The nurse is speaking to a client who takes desmopressin nasal spray for diabetes insipidus

Diabetes inspidus (DI) is a decrease in vasopressin, a hormone made by the pituitary gland, which controls the making of urine. Lack of this hormone causes increased urination and may lead to high body sodium levels. If DI is not treated, dehydration and seizures may occur.

DI may be caused by a brain tumor or injury, but many times the cause is unknown.

Desmopressin  (DDAVP®) is a synthetic form of vasopressin. It works on the kidneys to help decrease the amount of urine made.

How is the medicine given?

DDAVP can be given by mouth, into the nose, or into a vein (IV). It may be given in the hospital, clinic, or home.

Your doctor will explain how much DDAVP to give and how often to give it. Give the medicine at regular times to keep a steady level in the bloodstream.

___ Giving DDAVP by mouth

For children who cannot swallow pills:

1. Crush the tablet between 2 spoons, inside a plastic bag, or in folded paper.
2. Mix the powder with a very small amount of soft food, such as applesauce, chocolate syrup, ice cream, jelly, or yogurt.

___ Giving DDAVP into the nose

1. Make sure you have the correct DDAVP solution.
   
   • If your prescription is for DDVAP given by a special nasal tube system, the concentration should be 100mcg in each 1 ml of medicine.
   • If your prescription is for DDVAP nose spray, the concentration of the medicine should be 10 mcg in each spray.
   • Do not use the more concentrated nose spray called Stimate®. It has a different purpose.
2. Read the patient instruction guide for DDAVP before giving it.
3. If possible, children should blow their nose to clear out any mucus before receiving DDAVP. (If your child cannot do this, bulb-suction mucus out of the nose.)

___ Using the tube system

1. If this is the first time you open a bottle, pull the security seal off of the bottle's neck.
   
   
2. Remove the plastic cap.
   
   
3. Twist off the small seal from the dropper and set aside. Do not throw it away.
   
   
4. Measure the exact amount of medicine into the nasal tube:
   
   • Hold the arrow-marked part of the tube in one hand and the end of the dropper bottle in the other hand.
   • Insert the tip of the dropper into the end of the tube and hold the tube lower than the dropper tip.
     
     
   • Squeeze the dropper steadily until the medicine reaches the dose mark. Do not start and stop the squeezing, to prevent air bubbles.
5. Tilt the child's head back and gently insert the arrow-marked end of the tube into the nose.
   
   
6. Place the other end of the tube in your mouth and give a short, strong puff of air into the tube to give the medicine into
   the nose.
7. Tell the child to sniff in (if able) as the medicine is put into the nose.
8. Older children can be taught to blow their own medicine into their nose.
   
   
9. Put the small seal back on the dropper tip to prevent leaking. Put the plastic cap on the bottle.
   
   
10. Wash the tube with water and shake well, until no more water is left. If the markings become faint, darken them with a permanent marker.

___ Using the nose spray

1. Before using the medicine the first time, prime it by spraying into the air 4 times. If it has not been used for a week or more, prime it again by spraying once.
2. Give the prescribed number of sprays.
3. Tell the child to sniff in (if able) as the medicine is sprayed into the nose.
4. Rinse the spray tip with hot water and dry with a clean cloth or tissue.

Other instructions:

Are there any precautions for my child's diet?

The doctor or nurse will give you specific instructions if fluids need to be restricted. There are no restrictions for solid foods.

What should I do if a dose is missed?

___ If the usual dose is once a day, give the missed dose as soon as possible. Then go back to your normal dosing schedule. If you do not remember until the next day, skip the missed dose and go back to your regular dosing schedule. Do not give two doses in the same day unless instructed.

___ If the usual dose is more than once a day, give the missed dose as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Never give a double dose.

If you have any questions on how to make up a missed dose, please call the doctor.

What are the side effects?

Common

• fluid retention
• redness and warmth in face

Occasional

• runny or stuffy nose
• headache
• nausea (upset stomach)
• dizziness
• increased heart rate
• pain, redness, or swelling at the IV site (if given IV)

Rare

• slight increase or decrease in blood pressure
• blood clots in undesired areas
• seizure

When should I call the doctor?

• headaches or other pain not relieved by acetaminophen (such as Tylenol®)
• irritation or bleeding in the nose (if using the nose solution)
• faster heart rate
• rapid weight gain
• dizziness
• vision problems
• confusion
• seizures
• signs of an allergic reaction:
  
  • fever or chills
  • rash or hives
  • wheezing
  • trouble breathing - call 911

What else do I need to know?

DDAVP should not be used by any patient who has heart problems or who has ever had a blood clot.

If you are using the spray, check the bottle for the number of sprays it contains. After that number of sprays, throw the bottle away (even if there is still some liquid in the bottle). The patient instruction sheet that comes with it tells you how to keep track of the number of sprays.

Always make sure you have enough medicine on hand. Each time you refill your prescription, check to see how many refills are left. If no refills are left, the pharmacist will need 2 or 3 days to contact the doctor to renew the prescription.

Before giving the first dose, read the label. Be sure it is what was prescribed. After a refill, if the medicine looks different to you, ask your pharmacist about it before giving it.

Check the label for the expiration date. Flush outdated medicines down the toilet instead of putting them in the garbage.

It is best to store this medicine in the refrigerator, as far from children's reach as possible. Do not let it freeze. Closed bottles are good for up to 3 weeks at room temperature (68º to 77º F or 20º to 25º C).

If too much or the wrong kind of medicine is taken, call the doctor right away.

Questions?

This is not specific to your child but provides general information. If you have any questions, please call the doctor or pharmacist.

Last reviewed by Children's pharmacy 8/2015

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What is diabetes insipidus?

Diabetes insipidus is a rare disorder that causes the body to make too much urine. While most people make 1 to 3 quarts of urine a day, people with diabetes insipidus can make up to 20 quarts of urine a day. People with this disorder need to urinate frequently, called polyuria. They may also feel thirsty all the time and drink lots of liquids, a condition called polydipsia.

Are diabetes insipidus and diabetes mellitus the same?

Diabetes insipidus is not the same as diabetes mellitus. Although both conditions can increase thirst, intake of liquids, and urination, they are not related.

• In diabetes mellitus, the level of glucose in your blood, also called blood sugar, is too high. Your kidneys try to remove the extra glucose by passing it in your urine.
• In diabetes insipidus, your blood glucose levels are normal, but your kidneys can’t properly concentrate urine.

How common is diabetes insipidus?

Diabetes insipidus is rare, affecting about 1 in 25,000 people worldwide.1

Who is more likely to have diabetes insipidus?

People of all ages can develop diabetes insipidus. You are more likely to develop the condition if you1,2

• have a family history of diabetes insipidus
• had brain surgery or a major head injury
• take medicines that can cause kidney problems, including some bipolar disorder medicines and diuretics
• have metabolic disorders (high blood calcium or low blood potassium levels)

What are the complications of diabetes insipidus?

The main complication of diabetes insipidus is dehydration, which happens when your body loses too much fluid and electrolytes to work properly. If you have diabetes insipidus, you can usually make up for the large amount of fluids you pass in your urine by drinking more liquids. But if you don’t, you could quickly become dehydrated.

Symptoms of dehydration may include

• thirst
• dry mouth
• feeling dizzy or light-headed when standing
• feeling tired
• difficulty performing simple mental tasks
• nausea
• fainting

Seek care right away

Severe dehydration can lead to seizures, permanent brain damage, and even death. Seek care right away if you feel

What are the symptoms of diabetes insipidus?

The main symptoms of diabetes insipidus are

• needing to urinate often, both day and night
• passing large amounts of light-colored urine each time you urinate
• feeling very thirsty and drinking liquids very often

People with diabetes insipidus often feel thirsty all the time and drink lots of liquids.

What causes diabetes insipidus?

Diabetes insipidus is usually caused by problems with a hormone called vasopressin that helps your kidneys balance the amount of fluid in your body. Problems with a part of your brain that controls thirst can also cause diabetes insipidus. Specific causes vary among the four types of diabetes insipidus: central, nephrogenic, dipsogenic, and gestational.2

Central diabetes insipidus

In central diabetes insipidus, your body doesn’t make enough vasopressin, also called “antidiuretic hormone.” Vasopressin is produced in your hypothalamus, a small area of your brain near the pituitary gland. When the amount of fluids in your body falls too low, the pituitary gland releases vasopressin into your bloodstream. The hormone signals your kidneys to conserve fluids by pulling fluids from your urine and returning fluid to your bloodstream. But if your body can’t make enough vasopressin, the fluid may get flushed out in your urine instead.

Causes of central diabetes insipidus include

Nephrogenic diabetes insipidus

In nephrogenic diabetes insipidus, your body makes enough vasopressin but your kidneys don’t respond to the hormone as they should. As a result, too much fluid gets flushed out in your urine. Causes include

Dipsogenic diabetes insipidus

In this type of diabetes insipidus, a problem with your hypothalamus causes you to feel thirsty and drink more liquids. As a result, you may need to urinate often. Causes include

• damage to your hypothalamus from surgery, infection, inflammation, a tumor, or a head injury
• some medicines or mental health problems

Gestational diabetes insipidus

Gestational diabetes insipidus is a rare, temporary condition that can develop during pregnancy. This type of diabetes insipidus occurs when the mother’s placenta makes too much of an enzyme that breaks down her vasopressin. Women who are pregnant with more than one baby are more likely to develop the condition because they have more placental tissue.3 Because the liver plays a role in curbing the enzyme that breaks down vasopressin, diseases and conditions that affect liver function also increase risk. Examples include preeclampsia and HELLP syndrome.

How do health care professionals diagnose diabetes insipidus?

Your health care professional will do a physical exam and ask questions about your health history, including your family’s health. Other tests and procedures may include

• Urinalysis. A urinalysis can show if your urine is too diluted, or watery. It can also show if the level of glucose in your blood is too high, which is caused by diabetes mellitus, not diabetes insipidus.
• Blood tests. A blood test can measure sodium levels and the amount of certain substances in your blood, which can help diagnose diabetes insipidus and, in some cases, determine the type.
• Water deprivation test. This test can help health care professionals diagnose diabetes insipidus and identify its cause. The test involves not drinking any liquids for several hours. A health care professional will measure how much urine you pass, check your weight, and monitor changes in your blood and urine. In some cases, the health care professional may give you a man-made version of vasopressin or other medicines during the test.
• Magnetic resonance imaging (MRI). An MRI uses magnets and radio waves to make pictures of your brain tissues. Your health care professional may order this test to look for damage to your hypothalamus or pituitary gland that could cause diabetes insipidus.
• Stimulation tests. During these tests, you are given an intravenous solution that stimulates your body to produce vasopressin.4,5 A health care professional then measures your blood level of copeptin, a substance that increases when vasopressin does. Results can indicate if you have diabetes insipidus or a different condition called primary polydipsia, which can cause you to drink lots of liquids.

How do health care professionals treat diabetes insipidus?

The main way to treat diabetes insipidus is to drink enough liquids to prevent dehydration. But doing so can disrupt your regular lifestyle, including your sleep. Your health care professional may refer you to a specialist, such as a nephrologist or an endocrinologist for more specific treatments. Other treatments vary by cause.

Central diabetes insipidus

Health care professionals most often treat central diabetes insipidus with a man-made hormone called desmopressin, which replaces the vasopressin your body is not making.2,6 You can take this medicine as a nasal spray, a pill, or a shot.

Nephrogenic diabetes insipidus

In some cases, nephrogenic diabetes insipidus may go away after treating its cause. For example, switching medicines or taking steps to balance the amount of calcium or potassium in your body may be enough to resolve the problem. Your health care professional may also prescribe a class of diuretic medicines called thiazides to help reduce the amount of urine your kidneys make.2,7 Other treatments can include nonsteroidal anti-inflammatory drugs or other types of diuretics.

Dipsogenic diabetes insipidus

Researchers haven’t found an effective way to treat dipsogenic diabetes insipidus. Sucking on ice chips or sugar free candies to moisten your mouth and increase saliva flow may help reduce your thirst. If you wake up many times at night to urinate, your health care professional may suggest you take a small dose of desmopressin at bedtime. Your health care professional may also monitor your blood levels of sodium, which can drop too low if you have this condition.

Gestational diabetes insipidus

Health care professionals treat gestational diabetes insipidus with desmopressin, which is safe for both mother and baby. An expectant mother’s placenta does not destroy desmopressin as it does vasopressin. Gestational diabetes insipidus usually goes away after the baby is born, but may return if the mother becomes pregnant again.

Most people with diabetes insipidus can prevent serious problems and live a normal life if they follow their health care professional’s recommendations and keep their symptoms under control.

How do eating, diet, and nutrition affect diabetes insipidus?

Researchers have not found that eating, diet, and nutrition play a role in causing or preventing diabetes insipidus. To reduce symptoms, your health care professional may suggest you eat a diet that is low in salt and protein to help your kidneys make less urine. In some cases, these changes alone may be enough to keep your symptoms under control, particularly if you have nephrogenic diabetes insipidus.2,7

Clinical Trials for Diabetes Insipidus

The NIDDK conducts and supports clinical trials in many diseases and conditions, including kidney diseases. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.

What are clinical trials for diabetes insipidus?

Clinical trials—and other types of clinical studies—are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about disease and improve health care for people in the future.

Find out if clinical studies are right for you.

Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials.

What clinical studies for diabetes insipidus are looking for participants?

You can view a filtered list of clinical studies on diabetes insipidus that are open and recruiting at www.ClinicalTrials.gov. You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe. Always talk with your health care provider before you participate in a clinical study.

References

[1] Levy M, Prentice M, Wass J. Diabetes insipidus. British Medical Journal. 2019;364. doi: 10.1136/bmj.l321

[2] Christ-Crain M, Bichet DG, Fenske WK, et al. Diabetes insipidus. Nature Reviews. Disease Primers. 2019;5(1):54. doi: 10.1038/s41572-019-0103-2

[3] Quigley J, Shelton C, Issa B, Sripada S. Diabetes insipidus in pregnancy. The Obstetrician & Gynaecologist. 2018;20(1):41–48. doi: 10.1111/tog.12450

[4] Fenske W, Refardt J, Chifu I, et al. A copeptin-based approach in the diagnosis of diabetes insipidus. New England Journal of Medicine. 2018;379(5):428–439. doi: 10.1056/NEJMoa1803760

[5] Winzeler B, Cesana-Nigro N, Refardt J, et al. Arginine-stimulated copeptin measurements in the differential diagnosis of diabetes insipidus: a prospective diagnostic study. Lancet. 2019;394(10198):587–595. doi: 10.1016/S0140-6736(19)31255-3

[6] Baldeweg SE, Ball S, Brooke A, et al. Society for Endocrinology clinical guidance: inpatient management of cranial diabetes insipidus. Endocrine Connections. 2018;7(7):G8–G11. doi: 10.1530/EC-18-0154

[7] Kavanagh C, Uy NS. Nephrogenic diabetes insipidus. Pediatric Clinics of North America. 2019;66(1):227–234. doi: 10.1016/j.pcl.2018.09.006