Diabetes Insipidus Treatment

By Dr Ananya Mandal, MD

Diabetes insipidus treatment depends on the type and therefore pathology of the condition. For example, treatment of cranial or central diabetes insipidus aims at correcting deficient levels of the fluid regulator antidiuretic hormone (ADH) or vasopressin. Among those who have the nephrogenic form of disease however, ADH levels are normal and treatment is aimed at reducing diuresis or loss of excess water from the body.

Treatment

The general outline for treating diabetes insipidus is given below:

Treatment of cranial diabetes insipidus

  • Mild cases of cranial diabetes insipidus do not usually require any medical treatment and patients are usually advised to drink more water to compensate for the water loss. Diabetes insipidus is considered mild if around 3 to 4 litres of urine is passed every 24 hours.
  • In more severe cases, the deficient ADH or vasopressin may be replaced by a synthetic substitute called desmopressin.
  • Desmopressin is used most widely in the form of a nasal spray that is used once or twice a day. Also available is a tablet form of the drug but this may need to be taken more than twice a day since absorption of the tablet form is less effective than with the nasal spray. The side effects of desmopressin are usually mild and include a blocked or runny nose, stomach ache, headache, and nosebleed. However, a combination of excessive water intake along with the use of desmopressin can cause low sodium levels in the blood, a condition called hyponatremia.
  • Thiazide diuretics are a form of medication that is commonly used to treat water retention and increase the passage of water in urine. However, in patients with diabetes insipidus, the drug raises the concentration of urine and reduces the amount of urine passed from the body.
  • Non-steroidal anti-inflammatory drugs and in particular ibuprofen are commonly used along with thiazide diuretics to help reduce the amount of urine.

Treatment of nephrogenic diabetes insipidus

  • In mild cases, diet is modified so that it contains very low amounts of salt and protein. This helps the kidneys produce less urine.
  • In more severe cases, a combination of thiazide diuretics and an NSAID is used to reduce the amount of urine formation.
  • People with nephrogenic diabetes insipidus are advised to drink plenty of water to prevent dehydration.
  • Sometimes the nephrogenic form of diabetes insipidus is drug induced, through the use of lithium for example, which can decrease the expression of water channels called aquaporins in the kidneys. In these cases, stopping the drug may prevent disease progression. However, the cessation of the drug needs to be medically supervised.
  • Desmopressin cannot be used to treat these patients.

Reviewed by Sally Robertson, BSc

Sources

  1. http://www.nhs.uk/conditions/diabetes-insipidus/Pages/Introduction.aspx
  2. http://www.cc.nih.gov/ccc/patient_education/pepubs/di.pdf
  3. http://www.bsped.org.uk/patients/docs/DIABETES_INSIPIDUS.pdf
  4. http://www.ccjm.org/content/73/1/65.full.pdf+html
  5. http://www.apeg.org.au/Portals/0/hormonesme4_diabetesinsipidus.pdf
  6. http://www.omicsonline.org/2155-6156/2155-6156-S8-001.pdf

Further Reading

Last Updated: Oct 25, 2013

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