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What Are the Different Types of Diabetes Insipidus?

Diabetes insipidus comes in four different forms. Every kind has an array of possible causes and arises from distinct mechanisms. Treatment for diabetic insipidus varies depending on its kind.

The condition known as diabetes insipidus (DI) is characterised by excessive urine production. Individuals with DI might produce up to 20 quarts of pee daily, compared to the typical person's 1 to 3 quarts.

Another common symptom of DI is extreme thirst. As a result, one drinks more fluids during the day.

Since 2022, medical practitioners have referred to the illness as arginine vasopressin disorder. The main reason for changing the name was to prevent confusion with diabetes mellitus, which is often abbreviated as diabetes.

DI comes in four different forms. We go into further information about each category and its reasons below.



What are the 4 types of diabetes insipidus?

The majority of the time, problems with the hormone vasopressin cause DI. Vasopressin, commonly known as antidiuretic hormone, may also be seen.

The hypothalamus is a region of the brain that produces vasopressin. The pituitary gland stores it until it is required. Its function is to alert your kidneys to the need to save fluids when your body's fluid levels drop too low.

Four categories of DI exist:
  • central
  • dipsogenic
  • nephrogenic
  • gestational
The causes of each type of DI are distinct. Below, we go into further depth about these.



Central (cranial) diabetes insipidus

When you have central DI (cranial DI), your hypothalamus produces insufficient vasopressin. Insufficient vasopressin prevents your kidneys from reabsorbing fluid into the circulation. Urine flushes out the fluid instead.

Damage to your pituitary or hypothalamus may result in central DI. This may occur as a result of:
  • a head injury
  • complications from brain surgery
  • a brain tumor
  • an infection, such as encephalitis or meningitis
  • a stroke
  • an autoimmune disease
DI can also result from some genetic mutations that are inherited. The mutations that cause Wolfram syndrome are one instance.


Nephrogenic diabetes insipidus

Your hypothalamus produces normal amounts of vasopressin in nephrogenic DI. Your kidneys, however, don't take it well.

This implies that your kidneys won't change to retain more fluid even if your pituitary gland releases vasopressin in response to low fluid levels. Rather, fluid keeps leaving your body through urine.

Nephrogenic DI may be caused by the following factors:
  • inherited genetic mutations
  • specific kinds of drugs, including lithium
  • low potassium levels
  • high calcium levels
  • the harm caused by renal disorders, either acute or chronic
  • an obstruction in your urinary tract that damages your kidneys


Dipsogenic diabetes insipidus

Primary polydipsia, another name for dipsogenic DI, is a less common kind of DI. It's also the kind that doesn't arise from vasopressin-related problems.

Rather, a hypothalamic issue that causes extreme thirst is the cause of dipsogenic DI. Extreme thirst causes a person to drink more fluids and urinate more frequently.

You may get dipsogenic DI if your hypothalamus is damaged. Similar to central DI, this can be brought on by an injury, problems following brain surgery, inflammation, or infection.

Dipsogenic DI can also occur in certain individuals with specific mental health disorders, such as schizophrenia.


Gestational diabetes insipidus

A further uncommon kind of DI is gestational DI. Usually, it takes place in the third trimester of pregnancy.

The placenta overproduces an enzyme that degrades vasopressin in gestational DI. Vasopressin is less available to assist your kidneys in maintaining the proper levels of fluid in your body when it is broken down by this enzyme.

Those with liver illness who are pregnant may be more susceptible to this kind of DI. This is so because the liver is in charge of controlling the amount of the enzyme that breaks down vasopressin.


How is diabetes insipidus treated by type?

Make sure you consume adequate fluids if you have DI. By doing this, a potential issue called dehydration is avoided.

Additionally, your doctor could advise you to modify your diet to lessen the volume of pee your kidneys produce. Usually, this entails consuming less protein and salt.

Depending on the kind of DI you have, the particular treatment you receive may vary.

Central diabetes insipidus treatment

Central DI is treatable with desmopressin. This artificial hormone is meant to take the place of the deficient vasopressin. Usually, it is administered as an oral pill or nasal spray.

Nephrogenic diabetes insipidus treatment

Nephrogenic DI could disappear if the underlying cause is addressed. This may consist of:
  • correcting high calcium levels
  • addressing low potassium levels
  • removing a drug that's contributing to nephrogenic DI
Combining thiazide diuretics and nonsteroidal anti-inflammatory medications (NSAIDs) is another therapy option. Your kidneys' filtering rate may be lowered by this combo therapy, which will result in reduced urine production.

Dipsogenic diabetes insipidus treatment

As of yet, scientists have not discovered a cure for dipsogenic DI. Usually, coaching is used as a form of treatment to lower fluid intake.

Reducing thirst may also be a useful action to take. This may involve avoiding drugs that dry out the mouth or sucking on ice chips to maintain moisture in the mouth.

Gestational diabetes insipidus treatment

Similar to central DI, desmopressin is utilised in gestational DI to assist in replenishing lost vasopressin. The enzymes that break down naturally occurring vasopressin cannot break down desmopressin.

After delivery, gestational DI usually disappears in four to six weeks.


When to contact a doctor

Consult a physician if you experience DI symptoms. The following are the two primary symptoms:
  • urinating far more frequently than usual, especially at night
  • feeling constantly extremely thirsty
Your symptoms might be caused by something other than DI, which means you still need to get treated for it. One such condition is diabetes mellitus, which can also result in excessive thirst and increased urination.


How do doctors diagnose the type of diabetes insipidus you may have?

The type of DI you may have can be determined by a doctor using several tests after obtaining your medical history and performing a physical examination.

Diagnostic examinations may consist of:
  • Urinalysis: Your urine's degree of dilution can be determined with a urinalysis. Additionally, it may check for elevated glucose levels in your urine, which could be an indication of diabetes.
  • Blood tests: Blood tests can measure potassium and calcium levels, as well as vasopressin. To help rule out diabetes mellitus, blood testing can also assess blood sugar levels.
  • Water deprivation test: You abstain from drinking water for several hours when doing a water deprivation test. A medical specialist measures the volume and composition of the pee you pass throughout this period. Individuals suffering from DI still pass a lot of diluted urine.
  • Stimulation test: You will receive an injection of desmopressin during this test. You can have central DI if your body reacts by producing less urine that is more concentrated. Should your body persist in producing copious amounts of diluted urine, you may have nephrogenic DI.
  • MRI scan: Your doctor can check for hypothalamic or pituitary gland damage using an MRI scan. They can use this to diagnose dipsogenic or central DI.



Takeaway

DI results in excessive thirst and increased urination. It is frequently brought on by vasopressin hormone issues. DI comes in four different forms. Every kind has a unique process and possible causes.

Consult a physician if you experience DI symptoms. To identify the type of DI you have and confirm the diagnosis, they can request multiple tests. Your treatment plan is based on the type of DI you have.



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