Complications of Diabetes Insipidus

Having a doctor say that the diagnosis is diabetes insipidus (DI) can be a scary experience. When the word “diabetes” is heard, many people think of insulin shots, finger pokes for blood tests, and a life of avoiding sugary products that will spike their blood sugar. None of that exists with diabetes insipidus. This disease affects the kidneys and how fluids are reabsorbed or expelled from the body.

Why is it called diabetes?
Diabetes insipidus is in many ways the exact opposite of Type I or Type II diabetes. Instead of having too much sugar in the body and the kidneys trying to remove it by placing a bunch of sugar into the urine, DI causes the urine to be clear, like water. It is dull and lifeless. If one were to compare the two types of urine, Type I or Type II diabetes would create sugary urine, like overly sweetened iced tea. Diabetes insipidus creates urine that the average person would mistake for water.

Although diabetes insipidus isn’t necessarily life-threatening or shorten a person’s expected lifespan, there are some concerns that should be noted and observed when this diagnosis is received. Here are the complications that may happen and how to properly respond to them.

1. Increased Thirst.

Many people with diabetes insipidus find that they feel more thirsty than normal. This is caused by the increased need for the body to push fluids through the body. Because the kidneys aren’t concentrating urine on their own, the body responds by requesting more fluids to make that happen.

To resolve this situation, a doctor may recommend the following options.

  • Drink more fluids if the increased thirst is not bothersome or causing more frequent bathroom trips.
  • Recommend Desmopressin treatments to encourage urine concentration.
  • Add diuretics and NSAID medications to the treatment plan to reduce urination needs.

2. Increased Urination.

Excessive urination is another common issue that occurs when diabetes insipidus presents itself. It may be mild and result in only an extra bathroom trip or two during the day or may be very severe and keep someone up all night, every night. Treatment of this condition depends on the severity of the disease. If it is not bothersome, then it will likely be monitored, but ultimately ignored. Severe cases will have medications introduced to enhance urine concentration.

3. Mental Health Treatment Changes.

With a 40% incidence rate in long-term lithium users, diabetes insipidus can have a direct impact on mental health. Other medications may also contribute or cause DI as well. Doctors and psychiatrists will either look to use the lowest therapeutic levels of lithium, look for alternative medications, or treat the symptoms of the diabetes insipidus that develops because the lithium therapy is more important than the symptoms of DI.

How can DI just be ignored? In some cases, the need for stable mental health takes a priority over the need to resolve diabetes insipidus. Doctors will focus on reducing the desire of thirst and urination as best as possible by adding diuretics to the individual’s treatment plan. Because there is no real immediate risk to life with DI present, only extremely bothersome symptoms will typically cause a change to the lithium therapy.

4. Treatment Medications May Also Cause Side Effects.

The medications that are used to treat diabetes insipidus can also cause some side effects that may be troublesome. Dizziness, nausea, vomiting, and headaches are all common symptoms of the diuretic medications that are used. Having too much Desmopressin in the body can also cause life-threatening symptoms if it occurs. For this reason, only those who respond well to the synthetic hormone will have it prescribed to treat their diabetes insipidus.

5. It Can Be Genetic in Nature.

Children tend to suffer more from the effects of diabetes insipidus than adults. This disease can be passed along genetically from one or both parents and cause symptoms while still in infancy. For children that have consistently wet diapers, frequent diarrhea, and an inability to be consoled, there is a good possibility that the nephrogenic version of this disease has been obtained.

Nephrogenic DI affects men more than women. Fathers are more likely to pass on the faulty genes that cause diabetes insipidus than mothers. When passed along genetically, there is no way to make this disease go into remission. Treatments will happen throughout the child’s life to manage the symptoms of their condition.

6. Dehydration Can Happen At a Moment’s Notice.

Although one form of DI causes people to retain too much water, dehydration is a constant complication of this disease. The body will naturally want to retain too little water and this will cause it to not function as it should. The most common symptoms of dehydration are elevated blood sodium levels, low blood pressure, muscle weakness, and a dry mouth.

If dehydration continues on for a prolonged period of time, then chronic conditions may begin to develop as well. People may start to experience muscle twitches and cramping. Nerve parasthesias may be felt anywhere in the body, but especially in the fingers, toes, and face. Irregular and rapid heartbeats may occur that could lead to life-threatening conditions. When these symptoms are present, it is often necessary to see a doctor immediately to properly rehydrate.

7. Electrolyte Imbalances Can Happen Too.

Electrolytes are the minerals that can be found in the blood. They help to balance out the body and help the nerves and muscles function as they should. Calcium, magnesium, and potassium are the three main electrolytes that will typically become out of balance. Too much calcium can actually lead to diabetes insipidus on its own, so maintaining electrolyte levels is important to do.

For most people, a balanced and healthy diet is enough to keep these minerals where they should be. In cases of a deficiency, supplements may be ordered to help supplement better dietary choices to slowly raise electrolyte levels.

The issue with an electrolyte imbalance is that the symptoms can be vague and non-specific. The type of imbalance also matters. Here are the most common symptoms of an imbalance, but all of them or none of them may be present at any given time.

  • A general feeling of fatigue or lethargy that persists, even after a good night’s sleep.
  • Irritability that flares up whenever something unexpected occurs.
  • Random bouts of nausea that may come and go in an instant or last for several minutes.
  • A desire to avoid all food and a general feeling of wanting to get sick.
  • Muscle pains that are similar to cramps, but may come and go throughout the day.

8. Treating Diabetes Insipidus Can Sometimes Be Quite Difficult.

In severe cases of this disease, it can be virtually impossible to completely eliminate the extreme thirst or need to urinate frequently, which means lifestyle changes are forced. This may create a grieving process within the individual diagnosed with DI that could lead to further health situations. Although Desmopressin and other medications can make a difference, sometimes only small changes are achieved. Having a solid support network in place can help to make the needed lifestyle changes a lot easier to bear.

9. Some Forms of Diabetes Insipidus Do Resolve on Their Own.

The gestational form of diabetes insipidus is the most likely to resolve on its own. This version of the disease forms when enzymes produced by the mother’s placenta destroy the hormones that help the kidneys to properly read hydration levels. Once the pregnancy is resolved, it takes about 4-6 weeks for most cases of DI to subside. In rare cases, it may continue along indefinitely, however, so tracking disease progression is still important.

10. A DI Diagnosis Means Wearing a Medical Alert Bracelet.

Once a diagnosis of diabetes insipidus has been confirmed, it is considered a best practice to wear a medical alert bracelet. This may be a diagnosis specific bracelet or a general alert bracelet to let medical professionals know to check your file before initiating a treatment.

11. One Type of DI Has No Specific Treatment.

For primary polydipsia, which creates thirst when none exists, there is no actual treatment that has been deemed to be effective. Sometimes the thirst mechanisms of the hypothalamus malfunction and this can be treated, but the cause of this form of diabetes insipidus is often based in a mental illness or behavior disorder. The illness or disorder must be treated to relieve some of the symptoms.

The complications of diabetes insipidus can be wide and varied, just as the presentation of the disease itself can be quite unique. Use this guide to determine what complications may be faced in the future, work with an endocrinologist to develop an effective treatment plan, and make sure there are enough fluids close by at any given time. In doing so, diabetes insipidus may not be cured, but it can at least be conquered.