Diabetes Insipidus (DI): Symptoms, Causes, Diagnosis, and Treatment

Medically Reviewed by Jabeen Begum, MD on June 12, 2024
Written by Matthew Hoffman, MD, Angela McPhillips
9 min read

Diabetes insipidus is a rare condition that makes you have an intense thirst and causes your body to make a lot of colorless, odorless urine. Most people pee out 1 to 2 quarts a day, but people with diabetes insipidus can pee between 3 and 20 quarts a day. The main types of diabetes insipidus include central, nephrogenic, and pregnancy-related.

Central diabetes insipidus

You get this type when damage to your hypothalamus or pituitary gland affects how your body makes or releases a hormone called vasopressin. Vasopressin tells your kidneys to hold on to water, which makes your urine more concentrated. (Vasopressin is also called antidiuretic hormone or ADH.) If you have central diabetes insipidus, your kidneys remove too much fluid from your body, and you pee more. This damage can result from:

  • A tumor
  • A head injury
  • A blocked or bulging artery (aneurysm)
  • Diseases such as Langerhans cell histiocytosis
  • Infection
  • Inflammation
  • Surgery

Nephrogenic diabetes insipidus

You get this when your kidneys don’t respond to vasopressin and take too much fluid from your bloodstream. Doctors don’t always know why it happens, but some causes include:

Gestational diabetes insipidus

This is very rare. You get this type only during pregnancy. Sometimes, your placenta -- the organ that gives oxygen and nutrients to your baby -- makes an enzyme that breaks down vasopressin. Other pregnant people make more prostaglandin, a hormone-like chemical that makes their kidneys less sensitive to vasopressin. Most cases of gestational diabetes insipidus are mild and don’t cause clear symptoms. The condition usually goes away after birth, but it might come back in another pregnancy.

Symptoms include:

  • Severe thirst
  • Peeing more than 3 liters a day (your doctor might call this polyuria)
  • Getting up to pee a lot at night
  • Peeing in your sleep (bed-wetting)
  • Pale, colorless urine
  • Low urine concentration
  • Preference for cold drinks
  • Dehydration
  • Weakness
  • Muscle pains
  • Crankiness

With dehydration, you might notice:

  • Extreme thirst (often drinking more than 1 gallon of liquid per day)
  • Fatigue, or feeling extremely tired
  • Feeling sluggish
  • Dry mouth and lips
  • Dizziness
  • Confusion
  • Nausea
  • Fainting

Does diabetes insipidus cause weight loss?

Diabetes insipidus can cause weight loss, especially in infants and children. Severe thirst, a main symptom of this condition, can get in the way of a normal appetite. This means people with diabetes insipidus may eat less and not have the best nutrition, leading to weight loss in adults and slow growth in children.

Many of the symptoms are similar in younger people. In infants, watch for:

  • Crankiness
  • Slow growth
  • Poor feeding
  • Weight loss
  • Fever
  • Vomiting

In children, signs include:

  • Drinking a lot of water
  • Peeing often, sometimes every hour
  • New bed-wetting or waking up during the night to pee
  • Dehydration
  • Low energy

Your body makes a hormone called vasopressin in a part of your brain called the hypothalamus. Vasopressin is stored in your pituitary gland.

When you’re thirsty or a little dehydrated, your vasopressin levels go up. Your kidneys absorb more water and put out concentrated urine. If you’ve had enough to drink, vasopressin levels fall, and what comes out is clear and diluted.

When your body doesn’t make enough vasopressin, the condition is called central diabetes insipidus. Anyone can get this condition, but it's not common. Only about 1 in every 25,000 people get it.

If you make enough vasopressin, but your kidneys don’t respond to it the way they should, you have nephrogenic diabetes insipidus.

In either form, the result is the same. Your kidneys can't keep water, so they release a lot of pale urine even if you’re dehydrated.

Factors that raise your chances of having diabetes insipidus are:

  • Genetics. Changes in the genes that you inherit from your parents can make you more likely to get diabetes insipidus. This happens in 1%-2% of cases.
  • Medications. Certain medications, such as diuretics, can cause kidney problems and trouble making the right amount of urine.
  • Certain metabolic disorders. Conditions that cause high levels of calcium or low levels of potassium in your blood may lead to this condition.
  • Brain surgery or head injury. Changes in your brain from surgery or an injury may raise your risk.

Your doctor will do a physical exam. A checkup may not show any signs of central diabetes insipidus DI, except maybe an enlarged bladder or symptoms of dehydration.

They’ll ask questions about your health history, including your family’s health. You might get a series of tests that include:

  • Urinalysis. You’ll give a sample of your pee, and your doctor will send it to a lab to see whether it’s dilute or concentrated. They can also check for glucose (sugar), which can help them decide if you have diabetes insipidus or diabetes mellitus. You might need to collect your pee over a 24-hour period to measure the volume you pass in a day.
  • Blood test. There are a few different blood tests your doctor may order. These tests measure the electrolytes, glucose, and vasopressin levels in your blood. This lets your doctor know if you have diabetes mellitus or diabetes insipidus, and which type you have.
  • Water deprivation test. This measures the changes in your body weight, blood sodium, and urine concentration after you don’t drink anything for a while. There are two types: a short-form test that can be done at home and a formal test that is done in the hospital. During the long test, your doctor will closely measure your blood pressure, heart rate, and body weight. At the end of the test which usually lasts about 12 hours, your doctor will sometimes give you a dose of man-made vasopressin to help figure out which type of diabetes insipidus you have.
  • MRI. This test takes detailed pictures of your internal organs and soft tissues. The doctor uses it to see if there’s a problem with your hypothalamus or pituitary gland.
  • Genetic screening. Your doctor may suggest this test if your family members have had problems with making too much urine.

Diabetes insipidus vs. SIADH

Diabetes insipidus and the syndrome of inappropriate antidiuretic hormone secretion (SIADH) are conditions that cause trouble with your body’s water balance in different ways. Diabetes insipidus causes your body to let go of too much water, which means lots of trips to the bathroom. SIADH, on the other hand, causes your body to retain too much fluid. This extra fluid waters down your blood, causing electrolyte imbalances. Electrolytes are minerals in your body with a tiny electric charge. Sodium is an important electrolyte in your blood, and SIADH can lead to hyponatremia or low sodium levels.

Diabetes insipidus vs. diabetes mellitus

Despite having similar names, diabetes insipidus and diabetes mellitus are two different diseases. The only things they have in common are that they make you thirsty and make you pee a lot.

These conditions are caused by problems with different hormones.

If you have diabetes insipidus, the hormones that help your body balance liquids (vasopressin or ADH) don’t work. Only one in every 25,000 people gets this condition.

With diabetes mellitus (often shortened to “diabetes”), your body can’t use energy from food like it should. This is because there’s a problem with how your body makes or uses the insulin hormone. It’s far more common than diabetes insipidus. As of 2021, around 38.4 million Americans have type 1 or type 2 diabetes mellitus.

Diabetes insipidus that isn’t under control can make you more likely to have complications such as:

  • Dehydration. Diabetes insipidus makes it hard for your body to hold on to water. It’s easy to get dehydrated.
  • Electrolyte imbalance. When you lose too much water, your electrolyte levels can be abnormal. This might cause:
    • A headache
    • Feeling tired all the time (fatigue)
    • Irritability
    • Muscle pain
  • Less sleep. All those nighttime trips to the bathroom to pee disrupt your sleep, resulting in less restful nights.

How does diabetes insipidus affect pregnancy?

Gestational diabetes insipidus is a rare condition and symptoms usually don’t show up until the end of the second or third trimester. It might be tricky for your doctor to diagnose this condition because the main symptoms, extreme thirst and peeing a lot, are typical symptoms of late pregnancy. But in this case, these symptoms get worse over a few days or weeks. Without treatment, you might lose weight and feel extremely tired and nauseous. Your doctor will test your urine to see if you have this disorder, and if you do, you’ll be treated with medication. If you have gestational diabetes insipidus, you might be at risk of liver problems, so your doctor will monitor your liver closely.

First, your doctor will tell you to drink plenty of fluids. That will replace the constant loss of water. Other treatments depend on which type you have:

Central diabetes insipidus. You’ll take medications such as desmopressin (DDAVP). Desmopressin controls urine output, maintains fluid balance, and prevents dehydration. You take it two or three times a day. It usually comes as a nasal spray, tablet, or injection. There are also treatments to help these drugs work better.

Nephrogenic diabetes insipidus can be harder to treat. If it’s caused by a drug, stopping the medicine helps. Other medicines may ease symptoms. These include indomethacin (Indocin) and diuretics such as amiloride (Moduretic 5-50) or hydrochlorothiazide (Microzide). Though diuretics typically make you pee more, in this case, they help you make less urine. Sometimes, this condition goes away if you treat the cause.

Gestational diabetes insipidus. You can take desmopressin while you’re pregnant. Your problems should go away after you have the baby.

Is diabetes insipidus curable?

No. But the good news is that the condition is treatable. What’s more, certain types of diabetes insipidus are transient, which means the condition goes away on its own.

There are steps you can take to manage your symptoms and avoid complications. To stay healthy while living with diabetes insipidus, it’s important to:

  • Stay hydrated. Drinking plenty of fluids will help you avoid dehydration and electrolyte problems. Make sure you always have access to water by carrying a water bottle everywhere you go.
  • Wear a medical bracelet. A bracelet or medical alert card helps health care providers give you the right care if you have a medical emergency.
  • See your doctor. Regular visits to your doctor help them monitor your condition and make sure your treatment plan is working.

Diabetes insipidus doesn’t cause kidney failure or lead to dialysis. Your kidneys still do their main job, which is to filter your blood.

But you will be more prone to dehydration. Make sure you always have something to drink close by, especially when it’s hot or when you exercise. Carry your medication with you, and avoid situations where you can't get water. It's also a good idea to wear "medic alert" jewelry or keep a note with you about your condition so that health care workers know about it.

Diabetes insipidus is a condition that makes you very thirsty and causes you to pee a lot. It happens when your body doesn't produce enough of a hormone (vasopressin/ADH) that helps balance water or when your kidneys don't respond to this hormone. To manage it, drink plenty of water, take your prescribed medications, and keep an eye on your symptoms. Regular visits to your doctor are important to keep the condition under control.

Is diabetes insipidus a serious disease?

Diabetes insipidus is a serious disease that can be well managed with the right care. This includes avoiding dehydration by drinking plenty of fluids, taking your medication as prescribed, and regular visits to your doctor.

What deficiency causes diabetes insipidus?

A deficiency of the vasopressin hormone, also called antidiuretic hormone or ADH, causes diabetes insipidus.

What are type 1 and type 2 diabetes mellitus?

Type 1 and type 2 diabetes are caused by problems with how your body makes and uses the insulin hormone. Insulin is needed to change food into energy your body can use. Without enough insulin, you’ll have too much glucose, or sugar, in your blood which can make you really sick. If you have type 1 diabetes, your immune system attacks the cells that make insulin. Type 2 diabetes, the most common type, happens when your body doesn’t make enough insulin or your body doesn’t respond to it the right way, also called insulin resistance.