What Is the Main Idea?

Diabetes insipidus is a relatively rare condition but one worthy of awareness. This post describes the condition, how you would know if you might have it, and why it perhaps shouldn’t be called diabetes. The article “Changing the Name of Diabetes Insipidus: A Position Statement of the Working Group to Consider Renaming Diabetes Insipidus”, published in the journal Hormone Research in Paediatrics, may seem like an odd choice but it goes into an essential topic for healthcare workers and patients: The name of a disease carries weight.

What Else Can You Learn?

This post also talks about urination: a topic we might not love to discuss, but should know more about!

How Often Do People Urinate?

Our toilet habits are rarely a topic of casual conversation, which makes it all the more important to know the fundamentals. The average adult urinates (goes for a pee) 5 to 7 times and the average pre-teen 7 to 10 times in a 24-hour period. If an adult needs to urinate more than 7 times a day or a child more than 10 times a day, they should see a doctor. While there are healthy adults who urinate over 7 times per day, it’s still best to check: It might be nothing, but it might be a sign of something serious.

The amount of urine we produce is definitely not something we know off-hand. It’s easy to find the average amount online. You’ll find the values for an adult 0.8 to 2 liters per day, with less than 0.72 liters or more than 2.5 liters being cause for serious concern. This is translated to somewhere between 120 and 400 ml (or up to 2 cups) per restroom visit for an adult. Why is there such a range in the values of urine production? Because it depends on how much you drink, what you drink, and even what you eat.

Regarding drinking liquids: There is plenty of advice online on how much you should drink, but it’s also important to listen to your body. If you’re thirsty, you should drink. You’ll need more liquids in a dry environment, if you’re exercising, if you’re eating a lot of dry foods, if you have bowel problems, and in many other situations, but your body should let you know. That said, if you find yourself thirsty all the time, even directly after drinking, there may be something wrong.

The values of urine production for children change considerably as they grow up. Therefore, it’s best to talk to a pediatrician or to get a chart showing the ranges for various ages if you’re concerned about a child.

When Should I Ask a Doctor about Urination?

Summing up this information, if you are always thirsty, you urinate more than 7 times a day, and you pass small amounts of urine frequently or very large volumes every time, you should see a doctor. Among other possibilities, these could be symptoms of circulation or kidney problems, diabetes type 1 or 2, or a condition currently called diabetes insipidus.

What Is Diabetes Insipidus?

Diabetes insipidus is not actually related to diabetes type 1 or 2: It has nothing to do with glucose or insulin. It is a rare condition (affecting 1 in 25,000 people) that more commonly develops in adults but can also be seen in children and adolescents. Its main symptoms are polyuria (frequent urination) and polydipsia (frequent drinking). There are two known causes of the disorder: deficiency of a hormone called arginine vasopressin (AVP; sometimes called anti-diuretic hormone, ADH); or resistance to AVP’s actions.

What Is Arginine Vasopressin?

AVP is produced in the hypothalamus and stored in the pituitary gland. When the body’s water levels reduce too much, AVP should be released from the pituitary gland to stop water loss by causing the kidneys to produce a less diluted urine. You can see this in the change of color in your urine — when you’re fully hydrated, it can even be clear, but as you become dehydrated, it gets yellower until it is almost orange in hue.

In the first form of diabetes insipidus, the hypothalamus does not produce AVP. Since the hypothalamus is in the brain, this type of diabetes insipidus is sometimes referred to as central or having a central origin. In the second form, the hormone is produced but the kidneys do not respond to it. Thus, this type is sometimes referred to as nephrogenic.

Why Is It Called Diabetes If It Isn’t Related to Diabetes?

As outlined in “Changing the Name of Diabetes Insipidus: A Position Statement of the Working Group to Consider Renaming Diabetes Insipidus”, the three conditions now known as diabetes type 1, diabetes type 2, and diabetes insipidus were not always recognized as separate. The word diabetes comes from Greek and was related to the meanings “passing through” and “siphon”; the sense of the term as a diagnosis was that patients passed urine like water through a siphon. The history of discoveries about the three conditions is well described in the chapter titled “Historical Context”, so I won’t repeat it here. It’s well worth a read!

In the past 70 years, the discoveries were made that clearly differentiated the two forms of diabetes insipidus from types 1 and 2. However, the name remained the same but, as discussed in the chapter titled “Rationale for Changing the Name of Diabetes Insipidus”, the confusion caused by the umbrella term “diabetes” could even lead to mismanagement of the patient’s condition.

What Are the New Names Proposed?

The paper presents the name arginine vasopressin deficiency (AVP-D) for the form where AVP is not produced in the hypothalamus. It gives arginine vasopressin resistance (AVP-R) for the nephrogenic form. These descriptive names have been endorsed by multiple endocrinology experts and organizations, so it is a strong possibility that the name change will happen.

What’s in a Name and Why Should We Care?

The name of a condition or disease carries weight. As mentioned above, the confusion between diabetes insipidus and diabetes type 1 or 2 led to mismanagement of the condition. Focusing on glucose and insulin when they’re not involved is not just pointless, it’s dangerous. When the medical community or the broader populace adopt a name for a condition, it should be clear and relevant. Diabetes is too strongly connected with glucose and insulin, so I would also back this name change — not that anyone is asking me!

If you are diagnosed with diabetes insipidus or undergoing diagnosis for its symptoms, be sure that you, your family, and the healthcare professionals you work with understand this difference. It’s essential for your well-being. Don’t get tripped up on a name.

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