Diabetes insipidus is a rare and treatable condition in which your body produces too much urine. Diabetes insipidus is mostly caused by an issue with how your body makes and uses antidiuretic hormone (ADH, or vasopressin).
Diabetes insipidus is a rare but treatable condition in which your body produces too much urine (pee) and isn’t able to properly retain water. Diabetes insipidus can be chronic (life-long) or temporary and mild or severe depending on the cause.
Diabetes insipidus is mostly caused by an issue with a hormone called antidiuretic hormone (ADH, or vasopressin) — either your body doesn’t make enough of ADH or your kidneys don’t use it properly.
People with diabetes insipidus pee large volumes of urine several times a day and drink large amounts of water because they feel constantly thirsty. If you have diabetes insipidus and don’t drink enough fluid to replace water loss through urine, you can become dehydrated, which is dangerous to your health.
Because of this, diabetes insipidus is a serious condition that requires medical treatment.
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Antidiuretic hormone (ADH, or vasopressin) is a hormone that your hypothalamus makes and your pituitary gland stores and releases.
Hormones are chemicals that coordinate different functions in your body by carrying messages through your blood to your organs, skin, muscles and other tissues. These signals tell your body what to do and when to do it.
Your hypothalamus is the part of your brain that controls your autonomic nervous system and the activity of your pituitary gland. It makes ADH and then sends it to your pituitary gland for storage and release.
Your pituitary gland is a small gland located at the base of your brain below your hypothalamus. It’s a part of your endocrine system and is in charge of making, storing and releasing many different important hormones
ADH helps regulate the water balance in your body by controlling the amount of water your kidneys reabsorb while they’re filtering waste out of your blood. Your body normally produces and releases more ADH when you’re dehydrated or losing blood pressure. The increase in ADH tells your kidneys to hold onto more water instead of releasing it in your pee (urine).
In most cases of diabetes insipidus, your hypothalamus isn’t making enough ADH, your pituitary gland isn’t releasing enough ADH or your kidneys aren’t properly using ADH. This causes frequent and excessive water loss through your urine.
As an example, if a person without diabetes insipidus were in the desert with no access to water, their body would produce more ADH and retain as much water as possible. A person with diabetes insipidus would continue to urinate water and would quickly become dehydrated.
Diabetes insipidus and diabetes mellitus are two distinct conditions with different causes and treatments. They share the name “diabetes” because they both cause increased thirst and frequent urination. “Diabetes” comes from the Greek word “diabainein,” which means “go through” — much like the liquids that quickly go through your body in these conditions.
Diabetes mellitus, most commonly known as Type 1 diabetes, Type 2 diabetes or gestational diabetes, happens when your pancreas doesn’t make any or enough insulin or your body doesn’t use the insulin it makes properly. Your body needs insulin to transform the food you eat into energy.
If your body doesn’t have insulin to transform glucose into energy, it starts breaking down fat and muscle for energy instead, which produces a substance called ketones. Too many ketones can turn your blood acidic, so your body tries to get rid of them through your urine. Because of this, symptoms of diabetes often include extreme thirst and frequent urination.
Diabetes insipidus happens when your body doesn’t make enough antidiuretic hormone (ADH) or your kidneys don’t use it properly. Your body needs ADH to retain appropriate amounts of water. Without ADH, your body loses water through urine.
Diabetes mellitus is much more common than diabetes insipidus.
There are four types of diabetes insipidus, including:
People of all ages can develop diabetes insipidus. Gestational diabetes insipidus specifically affects people who are pregnant, though it’s rare.
Diabetes insipidus is a rare condition. It affects about 1 in 25,000 people worldwide.
The main symptoms of diabetes insipidus include:
While most people produce one to three quarts of urine a day, people with diabetes insipidus can produce up to 20 quarts of urine a day.
If diabetes insipidus isn’t treated or if a person with diabetes insipidus stops drinking fluids, it can quickly lead to dehydration.
Symptoms of dehydration include:
If you’re experiencing extreme thirst and frequent urination and/or dehydration, it’s important to go to the hospital as soon as possible.
While diabetes insipidus is rare, it’s not the only condition that causes these symptoms. Extreme thirst and frequent urination are significant signs that something in your body isn’t working properly and needs medical treatment.
In general, diabetes insipidus is caused by problems with how your body makes or uses antidiuretic hormone (ADH, or vasopressin), which helps your kidneys balance the amount of fluid in your body. The exact causes vary for the different types of diabetes insipidus. Sometimes, healthcare providers can’t determine the cause.
Central diabetes insipidus happens when there’s an issue with your hypothalamus or pituitary gland. Specific causes include:
Nephrogenic diabetes insipidus happens when your kidneys don’t use antidiuretic hormone (ADH, or vasopressin) properly. Specific causes include:
Dipsogenic diabetes insipidus (also known as primary polydipsia) happens when there’s an issue with your hypothalamus unrelated to ADH production that causes you to feel thirsty and drink more liquids. Specific causes include:
Gestational diabetes insipidus is a rare condition that affects people who are pregnant. It happens when your placenta makes too much of a certain enzyme that breaks down your antidiuretic hormone (ADH, or vasopressin). If you’re pregnant with more than one baby, you’re more likely to develop gestational diabetes insipidus because you have more placental tissue.
As other conditions, including diabetes mellitus, cause frequent thirst and urination, part of the process of diagnosing diabetes insipidus involves ruling out other conditions. Because of this, your healthcare provider may order several tests if you’re experiencing these symptoms.
A diagnosis of diabetes insipidus also involves determining the type and cause of it.
A water deprivation test is the simplest and most reliable method for diagnosing diabetes insipidus. If your provider orders this test, they’ll make sure you’re under constant supervision during the process, as it can cause dehydration.
A water deprivation test involves not drinking any liquid for several hours to see how your body responds. If you have diabetes insipidus, you'll continue to pee large amounts of watery (dilute), light-colored urine when normally you'd only pee a small amount of concentrated, dark yellow urine.
Your provider may also order the following tests to help diagnose diabetes insipidus or rule out other conditions:
In some cases, diabetes insipidus can’t be cured, but it can be managed with medications. Treatment for diabetes insipidus depends on what type you have.
Desmopressin is the first-line treatment for central diabetes insipidus. It’s a medication that works like an antidiuretic hormone (ADH, or vasopressin). You can take desmopressin as an injection (shot), a pill or in a nasal spray.
Healthcare providers also sometimes use desmopressin to treat gestational diabetes insipidus.
Treatment for nephrogenic diabetes insipidus is more complicated and sometimes involves a combination of approaches.
Healthcare providers often treat it with medications called thiazide diuretics, which reduce the amount of urine your kidneys produce. Your provider may also suggest taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, to help further reduce urine volume when they’re used in combination with thiazide diuretics. If your medication causes nephrogenic diabetes insipidus, your healthcare provider can sometimes treat it by changing your medication.
It might take a while to find the right combination that works best for you.
Researchers haven’t yet found an effective way to treat dipsogenic diabetes insipidus. If an underlying condition causes it, such as a mental health condition, treatment might be directed at that cause. If you wake up many times at night to pee, your provider may recommend you take a small dose of desmopressin at bedtime.
Desmopressin is generally very safe to use and has few side effects.
Possible side effects can include:
If you take too much desmopressin or drink too much fluid while taking it, it can cause your body to retain too much water, which can cause the following symptoms:
Symptoms of hyponatremia include:
If you’re experiencing symptoms of hyponatremia, call 911 or go to the nearest hospital as soon as possible.
If you have diabetes insipidus, aside from medical treatment, it’s important to drink water regularly to make sure you don’t get dehydrated.
If you have a mild case of nephrogenic diabetes insipidus, your healthcare provider may recommend reducing the amount of salt and protein in your diet, which will help your kidneys produce less urine. It’s important to always talk to your provider before drastically changing your diet.
If you have diabetes insipidus, it’s also important to see your provider regularly to make sure your treatment is working and that you have the right dosage of medication.
You’re more likely to develop diabetes insipidus if you:
If you’re pregnant, you’re at a higher risk of developing gestational diabetes insipidus if you:
The outlook (prognosis) for diabetes insipidus is generally good, and it usually doesn’t cause serious problems as long as it’s treated properly and you drink enough water.
The risk of complications and death is higher for infants, seniors and those who have mental health conditions because they may have trouble recognizing their thirst or they can’t do anything about it.
The main complication of diabetes insipidus is dehydration, which happens when your body loses too much fluid and electrolytes to work properly. If you have diabetes insipidus, you can usually make up for the significant volume of fluids you pass in your urine by drinking more liquids. But if you don’t, you could quickly become dehydrated.
Dehydration is dangerous and can be life-threatening. If you’re experiencing symptoms of dehydration, such as feeling dizzy, nauseous and sluggish, get to the nearest hospital as soon as possible.
If you have diabetes insipidus, it’s important to see your healthcare provider regularly so they can run tests to monitor your condition and make sure your treatment is working. If you’re experiencing any concerning symptoms, be sure to contact your provider.
If you’ve been diagnosed with diabetes insipidus, it may be helpful to ask your healthcare provider the following questions:
A note from Cleveland Clinic
Diabetes insipidus is a rare but serious condition in which your body produces too much urine (pee) and isn’t able to properly retain water. The good news is that it’s treatable and manageable. If you have diabetes insipidus, it’s important to see your healthcare provider regularly to make sure your treatment is working. If you have any questions about your condition, don’t be afraid to ask your provider. They’re there to help you manage your condition.
Last reviewed by a Cleveland Clinic medical professional on 07/13/2022.
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