Diabetes.

Adelekan Oluwaseun Ojo.

This is a disorder of salt and water metabolism marked by intense thirst and heavy urination.

Diabetes insipidus occurs when the body can’t regulate how it handles fluids. The condition is caused by a hormonal abnormality and isn’t related to diabetes.

Causes

The 2 main symptoms of diabetes insipidus are often needing to pee a large amount of urine and feeling extremely thirsty.

If you have diabetes insipidus, you may pee pale, watery urine every 15 to 20 minutes.

The amount of urine can range from 3 litres in mild cases to up to 20 litres per day in severe cases.

It’s also likely that you’ll feel thirsty all the time and have a “dry” feeling that’s always present, no matter how much water you drink.

If you need to pee regularly and always feel thirsty, your sleeping patterns and daily activities may be disrupted.

This can cause tiredness, irritability and difficulty concentrating, which can affect your daily life further.

You may also feel generally unwell and “run down” much of the time for no apparent reason.

Symptoms in children

Excessive thirst can be difficult to recognise in children who are too young to speak.

Signs and symptoms that could suggest diabetes insipidus include:

*Excessive crying

*Irritability 

*Slower than expected growth

*High body temperature (hyperthermia)

*Unexplained weight loss 

In older children, symptoms of diabetes insipidus include:

wetting the bed (enuresis) – although most children who wet the bed do not have diabetes insipidus

loss of appetite

feeling tired all the time (fatigue)

CAUSES

Diabetes insipidus is caused by problems with a chemical called vasopressin (AVP), which is also known as antidiuretic hormone (ADH).

AVP is produced by the hypothalamus and stored in the pituitary gland until needed.

The hypothalamus is an area of the brain that controls mood and appetite.

The pituitary gland is located below your brain, behind the bridge of your nose.

AVP regulates the level of water in your body by controlling the amount of urine your kidneys produce.

When the level of water in your body decreases, your pituitary gland releases AVP to conserve water and stop the production of urine.

In diabetes insipidus, AVP fails to properly regulate your body’s level of water, and allows too much urine to be produced and passed from your body.

There are 2 main types of diabetes insipidus:

• Cranial diabetes insipidus – where the body does not produce enough AVP, so excessive amounts of water are lost in large amounts of urine
• Nephrogenic diabetes insipidus – where AVP is produced at the right levels, but, for a variety of reasons, the kidneys do not respond to it in the normal way.

CRANIAL DIABETES INSIPIDUS 

The 3 most common causes of cranial diabetes insipidus are:

a brain tumour that damages the hypothalamus or pituitary gland

a severe head injury that damages the hypothalamus or pituitary gland

complications that occur during brain or pituitary surgery

No cause can be found for about a third of all cases of cranial diabetes insipidus.

These cases, known as idiopathic, appear to be related to the immune system attacking the normal healthy cells producing AVP.

It’s unclear what causes the immune system to do this.

Less common causes of cranial diabetes insipidus include:

cancers that spread from another part of the body to the brain

Wolfram syndrome, a rare genetic disorder that also causes vision loss

brain damage caused by a sudden loss of oxygen, which can occur during a stroke or drowning

infections, such as meningitis and encephalitis, that can damage the brain. 

NEPHROGENIC DIABETES INSIPIDUS 

Your kidneys contain nephrons, which are tiny intricate structures that filter waste products from the blood and help produce urine

They also control how much water is reabsorbed into your body and how much is passed in the urine when you pee.

In a healthy person, AVP acts as a signal to the nephrons to reabsorb water into the body.

In nephrogenic diabetes insipidus, the nephrons in the kidneys are not able to respond to this signal, leading to excessive water loss in large amounts of urine.

Your thirst increases to try to balance this loss from the body.

Nephrogenic diabetes insipidus can be present at birth (congenital) or develop later in life as a result of an external factor (acquired).

Congenital nephrogenic diabetes insipidus

Two abnormal changes in genes that lead to them not working properly (genetic mutations) have been identified that cause congenital nephrogenic diabetes insipidus.

The first, known as the AVPR2 gene mutation, is responsible for 90% of all cases of congenital diabetes insipidus.

But it’s still rare, occurring in an estimated 1 in 250,000 births.

The AVPR2 gene mutation affects the X sex chromosome. Women have 2 X chromosomes, which means women with this gene mutation may have no symptoms, as usually only 1 of their X chromosomes is affected. Men have only 1 X chromosome, so men with this gene mutation are more likely to have symptoms.

The remaining 10% of cases of congenital nephrogenic diabetes insipidus are caused by the AQP2 gene mutation, which can affect both males and females.

Acquired nephrogenic diabetes insipidus

Lithium is the most common cause of acquired nephrogenic diabetes insipidus.

It’s a medication often used to treat bipolar disorder.

Long-term lithium use can damage the cells of the kidneys so they no longer respond to AVP.

Up to 2 in 5 people on long-term lithium therapy develop some degree of nephrogenic diabetes insipidus.

Stopping lithium treatment often restores normal kidney function, although in many cases the damage to the kidneys is permanent.

Because of these risks, it’s recommended that you have kidney function tests every 3 months if you’re taking lithium.

Other causes of acquired nephrogenic diabetes insipidus include:

• Hypercalcaemia – a condition where there’s too much calcium in the blood (high calcium levels can damage the kidneys)
• Hypokalemia – a condition where there’s not enough potassium in the blood (all the cells in the body, including kidney cells, require potassium to function properly)
• Pyelonephritis (kidney infection) – where the kidneys are damaged by an Infection 
• Ureteral obstruction – where 1 or both tubes that connect the kidneys to the bladder (ureters) become blocked by an object, such as a kidney stone, which damages the kidneys. 

TREATMENT

Treatments for diabetes insipidus aim to reduce the amount of urine your body produces.

Depending on the type of diabetes insipidus you have, there are several ways of treating your condition and controlling your symptoms.

Cranial diabetes insipidus

Mild cranial diabetes insipidus may not require any medical treatment.

Cranial diabetes insipidus is considered mild if you produce approximately 3 to 4 litres of urine over 24 hours.

If this is the case, you may be able to ease your symptoms by increasing the amount of water you drink to avoid dehydration.

Your GP or endocrinologist (a specialist in hormone conditions) may advise you to drink a certain amount of water every day, usually at least 2.5 litres.

But if you have more severe cranial diabetes insipidus, drinking water may not be enough to control your symptoms.

As your condition is caused by a shortage of vasopressin (AVP), your GP or endocrinologist may prescribe a treatment that takes the place of AVP, known as desmopressin.

Desmopressin

Desmopressin is a manufactured version of AVP that’s more powerful and more resistant to being broken down than the AVP naturally produced by your body.

It works just like natural AVP, stopping your kidneys producing urine when the level of water in your body is low.

Desmopressin can be taken as a nasal spray, in tablet form or as a form that melts in your mouth, between your gum and your lip.

If you’re prescribed desmopressin as a nasal spray, you’ll need to spray it inside your nose once or twice a day, where it’s quickly absorbed into your bloodstream.

If you’re prescribed desmopressin tablets, you may need to take them more than twice a day.

This is because desmopressin is absorbed into your blood less effectively through your stomach than through your nasal passages, so you need to take more to have the same effect.

Your GP or endocrinologist may suggest switching your treatment to tablets if you develop a cold that prevents you using the nasal spray.

Desmopressin is very safe to use and has few side effects.

But possible side effects can include:

*Headache

*Stomach pain

*Feeling sick

*A blocked or runny nose

*Nosebleeds.

If you take too much desmopressin or drink too much fluid while taking it, it can cause your body to retain too much water.

This can result in:

headaches

dizziness

feeling bloated

hyponatraemia – a low level of sodium (salt) in your blood

Symptoms of hyponatraemia include:

a severe or prolonged headache

confusion

feeling sick (nausea) and vomiting

If you think you may have hyponatraemia, stop taking desmopressin immediately and call your GP for advice.

Nephrogenic diabetes insipidus

If you have nephrogenic diabetes insipidus that’s caused by taking a particular medication, such as lithium or tetracycline, your GP or endocrinologist may stop your treatment and suggest an alternative medication.

But do not stop taking it unless you have been advised to by a healthcare professional.

As nephrogenic diabetes insipidus is caused by your kidneys not responding to AVP, rather than a shortage of AVP, it usually cannot be treated with desmopressin.

But it’s still important to drink plenty of water to avoid dehydration.

If your condition is mild, your GP or endocrinologist may suggest reducing the amount of salt and protein in your diet, which will help your kidneys produce less urine.

This may mean eating less salt and protein-rich food, such as processed foods, meat, eggs and nuts.

Do not alter your diet without first seeking medical advice.

Your GP or endocrinologist will be able to advise you about which foods to cut down on.

Thiazide diuretics

Thiazide diuretics can reduce the rate the kidneys filter blood, which reduces the amount of urine passed from the body over time.

Side effects are uncommon, but include:

dizziness when standing

indigestion

very sensitive skin

erectile dysfunction (impotence) in men 

This last side effect is usually temporary and should resolve itself if you stop taking the medication.

Non-steroidal anti-inflammatory drugs (NSAIDs)

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce urine volume further when they’re used in combination with thiazide diuretics.

But long-term use of NSAIDs increases your risk of developing a stomach ulcer.

To counter this increased risk, an additional medication called a proton pump inhibitor (PPI) may be prescribed.

PPIs help protect your stomach lining against the harmful effects of NSAIDs, reducing the risk of ulcers forming.

However, JIGSIMUR is a 100% natural remedy to this ailment. Take 15mls morning and night.

………Adelekan   Oluwaseun Ojo, is a counseling psychologist, and a business & health consultant with Jigsimur Zdex Int’l, a company which is into the production and distribution of Jigsimur herbal health drink, a natural curative and preventive herbal medicine from South Africa.

For personal consultation, you can contact us on 07089225319 or 08035122399