What is diabetes insipidus?

What is diabetes insipidus?

 and why do we get it?

Diabetes  insipidus is caused by one of the problems with the production, or processing, of the hormone vasopressin (AVP). If you have it your kidneys are unable to retain water. It produces large amounts of urine and consequently increases thirst.  Diabetes insipidus can occur at any age but  it is most commonly found in adults. This is a rare disorder affecting only 1 in 25,000 people.

To understand  diabetes insipidus, we need to understand a little bit about how the body regulates water balance , how much water the body takes and how much it discharges. Water balance is very important for the body. A large part of who we are is made of water. In addition, the amount of water we have in our circulation is a major factor in determining the balance of salt in our body. As with any other important function, the body has a sensitive mechanism for regulating water balance. As with any good mechanism it is as simple as the two main components.

One is vasopressin (AVP or ADH - antidiuretic hormone) . This regulates the amount of water released from the body in the urine, thirst thirst and drinking  that determines body water content.

AVP (sometimes called an antihypertensive hormone or ADH) is a hormone that is released from the majority of the pituitary gland (posterior pituitary). The gland is located at the base of the brain, and is 3 to 5 cm behind the bridge of the nose. AVP circulates in the bloodstream and works to reduce the amount of water in the kidneys that is excreted in the urine.

 AVPs and thirsts work together with imitation of bathtubs Just like a bathtub, the body likes to maintain the water level at the right level for its purposes. There are only two ways to change the water level:

Water can be inserted into the bath by flushing the taps. Alcohol can cause excess water in the body.

The plug can be drained out of the bath. Just as the body can reduce the amount of AVP and allow more water to go out and so does more water like urine.

Unlike the bathtub, the body is very good at sensing the level of water it absorbs. If it does not have enough and is dehydrated, it stimulates us to drink more by activating thirst (flushing taps). At the same time, it does more AVP and thus reduces urine dehydration (it plugs in). On the other hand, if the body senses that the water level is too high, it clears the thirst (closes the taps) and reduces the AVP (removing the plug from the plug hole). Therefore, the water level is maintained through a common approach.

In both cases, AVP and thirst maintain water balance very effectively, where water is easy to find, or scarce. DI occurs when this method of adjusting the water balance is broken.

 Forms of diabetes insipidus

1. Cranial Diabetes Insipidus (CDI)

CDI is due to partial or complete reduction of AVP. Lack of AVP means that the kidneys cannot maintain the amount of water the body needs, and produce a large amount of urine. Therefore, the body relies on only one of its two methods to keep the amount of water in the body at the right level, thirst and drink. People with CDI are thirsty all the time. They often pass urine frequently during the day and often have to pass urine several times at night.

Sometimes CDI is itself and in many cases, it is accompanied by the loss of other hormones produced by the pituitary. This may be due to a problem with pituitary gland development. Tumors within or near the gland. Or the result of an accident, or near or near surgery, glandular

CDI may be temporary after pituitary surgery, lasting only a week or two. In some cases it can be permanent.

2. Nephrogenic Diabetes Inspections (NDI)

NDI is a condition in which the kidneys do not respond to common signals (AVPs) to reduce water loss. In this way, the kidneys cannot absorb the water passing through them.

The main symptoms of NDI are polyuria (excessive urination) and polydipsia (excessive thirst and alcoholism).

Hereditary NDI may appear in the first weeks of life. Symptoms may include irritability, failure to thrive, loss of appetite and vomiting. Investigations may reveal blood levels of sodium. 90% of inherited NDI cases are the result of mutations affecting the AVP-receptor (V2R) that is required for the kidney to respond to AVP and ribsorb water. The remaining cases are the result of a change in the pore through the kidney cells through which water is re-absorbed (AQP2). Although each type of inherited NDI has different genetic causes, the symptoms of each are similar.

Men are most likely to show symptoms of X-linked NDI, while men and women are more likely to show symptoms of NDI spontaneously. This is because the V2R gene carries over the X chromosome and only one X chromosome in men. Gene disturbances on the same X chromosome cannot be balanced by any other common X chromosome (position in women). Autosomal recessive NDI runs on non-sex chromosomes, so men and women have to inherit this problem equally.

Obtained NDIN is a common form of NDI and can occur at any time of life. Most often, the NDI obtained is the result of drug lithium use. The NDI obtained can also be from the use of other drugs, such as colchicine, methoxyflurane, amphotericin B, corticosterone, loop diuretics, and hemocyanin. It can also be a result of certain illnesses and physical conditions, which can result in permanent or temporary NDI such as:

Kidney chronic kidney failure

kidney Other kidney diseases

غیر Abnormal levels of potassium

۔ Abnormally high levels of calcium

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• And rarely, during pregnancy

Treatment of NDI

There is no cure for inherited NDI. Currently, NDI is managed by:

to ensure ready access to water

Follow a low sodium (and sometimes low protein) diet, and

th To reduce urine volume, use of thiazide diuretics, alone or with prostaglandin inhibitor or potassium sparing diuretic.

Thiazide diuretics screen reduces the poliovirus of an NDI patient, but it can also eliminate the body's potassium stores. This deficiency can cause other symptoms and can be dangerous. When taking thiazide diverticles, the patient's potassium levels need to be monitored. In order to maintain proper potassium in the body, treatment may require the addition of potassium supplements or amiloride (but not both) to therapeutics.

DI diabetes is not related to mellitus

It is important to mention that DI is not related to the type of diabetes that most people have heard of - diabetes mellitus, which is very common and can cause symptoms of excessive urination and thirst. ۔ In DI, there is no problem with blood sugar or urine levels. This is important because friends, relatives and health care workers can speculate on your condition, which is normal.

 Symptoms of  diabetes insipidus

The main symptoms you will notice are thirst (no matter how much you drink) and need to pass urine frequently, even at night. You will move large amounts of urine; you can urinate up to 4 - 10 liters a day. It is important that you do not try to stop your thirst and drink less, or you will disturb the balance of water in your body.

You may have good symptoms of dehydration, for example, tremor and nausea due to headache. People with DI have reported that their excessive thirst can be compared to eating 4 or 5 dry cream crackers one after another without any drinks.

Most patients have a thirst procedure, but some patients do not. This is called HYPODipsia. The combination of DI and hypodipsia is unusual and requires special attention from patients, caregivers and doctors.

 Diagnosis of  diabetes insipidus

What tests are done and how will they feel?

Here are the ways to diagnose patients with excessive urine output.

 Measurement of plasma osmolality from blood tests (a measure of sodium and glucose in the blood)

• Water Deprivation Test (described below)

des desmopressin therapy (DDAVP®)

Water deprivation test leaves you with fluid for 6-8 hours to see if there is any decrease in urine volume. You can expect to feel thirsty during this exam. The next step is to give you a small amount of desmopressin, usually as an injection. If you have a CDI, you should notice a decrease in urine volume. This shows that your kidney is responding to the hormone.

If you have NDI, this reaction does not appear or worsen, as the kidneys do not recognize the hormone effect in small amounts. Once you are allowed to drink alcohol again you will start to feel better. If you need other hormone treatments, you need to continue with them during the test. This test can be performed like a one-day affair.

 Treatment of diabetes insipidus

CDI is treated with a drug such as AVP called desmopressin or DDAVP. These medicines typically act like natural AVPs on similar kidneys, though they are longer than natural AVPs because they are more resistant to defects.

Different preparations are available, each given by a different route: injections, nasal drops, nasal sprays, swallowing and swallowing pills, or oral lyophilisates (wafers that melt in the mouth). All are working and it is a matter of finding the best match for everyone based on preference and lifestyle. Sprays and pills are a popular choice. Depending on the severity of DI, it is usually taken 1 to 3 times a day. Some people have to take the medicine 4 times a day. Dosage varies among people, partly based on the degree of their symptoms. An ideal goal is to have patients take 2 liters of urine in 24 hours while they take their dystopian. A good test of fluid level management is to weigh yourself every morning. Different body weights on a daily basis, can help you monitor fluid balance when you start treatment. Remember that 1 liter of water weighs 1 kg.

There are very few side effects of the treatment. People who use nasal sprays when they have severe diarrhea may experience some difficulties working with the drug. Some people, who use pills, work less when they have a stomach upset. Some people may suffer from anxiety if the balance in treatment means they are consuming more water than going out. This can lead to a gradual development of water overload and decrease sodium levels in the bloodstream (hypotension). Re-balancing focuses on better resolution of the treatment, which shows how much desmopressin is given and how much fluid is taken into it. When you take desmopressin, you will gradually feel better. Overall, treating DI is straightforward, but if you are having difficulty controlling your DI, please talk to your endocrinologist.

Please note that however, according to DDAVP-Melt-like preparations, Desmo Melte is the product name for children or adults with aneurysms, not diabetes diabetes.

General versions of desmopressin It has come to our notice that generic alternatives to the DDAVP پی range of diabetic inspiration are available. These common anti-diabetic 9 post-treatment alternatives may present some differences in patients compared to their usual DDAVP brand, especially for those who are not thirsty, Or for children.

Adults with DI may find that they break first, (with more thirst and urine output) or maybe later (with less thirst and urine output) than take desmopressin and stabilize.