the ability of the kidney to concentrate the urine. This condition usually affects men but women may pass the gene of this condition to the children.

Genetic – Changes in genes would make you more likely to get diabetes insipidus. This happens in 1-2% of cases.

Complications

Dehydration – leading to thirst, dryness of the mouth, changes in the elasticity of the skin and fatigue

Electrolyte imbalance – An imbalance of sodium and potassium which maintain the fluid balance occurs. This may lead to wide array of symptoms including weakness, muscle cramps, nausea, vomiting, loss of appetite and confusion.

Less sleep (mainly due to nocturia) – one doesn’t get proper sleep due to excessive and frequent urination during night and also due to repeated awakening to attend toilet at night.

Diagnosis

Diabetes insipidus is usually diagnosed by physical examination and thorough case taking conducted by a doctor.

One or more of the below mentioned tests may be conducted to diagnose diabetes insipidus. They include –

Urinalysis – is done to differentiate this condition from diabetes mellitus. The urine is checked for its concentration and glucose and the quantity of output during a 24 hour interval is also analyzed.

Blood test – is done to measure electrolytes and glucose in your blood. This also helps in differentiating this condition from mellitus.

Fluid Water / Deprivation Test – measures changes in your body weight, urine concentration and blood sodium.

Water deprivation test is done to measure changes in the –

• Blood sodium and osmolality levels
• Urine output
• Urine composition
• Body weight
• Blood ADH levels

MRI – is done to check if there is a problem with your hypothalamus or pituitary gland.

Genetic screening – is done to check if your family members have similar problems.
Read – Excessive Thirst – Ayurvedic Understanding And Treatment

Right time to consult doctor

You should immediately see a doctor if you have

• frequent troublesome symptoms related to urination,
• excessive urination
• sudden change in pattern of urination and persisting for long time
• feel frequent extreme thirst

Lifestyle changes, Home Remedies

Prevention of dehydration – You should always have access to water and medication. Carry them wherever you go. This will prevent serious problems including dehydration.

Medical alert equipments – Carrying a medical alert card or wearing a medical alert bracelet will help in help in alerting a health care professional in case of medical emergency.
Read – Prameha: Ayurvedic Approach To Urinary Disorders

Prevention

It is difficult or impossible to prevent diabetes insipidus since it has its origin in genetic problems or other conditions. It is often a lifelong condition. But the symptoms of the disease may be managed effectively. When treatment is done promptly, the outlook of the disease will be good.

Diabetes Insipidus cannot be prevented in any specific way. On the other hand some preventive steps might help in avoiding serious complications of the disease. These measures are –

• Monitoring of urine output – should be done constantly especially if the patient has undergone brain tumors or kidney diseases
• Low salt – should be taken in the diet on daily basis
• Signs of dehydration – should be regularly checked by monitoring self for the signs
• Regular physical health
• Regular practice of yoga for maintaining overall health

Natural Treatments

Changes in diet –

Your diet needs to be rich in nutrients. It should also include fruits and vegetables rich in water content. (Read here)

Consume water based hydrating foods daily – the examples are as said below –

• Cucumber, Spinach, Kale, Watermelon
• Citrus fruits, Strawberries
• Red cabbage, Red pepper, Blueberries
• Pineapples, Kiwi

Starchy vegetables –

• Potatoes, Banana, Avocado, Squash etc.

Coconut Water – helps in hydrating your body. It also balances your electrolytes.

Avoid consuming –

• Processed foods (having high sodium and other chemicals / preservatives)
• Caffeine
• Carbonated drinks

Keep hydrated regularly

Drink enough liquids. This will replace and compensate the fluid loss. It will also help in relieving thirst. Make sure you promptly compensate fluid loss occurring due to active work and exercising, when you are sick or whenever your body is losing lot of fluids. Carry water wherever you go. Also wear a medical alert bracelet which could alert your condition to the professionals who could help you to handle the situation.
Read – Benefits And Usage of Water As per Ayurveda: Complete Compilation

Electrolyte Balance

Calcium, magnesium, sodium, potassium, chloride and phosphate are the main electrolytes found in the body. Their balance is a must. They not only help in balancing the fluid levels of your body but also stimulate your nerves. Sodium plays a major role in retention or release of water in the body. If your diet is rich in sodium, more water is excreted from the kidneys.

Keep your mouth moistened always

Suck ice chips or sour candies. This will keep your mouth moist, increase your saliva flow and reduces your desire to drink water.

Keep a check on your medications

Diuretics, hormone pills, antibiotics, cancer treatments and blood pressure medications can cause electrolyte imbalances. Those on chemotherapy as part of cancer therapy experience serious forms of electrolyte imbalances. Diuretics and laxatives also change sodium and potassium levels within blood and urine. Hormonal interactions from antidiuretic hormone medications, aldosterone and thyroid hormones may also cause electrolyte imbalances. Fluid and electrolyte levels can become imbalanced when the hormones are impacted by high levels of psychological stress. Check out if a new medicine or supplement is causing your electrolyte or fluid imbalances, especially if you are experiencing the signs and symptoms of diabetes insipidus.
Read – Stress Causes, Types, Tips On How To Handle Stress

Treatment

Central diabetes insipidus – You will be required to increase the quantity of intake of water if you have milder form of this type of diabetes insipidus. The underlying abnormality will be addressed by your doctor if this condition is caused by an abnormality like tumor in the pituitary or hypothalamus.

This condition is treated with desmopressin, a man made hormone. This substitutes ADH and hence decreases urination. It is used in the form of oral tablets, injection or nasal spray. Other medicines like indomethacin, chlorpropamide etc. which can make ADH available in the body may also be prescribed.

Nephrogenic diabetes insipidus – A low salt diet is prescribed to help the kidneys to produce less urine. Enough water needs to be taken to avoid dehydration. Desmopressin will not help in this condition since the kidneys will not respond properly to ADH. Hydrochlorothiazide will also improve the symptoms. You might have to stop medications if they are causing symptoms.

Gestational Diabetes Insipidus – is usually done with synthetic hormone desmopressin.

Primary Polydipsia – Other than decreasing intake of fluids, there is no specific treatment for this kind of diabetes insipidus. Treating mental illness will relieve the symptoms if they are caused by mental illness.

Few things which might help to ease the symptoms of dipsogenic diabetes insipidus include sucking ice chips or sour candy. This will moisten your mouth, increases salivation and lowers your desire to drink water. A small dose of desmopressin at bedtime might help in nocturia.

Important points

In serious disease about 19-20 liters of urine output may be seen in a day especially if you are drinking large quantities of fluids.

Diabetes insipidus will not cause your kidneys to fail or lead to a condition wherein you would need dialysis. The kidneys almost filter your blood normally. But you will be prone to dehydration. Keep something close to drink to keep yourself hydrated. This is more essential when the climate is hot or when you are exercising.
Read – Exercise Timing, Physical And Mental Benefits

Word of caution

Dehydration is a major complication of Diabetes Insipidus. Therefore one needs to take care of dehydration or see that he or she doesn’t suffer from dehydration. This can be done by increasing the quantity of liquids that one drinks. Seek immediate medical help if you experience the signs of dehydration like confusion, dizziness or sluggishness.

Ayurvedic Concept

Diabetes Insipidus as Prameha

Diabetes Insipidus can be discussed grossly under the heading of Prameha explained in Ayurveda.

Diabetes Insipidus is marked by excessive urination. Prabhuta Mutrata i.e. excessive urination is also an important and specific symptom of prameha.

Prameha is grossly of three types,

• kaphaja – caused by predominant vitiation of kapha which are 10 in number,
• pittaja – caused by predominant vitiation of pitta which are 6 in number,
• vataja – caused by predominant vitiation of vata which are 4 in number

Therefore prameha is of 20 kinds. Though prameha is caused by all three doshas, kapha is the predominant dosha involved in causation of all 20 types of prameha.
Read – Charaka Prameha Chikitsa – 6th chapter

Diabetes Insipidus as Kaphaja type of Prameha

Excessive urination in prameha is mainly caused by kapha. This is because kapha is predominantly formed by water and earth elements.
Master Charaka tells that excessive fluidity in the body is mainly caused by kapha and is contributory to kapha.
Since in Diabetes Insipidus there is excessive excretion / voiding of fluids (water / urine) it can be precisely considered as kaphaja type of prameha.

Diabetes Insipidus as Udaka Meha

Udaka Meha is one among the 10 kinds of Kaphaja Prameha.
Udaka means water. Meha means ‘to void or pass urine’.
Udaka Meha means ‘to void or pass urine which resembles water in form and consistency’. This is exactly what happens in diabetes insipidus.

Cold, clear and cold qualities of kapha are said to be contributory to udaka meha.

Signs and symptoms of Udaka Meha

The urine passed out in udaka meha will have the below mentioned appearance –

• achcham – clear
• bahu sitam – excessively white
• bahu sheetam – excessively cold
• nirgandham – devoid of any abnormal smell
• udakopamam – resembles water
• kinchid avilam – slightly dirty
• kinchit pichchilam – slightly slimy

Though the condition cannot exactly be equated with diabetes insipidus, udaka meha can be considered as its closest comparison.
Read – Appetite And Digestion In Diabetic Patients – An Ayurveda Perspective

Sanskrit Verses

Treatment principles in Ayurveda

Diabetes Insipidus should be treated on the lines of ‘treatment of prameha’, especially kaphaja prameha.

The chief principles of treating kapha type of prameha include – vamana i.e. therapeutic emesis and langhana i.e. therapies which bring about lightness in the body. These therapies should be administered judiciously after analyzing the strength of the patient and disease.

Other principles

Diabetes insipidus can also be treated on the lines of –

Trishna Chikitsa – treatment of thirst – since thirst is one of the chief complaints of Diabetes Insipidus. This will help in dealing with not only thirst but also dehydration related to excessive fluid loss.

Treating Udakavaha Sroto Dushti – Excessive thirst is a result of dehydration caused due to excessive fluid loss through urination. If this continues for longer duration and the pathogenesis becomes deep rooted, it contaminates the channels of transportation of water in the body. The treatment principles should be to cleanse this contamination.
Read – Udakavaha Srotas: Channels of water transport, Signs of damage, Treatment

Treating Medovaha Sroto Dushti – In prameha the channels of formation and transportation of fat tissue are said to be chiefly contaminated. Fat belongs to kapha category of tissues. Treatment should be oriented towards correction of this contamination and balancing fat metabolism in the body.

Correction of pachaka pitta and apana vata imbalances – Pachaka Pitta, with the help of samana vata – the gut doshas, is responsible for formation of urine from the food and drinks we consume. Apana vata is responsible for proper elimination of urine. The imbalances in these two doshas should be corrected while treating udaka meha vis-à-vis diabetes insipidus.
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