Treatment for diabetes insipidus aims to reduce the amount of urine that your body produces. Depending on the type of diabetes insipidus you have, there are several ways of treating your condition and controlling your symptoms.
Treating cranial diabetes insipidus
If you have mild cranial diabetes insipidus, you may not need any medical treatment for your condition.
Cranial diabetes insipidus is considered to be mild if you produce approximately three to four 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 (specialist in hormone conditions) may advise you to drink a certain amount of water every day, usually at least 2.5 litres.
However, if your cranial diabetes insipidus is more severe, drinking water may not be enough to keep your symptoms under control. As your condition is due to a shortage of antidiuretic hormone (ADH), your GP or endocrinologist may prescribe a treatment that takes the place of ADH, known as desmopressin.
Desmopressin
Desmopressin is a manufactured version of ADH, and is more powerful than the ADH naturally produced by your body. It works just like natural ADH, stopping your kidneys producing urine when the level of water in your body is low.
Desmopressin is usually taken as a nasal spray called Desmospray, but you may also be prescribed desmopressin tablets known as DDAVP (which also comes as a nasal spray).
If you are prescribed a Desmospray or DDAVP nasal spray, you will need to spray it inside your nose once or twice a day, where it is quickly absorbed into your bloodstream.
If you are prescribed DDAVP 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 DDAVP tablets if you develop a cold that prevents you from using the nasal spray.
Desmopressin is very safe to use. There are very few side effects, but they can include:
- headache
- stomach pain
- nausea
- 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
- a dangerously low level of sodium (salt) in your blood (known as hyponatraemia)
Symptoms of hyponatraemia include:
- an unusually bad or prolonged headache
- confusion
- unexplained weight gain
- nausea
- vomiting
If you think you may have hyponatraemia, immediately stop taking the medication and call your GP for advice. If this is not possible, go to your local accident and emergency department.
Thiazide diuretics
Thiazide diuretics are a type of medication normally used to increase the flow of urine from the body, so their use may seem counterproductive in the treatment of diabetes insipidus.
However, they have the useful side effect of making the urine more concentrated (so it contains a high level of waste products).
For people with diabetes insipidus, the medication has a completely opposite effect to that which is normally expected. By increasing the concentration of the urine, the medication reduces the amount of urine passed from the body.
Side effects are uncommon but include:
- dizziness when standing
- indigestion
- skin becoming very sensitive
- erectile dysfunction (impotence)
This last side effect is usually temporary and should resolve itself if you stop taking the medication.
Non-steroidal anti-inflammatory drugs (NSAIDs)
For reasons that are still unclear, when used in combination with thiazide diuretics, the class of painkillers called non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce urine volume further.
However, long-term used of NSAIDs increases your risk of developing a peptic ulcer. See the Health A-Z topic on Peptic ulcers for more information.
Treating nephrogenic diabetes insipidus
If your nephrogenic diabetes insipidus is caused by taking a particular medication, such as lithium or tetracycline, your GP or endocrinologist may stop your treatment and suggest an alternative medication. Do not stop taking any medication unless you have been told to do so by a healthcare professional.
As nephrogenic diabetes insipidus results from your kidneys not responding to ADH, rather than a shortage of ADH, it cannot be treated with desmopressin. However, it is still important to drink plenty of water to avoid dehydration.
If your condition is mild, your GP or endocrinologist may suggest changing your diet so it is very low in salt and protein, which will help your kidneys produce less urine. This may mean eating less salt and less protein-rich food, such as processed foods, meat, eggs and nuts. Do not alter your diet without medical advice. Your GP or endocrinologist can advise you about which foods to cut down on.
If your nephrogenic diabetes insipidus is more severe, you may be prescribed a combination of thiazide diuretics and an NSAID to help reduce the amount of urine your kidneys produce.
