Diabetes insipidus is an entirely different disorder than diabetes mellitus, or "sugar diabetes." Diabetes insipidus occurs in patients with pituitary disease, such as a pituitary tumor, or recent surgery to the pituitary gland, and in patients with disease of the hypothalamus and pituitary stalk. Diabetes insipidus results from an inadequate secretion of vasopressin or ADH from the back part of the pituitary. Vasopressin is made and stored in the hypothalamus. It then travels through the stalk to the posterior part of the pituitary where it is stored for release into the bloodstream when needed.
Symptoms
The main purpose of vasopressin is to acts on the kidneys to hold onto any water in the body to prevent dehydration. If you have an inability to release this hormone when needed, then you will urinate very frequently, sometimes as often as every 15 minutes. Your urine will also be very clear, like water. Because your body is getting rid of so much water you will also become very thirsty. Most people are so thirsty that they will drink enough water to keep up with all of the water they are urinating, and therefore will not become dehydrated. The frequent thirst and urination as a result of this disorder is not only uncomfortable, but also inconvenient.
Treatment
The medication used to treat this disorder is called desmopressin acetate (DDAVP). DDAVP is manufactured to be very similar to the hormone vasopressin that is naturally produced by your body. DDAVP comes in several forms and your doctor will work with you to prescribe the one that works best for you. These different forms are:
1. Nasal Spray: This is a non-refrigerated medication that you squirt into your nostril. A dose is usually taken at bedtime so that you may sleep through the night uninterrupted. Some people also require a dose during the day.
2. Rhinal Tube Solution: This form has to be stored in the refrigerator at all times. This method uses a small tube to deliver very precise doses of medication into your nose. Though the medication can be more difficult to deliver through the rhinal tube, this form has the advantage of allowing one to administer varying doses of the medication. Therefore, it would be more helpful to someone who has a varying daily schedule or who only needs very small doses of the medication. Both this form and the nasal spray are delivered into your nostril for very rapid absorption into the bloodstream. It is helpful to clean the nose with a tissue before delivering the medication to allow for more reliable absorption.
3. Pills: Pills are a very convenient way to deliver any medication. However, these have a delayed onset of action, and you will not feel your thirst go away as quickly as you would by taking the spray or rhinal tube. Additionally, the pill forms are often not quite as effective in controlling symptoms in some patients.
It is very important to know how to dose your DDAVP, no matter which form of the medication you choose. Most people take a dose at beditme so that they sleep through the night comfortably. You may find that you sometimes need a dose during the daytime to control your symptoms, and sometimes you do not. You may also find that your needs change if you become ill, particularly if you have a stuffy nose, when the DDAVP spray may not be absorbed as well.
You do not have to take the DDAVP every day at the same time. In fact, you should not take it unless you need it. You will know that you need a dose of your DDAVP because: 1) you will urinate much more frequently 2) your urine will be clear like water and 3) you will become thirsty. Taking too much DDAVP or taking it when you do not really need it can lead to your body holding onto too much water and a condition called hyponatremia. This condition can also result from the ingestion of large amounts of fluids (beer, water for diet purposes) while taking DDAVP. Hyponatremia can be quite dangerous and even life-threatening. Warning signs of this disorder include decreased thirst and urination, headache, nausea, fatigue, and confusion.
You will easily learn how to dose your DDAVP correctly. It is important that you use the medication so that you are comfortable and so that diabetes insipidus does not interfere with your life. At the same time you should also be aware of the dangers and warning signs of taking too much DDAVP. If you feel that your symptoms are not being controlled or if you are experiencing some of the warning signs of hyponatremia, it is very important that you contact your physician so that any necessary treatments and adjustments can be made. Our goal is that your disorder be adequately treated such that you are able to lead as normal and healthy of a life as possible.