Diabetes Insipidus

The pea-sized pituitary gland, part of your endocrine system, makes several important hormones that keep your body running efficiently. One is the antidiuretic hormone, vasopressin, which regulates the amount of water and sodium in your body.

When your pituitary gland doesn’t make enough ADH, your body can’t retain water properly. So, you might start feeling thirsty all of the time (extreme thirst or polydipsia) and pee constantly (frequent urination). This can also happen when your body doesn’t use ADH properly. Or it can happen when another gland, the hypothalamus, doesn’t work right and causes constant thirst.

These symptoms are often common signs of other things, like diabetes mellitus (which isn’t related to diabetes insipidus), hypercalcemia (too much calcium in your blood) or hypokalemia (not enough potassium in your blood). Certain kidney and liver conditions can also cause excessive thirst and urination.

It’s important to find healthcare providers who have experience zeroing in on diabetes insipidus. And know how to recognize what type it is, like:

• Central diabetes insipidus: Happens when your body doesn’t make or release enough antidiuretic hormone (ADH).
• Nephrogenic diabetes insipidus: Happens when your kidneys don’t use ADH properly.
• Dipsogenic diabetes insipidus: Results from a problem with your hypothalamus.
• Gestational diabetes insipidus: Develops during pregnancy and goes away shortly after birth.

What to expect at your first visit

When you come to your first appointment, your provider will ask you to do something important — share your story. Hearing this helps them get a better picture of what’s been going on.

Please share as many details as possible. Talk about your symptoms, how long you’ve been feeling this way and other medical conditions you have — even if something doesn’t seem related to the reason for your visit. All this information helps your care team get closer to finding out what kind of diabetes insipidus you have — and what’s causing it.

To further pinpoint a diagnosis, your provider will also order tests to look for signs of diabetes insipidus or other conditions.

• Water deprivation test: This is the main test for diabetes insipidus. We restrict your liquid intake for up to 12 hours to see if you still have diluted urine.
• Vasopressin test: After a water deprivation test, we give you a vasopressin (ADH) injection (Pitressin® or Vasostrict®). If it causes you to stop peeing, you probably have central diabetes insipidus. If you keep peeing, you probably have nephrogenic diabetes insipidus.
• Blood tests: We look for low ADH levels in your blood, which can indicate diabetes insipidus. These tests can also rule out diabetes mellitus and other conditions that cause you to drink and pee a lot.
• Urinalysis: This test checks the concentration and contents of your urine.
• Imaging exams: Imaging exams like an MRI (magnetic resonance imaging) or CT scan (computed tomography scan) help us look for hypothalamus or pituitary gland damage.

Meet Our Diabetes Insipidus Team

Cleveland Clinic’s team-based approach to diagnosis, treatment and follow-up means you’ll have all the providers you need to plan and manage your care. And they’re all selected based on your specific needs. Your care team could include:

• Endocrinologists.
• Nephrologists.
• Nurse practitioners.
• Physician assistants.
• Dietitians.
• Pathologists.
• Radiologists.

Treatment for diabetes insipidus depends on what type you have. Overall, you’ll likely need to make lifestyle changes and take medications. Your healthcare providers work together to find ways to relieve symptoms and prevent complications like chronic dehydration, organ damage, weight loss and low blood pressure.

Central diabetes insipidus treatment

The most common treatment for central diabetes insipidus is hormone therapy. You receive either vasopressin or desmopressin, a synthetic version of vasopressin (DDVAP^®, Minirin^® or Stimate^®). We may prescribe tablets, injections or nose sprays.

Gestational diabetes insipidus treatment

We treat gestational diabetes insipidus like central diabetes insipidus, with vasopressin or desmopressin. After pregnancy, the condition usually goes away on its own.

Nephrogenic diabetes insipidus treatment

Nephrogenic diabetes insipidus doesn’t respond to hormone therapy. It happens because of how your kidneys use vasopressin rather than not having enough of it. To control how much pee your body makes, we usually recommend:

• Low-salt diet.
• Thiazide diuretics.
• Nonsteroidal anti-inflammatory drugs (NSAIDs).

Dipsogenic diabetes insipidus treatment

There isn’t an effective treatment for dipsogenic diabetes insipidus. We may recommend a small dose of desmopressin at night if you wake up a lot to pee. And there are ways to control your thirst so that you don’t urinate as often:

• Avoid alcohol.
• Cut out salty or spicy foods.
• Drink water, not sugary or caffeinated beverages.
• Get plenty of electrolytes.

Taking the Next Step

If you have diabetes insipidus, you may think that being thirsty all the time and constantly running to the bathroom is a way of life. But it doesn’t have to be. Diabetes insipidus is treatable. And it doesn’t have to limit what you do — or how you feel about yourself. Cleveland Clinic healthcare providers can help you learn how to manage lifestyle changes and medications so you can get back to enjoying life.