Types of diabetes insipidus

• Central Diabetes Insipidus - caused when the pituitary gland does not secrete enough antidiuretic hormone (ADH) [also called vasopressin].  This type of DI may be the caused by a congenital defect, trauma, a tumor on the pituitary gland, or unknown causes.

• Nephrogenic Diabetes Insipidus - caused when the kidneys do not respond to the ADH that is produced by the pituitary gland.  This type of DI may be caused by a congenital defect, drugs, or caused by other metabolic disorders

Signs

• polyuria (excessive urination)
• polydipsia (excessive drinking)

Diagnosis

• Diagnosis includes ruling out other diseases such as hyperadrenocorticism (Cushing's disease), diabetes mellitus, hyperthyroidism (in cats), renal failure, liver disease, pyometra (infection of the uterus), and other disorders. 

• Images of the pituitary gland may be taken to determine if there is a tumor. 

• A water deprivation test or an ADH trial with DDAVP may be done. These tests determine if the animal is able to produce more concentrated urine as water is withheld or following the injection of DDAVP (the drug used to treat DI).

Treatment

• Central DI is treated with desmopressin, a drug that mimics the actions of ADH. It is available under the trade name DDAVP and as a generic. DDAVP is available in several formulations: as a nasal spray pump; as a liquid for use with rhinal tube; as an injectable liquid; and in tablets. Most pet owners use the nasal spray or rhinal liquid formulations and use them as eye drops, nose drops, or inject it subcutaneously. 

• Nephrogenic DI is commonly treated with thiazide diuretics.  These drugs help to concentrate the urine.  An oral drug called chlorothiazide acts on the kidneys to help concentrate the urine. Other treatments may include chloropropamide, which increases the effects of ADH on the kidney.  But chloropropamide is not always successful. Nonsteroidal anti-inflammatory drugs may be used in dogs. 

• No therapy may be chosen, and the pets can survive as long as plenty of water is always available. You CAN NOT limit their water intake. When Sonny's DI first started, he would lay in front of his water bowl and just drink and drink and drink. Of course he also had to go outside very frequently, and his urine was like water - literally.

Personal Stories and Resources

• Ziggy, Puff, and Simone are three kitties with DI.  Ziggy also has diabetes mellitus (yes, both diseases can occur together ... remember they are totally separate diseases).
  
  We use the generic 0.01% nasal spray form for all three of our cats. Originally, we used it as eye/nose drops, but it cost an awful lot of money using it that way. Eventually, we found some veterinary papers and texts that suggested using the nasal spray form as a subcutaneous injection. We found several big benefits from switching to injections. First, the cats tolerated it better -- they hated eye drops and hated nose drops even more, often flinging whole drops of the drug around the room. Second, while the eye drops controlled the DI symptoms for about 8 hours, the injections controlled the symptoms for 14-16 hours. Third, use as an injection required lots less of the drug. A bottle lasted for about 28 days when used for eye/nose drops. When used for injection, it lasts over 150 days. We are currently paying about $130 for a 5 mL bottle of generic 0.01% nasal spray. You can imagine how the cost of treating the cats dropped when we switched to injecting the nasal spray.
  
  You don't want to use the injectable form.  You DO want to use the nasal spray form. The reason is that the injectable form is 25 times less concentrated than the nasal spray, so you have to use 25 times the volume! In addition, I understand it is even more expensive (though I have not priced it myself).
  
  The dosage seems to be unique to each animal rather than being based on the animal's weight. All three or our cats get injections of 0.02 mL (this is a VERY TINY volume … about 1/10th the size of a drop of water) twice a day. Our cats range in weight from about 7 pounds to 18 pounds. We have had email contact with several people who have DI dogs, and know one owner also injects the nasal spray and gives the same dose we use for the cats. 
  
  We use insulin syringes for the injections (the 3/10 cc kind). The needles are so fine and sharp, the cats do not even notice the injections. We estimate the cost of treatment at about $35 per month.
  
  The injections have made a really big difference to us.  It is a lot less expensive and the cats no longer run from us when it is time for meds, and they no longer have about 4 hours when they are so very thirsty!
  
  Ziggy, Puff and Simone's owners MJ and Pat are always happy to talk to anyone with a pet who has diabetes insipidus. They are working on a central DI web page that you can check for more information. (Jan. 2002)
   
• Sonny is my Samoyed. We used DDAVP Rhinal nasal solution, 2.5 ml bottle. We used it as an eye drop. Just like in the nose, the DDAVP is absorbed across the mucous membranes when used as an eye drop. The bottle (without the little tube) is not designed to be used as eye drops, so it is not always easy to get one drop out of the bottle.  
  
  When we suspected DI, Sonny didn't have a DDAVP injection - we just started with the drops. We saw an improvement very quickly. Rather than going through other tests which can be expensive, our vet said it wouldn't hurt him to try the drops and rule in or out DI. We did do all the blood work and urinalysis several times though, to rule out renal insufficiency or renal failure. Our vet has had a couple of other DI cases over the years... which really is a lot because DI is pretty rare (in both humans and in dogs). He told us he's had great results from using the DDAVP as an eye drop.
  
  We started with a dose of 1 drop twice a day. My vet said we should monitor Sonny's water intake and adjust the dose ranging from 1 drop once a day to 2 drops twice a day depending on how he was doing. Sonny's drinking became normal again, and eventually we were able to lower the dose to 1 drop, once a day.  The DDAVP is expensive, but a 2.5 ml bottle lasted us about 3-4 weeks.  
  
  DI certainly is rare in dogs, cats and humans. But Sonny did something even stranger... he recovered from it. He no longer is on DDAVP and hasn't been for close to a year now. That's even more rare! There are times when DI may be a temporary condition if caused by trauma, such as a head injury in some cases. Sonny had no head (or other) trauma though, so we don't know exactly what the cause was or why his symptoms disappeared after a couple of years. That's not something that normally happens.
  
  A dog with DI should be able to live a long and healthy life. Our Sonny will be 13 years old in March. He has some added complications though - he's also diabetic (Diabetes Mellitus, and is on insulin now) and hypothyroid as well. But those are not related to the DI at all, and it's extremely rare to have a dog with DI and DM at the same time. Sonny was diagnosed with DI about 1-1/2 years before the DM, and there is no connection between the two.
  --Contributed by Kerry (Jan. 2002)
   
• Shirley has a suggestion for a method of using the nasal Desmopressin (DDAVP) solution as an eyedrop.  Her blue merle Shetland Sheepdog Ferris has DI and this helps her get the eye drop in his eye and not waste any of the very expensive medication.  Here's her method:  
  • Purchase a bottle of Clear Eyes eye drops from the drug store.
  • Wash your hands and prepare a clean work surface.
  • Using a paper towel or napkin, take the top off the Clear Eyes bottle and pour out the solution.
  • Let the Clear Eyes bottle dry out by putting it upside down on a clean paper towel (don't touch the top of the bottle and don't put anything inside the bottle to try to dry it).
  • Take a clean knife or scissors and snip the top off the bottle of Desmopressin
  • Pour the Desmopressin into the the Clear Eyes bottle.
  • Again using a paper towel, replace the Clear Eyes bottle tip, making sure it is securely in place.
  • During use, keep the bottle as clean as possible and replace the Clear Eyes bottle every 3 months (or 3 bottles of Desmopressin in Ferris' case).

  I did lose a few drops (expensive and precious, I might add) the first few times I used it. The drops come out of the bottle very easily, so I make sure I have Ferris' eye ready to receive the drop before I even turn the bottle over.

  I have tried other eye drop bottles but found the Clear Eyes one to be sleekly designed and thus I can get every drop of Desmopressin out of it.
   

• Sunny Bear is a 9 year-old male Rottweiller.  He is our sunshine, and our very good friend.  He is gentle giant, even though he weighs 146 pounds.  We have a very fixed income and were very afraid we might not be able to afford the medicine that he requires. Here in Alaska, the medicine cost $154 for a 5-ml bottle, and sometimes he takes twice that amount in a month. Putting our sunshine and our friend to sleep was not even an option, but I was at a great loss as where to go for help. I looked up the company that makes the medicine and asked many questions as to where what how, we could find help, and it paid off.  The sales representative was also a pet owner and understood about the cost of the medicine. I found that this medicine is only available as a prescription for humans, and I thought that was strange. I talked with our local pharmacy and learned that they could compound Sunny Bear's medicine for us. Now instead of the medicine costing us $154.00 a month, we now get the same medicine for $40.00 a month.  We can fit that into our budget and  Sunny Bear can have his needed medicine. 
  -- Contributed by Rick Handel (May 2000) 

• Diabetes Insipidus Foundation

References

• The 5 Minute Veterinary Consult: Canine and Feline Larry Tilly and Francis W.K. Smith, Jr. 1997.
• Veterinary Drug Handbook.  Second Edition.  Donald C. Plumb.  1995.
• Pocket Companion to the Fourth Edition of Textbook of Veterinary Internal Medicine Stephen J. Ettinger.
• The Cornell Book of Cats: A Comprehensive and Authoritative Medical Reference for Every Cat and Kitten. Mordecai Siegal (Editor), et al.1997.

Updated June 2002
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