Diabetes Insipidus

Dr. Suvansh Raj NirulaMBBS

January 27, 2021

December 20, 2022

Diabetes Insipidus
Diabetes Insipidus

In diabetes insipidus (DI), due to the decreased secretion or reduced sensitivity to the effects of antidiuretic hormone (ADH), excessive fluid is lost in the urine and the patient experiences increased thirst. Diabetes insipidus symptoms are polyuria (increased frequency and output of urine) and polydipsia (increased thirst and water intake). Other diabetes insipidus symptoms are dehydration and electrolyte imbalance, which can also prove fatal. The underlying diabetes insipidus causes influence the presentation. Diagnosis is made by taking a thorough medical history, conducting a physical examination, laboratory investigations, radiological imaging, and some special tests. Diabetes insipidus treatment includes fluid and electrolyte correction followed by desmopressin in some cases of central diabetes insipidus. The overall outlook is good; however, electrolyte imbalance can be deadly.

Diuresis is the technical term that refers to the excessive production of urine by the kidneys due to the filtration of extra body fluids. ADH, also known as arginine vasopressin (AVP), is synthesized by the hypothalamus and is released by the pituitary gland, along with oxytocin, through its posterior lobe. Vasopressin, by binding with V2 receptors in the distal convoluted tubules (DCT) of the kidneys, increases water permeability and resorption of extra fluid. Thus, by reducing the urine output, it exerts an antidiuretic effect. When a person is dehydrated or thirsty, the vasopressin level is raised by the central nervous system (hypothalamus and pituitary gland) and this causes more water to be absorbed back from the urine (which becomes more concentrated and dark) in the kidneys. Similarly, when a person is adequately hydrated and has had enough to drink, the vasopressin levels are down-regulated by the same organs and more water is allowed to leave the body through urine (which becomes diluted and pale).

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Certain conditions can produce central diabetes insipidus (DI), where the synthesis or secretion of ADH is reduced significantly. In other cases, due to underlying causes, the V2 vasopressin (ADH) receptors in the distal convoluted tubules (DCT) of the kidney can become insensitive to the hormone. That is to say, the receptor molecules do not bind with the hormone molecule and the physiological change necessary for the fluid to be absorbed back into the circulatory system of the body does not occur.

In this article, you will get information about diabetes insipidus symptoms, causes, and treatment.

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Diabetes Insipidus Types

Depending on the diabetes insipidus cause, 4 distinct diabetes insipidus types exist - 

Central Diabetes Insipidus

The body does not produce sufficient ADH and water is continuously lost through the urine. Even if the person becomes dehydrated, due to the deficiency of vasopressin, the body is unable to claim fluid back from the urine in the kidneys. Hormone production can be affected due to infections, tumors, trauma, or surgery of the hypothalamus or the pituitary gland. Central diabetes insipidus is the most common type. 

Nephrogenic Diabetes Insipidus

Certain substances (including drugs and imbalanced electrolytes) can cause malfunctioning of the receptors that recognize and bind with the ADH to reabsorb water. Sometimes, nephrogenic diabetes insipidus can also be genetically inherited and present since birth. The most common cause of nephrogenic diabetes insipidus is the use of lithium (used to treat mania and bipolar disorder). 

Dipsogenic Diabetes Insipidus

This is also called primary polydipsia (increased oral fluid intake) and generally occurs not due to the absence or insensitivity of kidney receptors towards vasopressin, but due to damage to the thirst-regulating mechanism. The center in the brain that regulates thirst, and thus oral fluid intake, is present in the hypothalamus. Any injury, infection, or damage to it, or due to other associated mental health problems, primary polydipsia can set in.

Gestational Diabetes Insipidus

Gestational diabetes insipidus is the term used to exclusively refer to the disease that occurs during pregnancy and in the immediate postpartum period. It may occur due to a few reasons, the first being the production of an enzyme (vasopressinase) by the placenta, which breaks down vasopressin and prevents its action. In some women, this enzyme may not get cleared and gestational diabetes insipidus can set in. However, sometimes the presence of diabetes insipidus may be related to other more complex disorders seen in pregnancy like gestational hypertensionpreeclampsia, or HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome.

Further, you will read about diabetes insipidus symptoms.

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Diabetes Insipidus Symptoms & Signs

The following diabetes insipidus symptoms can be seen in adults -

The following diabetes insipidus symptoms can be seen in infants -

  • Crankiness
  • Slow growth
  • Poor feeding
  • Dehydration in newborns: 
    • Sunken soft spot on the top of the head (called the anterior fontanelle in medical terms)
    • Sleeping too much (more than usual for a baby)
    • Sunken eyes
    • Crying with little or no tears
    • Fussiness
    • Cold or discolored hands and feet
    • Wrinkly skin
  • Dehydration in older infants and toddlers: 
    • Tired or cranky
    • Not playful
    • A dry diaper for 6 hours or longer
    • Sunken eyes
    • Crying with few or no tears
    • A dry mouth
    • Constipation or hard and few bowel movements 
    • Cold hands
    • Fast breathing
    • Fast heart rate

The following diabetes insipidus symptoms can be seen in children -

  • Drinking a lot of water
  • Frequent voiding of the bladder, sometimes every hour
  • New bedwetting habit or waking up at night to urinate
  • Dehydration:
    • Fatigue
    • Feeling sluggish
    • Dizziness
    • Confusion
    • Nausea

Now, please check out diabetes insipidus causes in the next section of this article.

Diabetes Insipidus Causes

The possible diabetes insipidus causes vary depending on the type -

Central Diabetes Insipidus

  • Idiopathic (due to unknown causes)
  • Genetic
  • Post-surgery (especially transfrontal and transsphenoidal)
  • Traumatic brain injury
  • Tumors
    • Craniopharyngioma
    • Pituitary tumors (Read more: Prolactinoma)
    • Hypothalamus tumors
    • Metastasis (tumors spread from cancer elsewhere in the body, like lungs, etc.)
  • Infections
  • Autoimmune disease
  • Infractions
    • Aneurysm (dilated ballooned-out blood vessel) rupture
    • Sheehan’s syndrome (after childbirth, sometimes the pituitary gland can lose its blood supply and its tissue can die)
  • Toxins (like snake venom)

Nephrogenic Diabetes Insipidus

  • Genetic
    • Autosomal dominant 
    • Autosomal recessive 
    • X-linked
  • Drug-induced
  • Electrolyte imbalance
  • Kidney diseases affecting the kidney medulla
    • Pyelonephritis (purulent kidney infection)
    • Hydronephrosis 
    • NSAID-induced kidney damage (nephropathy)
    • Amyloidosis
    • Sarcoidosis
    • Polycystic kidney disease
    • Multiple myeloma
    • Fanconi syndrome
  • Infections
  • Sickle cell anemia, etc. 

Dipsogenic diabetes insipidus

Gestational Diabetes Insipidus

  • Due to the vasopressinase enzyme secreted by the placenta during pregnancy that deactivates vasopressin or ADH.

(Read More - Ayurvedic treatment for Diabetes)

Diabetes Insipidus Diagnosis

The doctor will begin by taking a proper medical history with an emphasis on recent brain surgery, brain infection, head trauma, mental illnesses, autoimmune diseases, or pregnancy. Any new psychiatric or neurological manifestations are also sought out. Usually, suspicion of diabetes insipidus (DI) is raised due to complaints of unexplained polyuria (excessive urination) and/or polydipsia (excessive thirst and water intake). 

A clinical examination is conducted with a focus on neurological testing. A psychiatric evaluation might also be needed to rule out psychogenic causes. After ruling out the other differential diagnoses, with the help of various investigations and tests, the underlying cause of diabetes Insipidus is elucidated and treated accordingly. 

The differential diabetes insipidus diagnosis -

  • Diabetes mellitus: Both diseases present with polyuria and polydipsia but are caused due to different reasons. Furthermore, the other presenting features set the two apart. 
  • Enuresis or bedwetting in older children: The inability to control the urine at night is not necessarily due to the overproduction of urine. 
  • Urinary tract infection (UTI): While a patient complains of increased urgency to urinate in a UTI, urine volume itself is not increased.
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Diabetes Insipidus Test

Following are the tests you might be asked to get done -

Blood tests

Urine tests

  • The physical appearance of urine: The color of urine (dark or pale) indicates the hydration status of the individual.
  • 24-hour urine output: Urine output is more than 3L per day in diabetes insipidus.
  • Urine osmolality: This informs about the concentration of the urine and also helps grade the results of the water deprivation test described later. 
  • Urinalysis (urine routine) gives information about the loss of electrolytes and indication for imbalance.
  • The presence of glucose or ketone bodies in urine also indicates uncontrolled diabetes mellitus.

Other investigations

  • Lumbar puncture and cerebrospinal fluid analysis, culture, and sensitivity testing: They can rule out infection of the brain (encephalitis) or the brain covering (meningitis).
  • Peripheral blood smear test: It can show sickle red blood cells in case of sickle cell anemia.

Radiological imaging studies

Various modalities can be used to diagnose the possible underlying cause of central or dipsogenic diabetes insipidus. Tumors or injuries to the hypothalamus or pituitary gland can be visualized using:

  • X-ray of the skull
  • CT scan
  • MRI of the brain 
  • Kidney diseases can also require radiological imaging investigations and at times biopsies as well for diagnosis. 

Special tests

Some special tests are carried out to confirm the diagnosis of diabetes insipidus and to differentiate between central and nephrogenic types. These tests are:

  • Water deprivation test: A special test in which the patient does not consume water or other fluids for a prolonged period (of at least 6 to 8 hours). The urine output is measured after this. If there is a decrease in the volume from the previously recorded output, the cause of polyuria was most likely excessive water intake. However, if the urine output volume remains unchanged the patient is likely suffering from diabetes insipidus. A water deprivation test is followed up by an antidiuretic hormone test. 
  • Antidiuretic hormone test: A medicine called desmopressin, similar to the naturally occurring vasopressin, is given to the patient after a period of water deprivation (6 to 8 hours).

Keep reading this article to know more about diabetes insipidus treatment.

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Diabetes Insipidus Treatment

Diabetes insipidus treatment would depend on type - 

Central diabetes insipidus

  • Mild cases can be managed by fluid replacement by increasing oral intake. Dehydration can be corrected with intravenous fluids and electrolytes.
  • ADH replacement by desmopressin can be done. However, this increases the risk of hyponatremia and should be prescribed judiciously. 

Nephrogenic diabetes insipidus

  • Cases with less than 4L per day of urine output do not need definitive management.
  • In the case of drug-induced diabetes insipidus (very common with lithium use), the drug dose should be stopped or reduced.
  • Mild to moderate diabetes insipidus can be treated with desmopressin. A combination of a thiazide diuretic and an NSAID can be given to further reduce urine volume.
  • Intermittent catheterization is needed in severe cases to prevent bladder backflow complications.

(Read More - Homeopathic treatment for Diabetes)

Diabetes Insipidus Complications

Some of the complications that can occur because of diabetes insipidus are: 


Dehydration can set in due to unchecked loss of water through urine and an imbalance in ADH, which regulates the water balance of the body. Along with water, other electrolytes like sodium can also be lost.

Electrolyte imbalance

Loss of the body's electrolytes can impact the overall functioning of the body. Vital organs can be affected and death can also occur in severe cases. 

Sleep disturbance

Repeated waking at night to urinate can disrupt the sleep-wake cycle.

Diabetes Insipidus Prognosis

In cases where diabetes insipidus treatment along with fluid and electrolyte correction is started on time, the outlook is good. The elderly, children and those with acute illnesses are at greater risk of dehydration, hypernatraemia, cardiovascular collapse, and even death. The underlying cause significantly determines the overall outcome.

(Read More - Diabetic Ketoacidosis treatment)


  1. Christ-Crain Mirjam. Diabetes insipidus. Nat Rev Dis Primers. 2019 Aug 8;5(1):54. PMID: 31395885.
  2. Schernthaner-Reiter Marie Helene. Genetics of Diabetes Insipidus. Endocrinol Metab Clin North Am. 2017 Jun;46(2):305-334. PMID: 28476225.
  3. Di Iorgi Natascia. Diabetes insipidus--diagnosis and management. Horm Res Paediatr. 2012;77(2):69-84. PMID: 22433947.
  4. Robertson Gary L. Diabetes insipidus: Differential diagnosis and management. Best Pract Res Clin Endocrinol Metab. 2016 Mar;30(2):205-18. PMID: 27156759.
  5. Kalra Sanjay, et al. Diabetes insipidus: The other diabetes. Indian J Endocrinol Metab. 2016 Jan-Feb; 20(1): 9–21. PMID: 26904464.
  6. Hunter Janel D, Calikoglu Ali S. Etiological and clinical characteristics of central diabetes insipidus in children: a single center experience. Int J Pediatr Endocrinol. 2016; 2016: 3. PMID: 26870137.

Doctors for Diabetes Insipidus

Dr. Narayanan N K Dr. Narayanan N K Endocrinology
16 Years of Experience
Dr. Tanmay Bharani Dr. Tanmay Bharani Endocrinology
15 Years of Experience
Dr. Sunil Kumar Mishra Dr. Sunil Kumar Mishra Endocrinology
23 Years of Experience
Dr. Parjeet Kaur Dr. Parjeet Kaur Endocrinology
19 Years of Experience
Consult a Doctor

Medicines for Diabetes Insipidus

Medicines listed below are available for Diabetes Insipidus. Please note that you should not take any medicines without doctor consultation. Taking any medicine without doctor's consultation can cause serious problems.