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Diabetes Insipidus, or DI, is often confused with diabetes mellitus. It is a rare disease, not widely diagnosed, in which the kidneys produce an abnormally large amount of dilute urine.

Despite similar names, Diabetes Insipidus (or water diabetes) is not related to Diabetes Mellitus (which is sometimes called sugar diabetes). Insipidus comes from the latin "having no flavor". About 1 in 25,000 people have DI. In DI, the kidneys are unable to conserve water while carrying out their duties of filtering the blood. The amount of water conserved is controlled by an anti-diuretic hormone (ADH) called vasopressin.

Vasopressin is produced by the hypothalamus, an area of the brain, and stored in and released by the pituitary gland located at the base of the brain.

When DI is caused by insufficient vasopressin, it is called central diabetes insipidus, or neurogenic, hypothalamic, pituitary or neurohypophyseal DI. It is caused by damage to the hypothalamus or pituitary gland as a result of surgery, infection, tumor, or head injury. Although rare, this form of DI is more common than nephrogenic DI.

Nephrogenic DI is caused by a failure of the kidneys to respond to vasopressin. It involves a defect in the parts of the kidneys that reabsorb water back into the bloodstream. Nephrogenic DI may be inherited if male children receive an abnormal gene on the X chromosome from their mothers. It can also be caused by kidney disease (such as polycystic kidney disease). Some drugs can cause it, such as lithium, amphotericin B, and ademeclocycline.

Central and Nephrogenic DI affect males and females about equally.

Gestagenic DI is another form of DI that only occurs during pregnancy, the result of a lack of vasopressin.

Dipsogenic DI is caused by abnormal thirst resulting in primary polydipsia (increased fluid intake).

Symptoms of diabetes insipidus

The major symptom of DI is extreme thirst and excessive urination. People with DI will consume a large quantity of water to compensate for that lost by urination. They are thirsty all the time and want to drink every hour. Bladder enlargement, and signs of dehydration may be present with no other signs.

Symptoms vary with the patient's ability to access water; those with free access may have no symptoms at all. A physical examination may have results that vary with the severity and chronicity of the DI. The results can be entirely normal.

Infants may experience crying and irritability, their growth may be retarded, they may have hyperthermia and weight loss.

Children may experience enuresis, anorexia, linear growth defects, and fatigue.

If you have DI and are not bothered by the symptoms, if thirst mechanisms are normal and adequate fluids are consumed, then nothing needs to be done. You should be sure you are consuming a sufficient amount of water so you are not dehydrated.

If inadequate fluids are consumed, the large amount of water lost in the urine may cause dehydration and high sodium levels in the blood.

Mortality is rare in adults as long as water is available.




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