Access to Diabetes Care: If Not Now, When?
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When we hear of the phrase ‘diabetes’, we often think of the medical condition in which the body is unable to process sugar properly—that’s called diabetes mellitus. However, there’s another medical condition that goes by the name diabetes insipidus, and it has nothing to do with the metabolism of sugar.
Diabetes insipidus is a rare condition that causes the body to make too much urine. This can happen when there are problems with a hormone called antidiuretic hormone (also called vasopressin), which helps balance the amount of fluid in the body.
The urine that is produced by individuals who have diabetes insipidus are often large in volume, dilute and odorless. In most people, the kidneys pass about 1 to 2 quarts (1 quart = 1.13 litres) of urine a day. In people with diabetes insipidus, the kidneys can pass 3 to 20 quarts of urine a day. As a result, a person with diabetes insipidus may feel thirsty all the time.
The types of diabetes insipidus include
Central diabetes insipidus — This happens when there’s damage in a person’s part of the brain, called hypothalamus, that produces the antidiuretic hormone we mentioned earlier.
Nephrogenic diabetes insipidus — This occurs when the production of antidiuretic hormone is normal, however the kidneys do not respond normally to the antidiuretic hormone and continue to remove too much fluid from a person's bloodstream. Nephrogenic diabetes insipidus can be caused by many reasons, such as genetics, lithium toxicity, kidney disease, imbalance of calcium and potassium and certain medications.
Dipsogenic diabetes insipidus — A defect in the thirst mechanism, located in a person's hypothalamus, causes dipsogenic diabetes insipidus. This defect results in an abnormal increase in thirst and liquid intake that reduces the antidiuretic hormone secretion and increases urine output.
Gestational diabetes insipidus — Gestational diabetes insipidus occurs only during pregnancy. In some cases, an enzyme made by the placenta—a temporary organ joining mother and baby—breaks down the mother's antidiuretic hormone, rendering it useless. In other cases, pregnant women produce more prostaglandin, a hormone-like chemical that reduces kidney sensitivity to antidiuretic hormone.
The main treatment of antidiuretic hormone is to ensure the person drinks enough water to prevent dehydration. At the same time, the patient may be referred to an endocrinologist to treat the underlying causes of diabetes insipidus. Depending on the type of diabetes insipidus, the treatment strategies may be different.
Central diabetes insipidus — Patients may be given a medication called desmopressin, which is a man-made antidiuretic hormone. The patient may also be put on a low-solute (mostly low-sodium, low-protein) diet; or in combination with a thiazide diuretic (‘water pill’). Desmopressin is available as 0.1mg and 0.2mg tablets, 100mcg/ml nasal spray and 4mcg/ml injections.
Nephrogenic diabetes insipidus — Nephrogenic diabetes insipidus typically goes away after addressing the underlying causes, such as correcting the imbalance of calcium or potassium in the body. If such an approach is inadequate, thiazide diuretics (‘water pill’), either alone or combined with a non-steroidal anti-inflammatory drug (NSAIDs), can be given.
Dipsogenic diabetes insipidus — Scientists have not yet found an effective treatment for dipsogenic diabetes insipidus. Patients can try sucking on ice chips or sour candies to moisten their mouths and increase saliva flow, which may reduce the desire to drink. For a person who wakes multiple times at night to urinate because of dipsogenic diabetes insipidus, taking a small dose of desmopressin at bedtime may help. Initially, the doctor will monitor the patient’s blood sodium levels to prevent hyponatremia, or low sodium levels in the blood.
Gestational diabetes insipidus — Most pregnant women with gestational diabetes insipidus show mild symptoms, and the condition usually goes away after delivery. Nonetheless, the doctor can also prescribe desmopressin for women with gestational diabetes insipidus. An expecting mother’s placenta does not destroy desmopressin as it does antidiuretic hormone.
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Diabetes Insipidus. The Journal of Clinical Endocrinology & Metabolism [Internet]. 2013 [cited 8 August 2021];98(7):35A-36A. Available from: https://academic.oup.com/jcem/article/98/7/35A/2536725
Cover image credit: Photo by engin akyurt on Unsplash
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