Diabetes Insipidus: Causes & Symptoms

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Diabetes Insipidus: Causes & Symptoms

Diabetes insipidus 5 natural treatments
Diabetes insipidus, is a debilitating and rare disease, with a prevalence of 1 out of 25,000 people. Often referred to as “water diabetes,” it is a condition characterized by frequent and heavy urination, excessive thirst and an overall feeling of weakness. It’s caused by a defect in the pituitary gland or in the kidneys. (1)

The term insipidus means “without taste” in Latin, while diabetes mellitus involves the excretion of “sweet” urine. People with diabetes insipidus pass urine that is diluted, odorless and relatively low in sodium content.

Diabetes insipidus and diabetes mellitus (which includes both type 1 and type 2 diabetes) are unrelated. Both conditions do cause frequent urination and constant thirst. People with diabetes insipidus have normal blood sugar levels, but their kidneys cannot balance fluid in the body.

Although the symptoms of diabetes insipidus can be bothersome and sometimes even life-changing, the condition doesn’t increase future health risks when it is managed properly. It’s important to find the right treatment plan, which typically involves taking measures to avoid dehydration.

What is Diabetes Insipidus?
Diabetes insipidus is a condition that disrupts normal life due to increased thirst and passing of large volumes or urine, even at night. It is a part of a group of hereditary or acquired polyuria (when large amounts of urine is produced) and polydipsia (excessive thirst) diseases. It’s associated with inadequate vasopressin or antidiuretic hormone secretion.

Vasopressin, which includes arginine vasopressin (AVP) and antidiuretic hormone (ADH), is a peptide hormone formed in the hypothalamus. It then travels to the posterior pituitary where it releases into the blood. In order to fully understand the cause of diabetes insipidus, you must first learn about the role of vasopressin and how it affects your kidneys and fluid balance. (2)

Every day, your kidneys normally filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine. Urine is composed of wastes and extra fluid. Your urine then flows from your kidneys to the bladder and through tubes called ureters. Your body regulates fluid by balancing liquid and removing extra fluid. Thirst usually controls your liquid intake, while urination removes most fluid. People also lose fluid through sweating, breathing or diarrhea.

The hypothalamus (a small gland located at the base of the brain) produces vasopressin. Vasopressin is stored in the pituitary gland and released into the bloodstream when the body has a low fluid level. Vasopressin signals your kidneys to absorb less fluid from the bloodstream, resulting in less urine. But when the body has extra fluid, the pituitary gland releases smaller amounts of vasopressin, or even none at all. This causes the kidneys to remove more fluid from the bloodstream and produce more urine. (3)

These issues with the release of vasopressin lead to this rare disorder that occurs when the kidneys pass an abnormally large volume of urine that is insipid — dilute and odorless.

What is diabetes insipidus
Causes and Risk Factors
There are four different types of diabetes insipidus — central, nephrogenic, dipsogenic and gestational. Each type of diabetes insipidus has a different cause.

Central Diabetes Insipidus

Central diabetes insipidus (or neurogenic diabetes insipidus) is the most common form of diabetes insipidus. It occurs in both males and females equally and at any age. Inadequate synthesis or release of vasopressin causes it, often due to surgery, head injury, an infection or a tumor that damages the hypothalamus or posterior pituitary gland. (4) The disruption of vasopressin causes the kidneys to remove too much fluid from the body, leading to an increase in urination.

Nephrogenic Diabetes Insipidus

Nephrogenic diabetes insipidus results from the failure of the kidneys to respond to vasopressin. This causes the kidneys to continue to remove too much fluid from a person’s bloodstream. Nephrogenic diabetes insipidus can result from inherited gene changes or mutations that prevent the kidneys from responding normally to vasopressin. (5) Chronic kidney disease, low potassium levels in the blood, high calcium levels in the blood, a blockage of the urinary tract and certain medications (like lithium) can cause nephrogenic diabetes insipidus. (6)

Dipsogenic Diabetes Insipidus

Dipsogenic diabetes insipidus (also known as primary polydipsia) is a defect in the thirst mechanism, located in the hypothalamus. This defect results in an abnormal increase in thirst and liquid intake that suppresses vasopressin section and increases urine output. Events or conditions that damage the hypothalamus or pituitary gland cause it, such as surgery, inflammation, a tumor or a head injury. Certain medications or mental health problems may predispose a person to this type of diabetes insipidus.

Gestational Diabetes Insipidus

Gestational diabetes insipidus can occur during pregnancy when an enzyme made by the placenta breaks down the mother’s vasopressin. Or, in some cases, a pregnant women produces more prostaglandin, which reduces chemical sensitivity to vasopressin. Symptoms of gestational diabetes insipidus often go unnoticed. The condition typically goes away after the mother delivers the baby. (7)

Diabetes insipidus can develop at any age and the prevalence is equal among males and females. Nephrogenic diabetes insipidus that’s present at or shortly after birth is usually genetic and tends to affect males. However, women can pass the gene on to their children.

Common Signs and Symptoms
The most common signs and symptoms of diabetes insipidus include extreme thirst and the excretion of an excessive amount of diluted urine. A person’s body regulates fluid by balancing liquid intake and removing extra fluid. Thirst usually controls a person’s rate of liquid intake, while urination removes most fluid.

Normally, a healthy adult will urinate an average of less than 3 liters a day. Depending on the severity of the disease, urine output can be as much as 15 liters a day when you’re drinking a lot of fluids. Because of this frequent urination, people with diabetes insipidus usually have to get up in middle of the night to urinate (called nocturia). They may even struggle with bedwetting.

Infants and young children with diabetes insipidus may have trouble sleeping, or show other signs and symptoms of disease. These can include: unexplained fussiness, inconsolable crying, fever, vomiting, diarrhea, constipation, excessively wet diapers, weight loss and delayed growth. (8)

The main complication of diabetes insipidus is dehydration, which occurs when fluid loss is greater than liquid intake. Signs of dehydration include: thirst, dry skin, sluggishness, fatigue, dizziness, confusion and nausea. If you are severely dehydrated, you can even experience seizures, permanent brain damage and death.

Another common complication is an electrolyte imbalance. Electrolytes are certain nutrients or chemicals (such as sodium and potassium) present in your body that have many important functions, from regulating your heartbeat to allowing your muscles to contract so you can move. Electrolytes are found within bodily fluids, including urine, blood and sweat. When you have an imbalance, you may experience muscle aches, spasms or twitches, anxiety, frequent headaches, feeling very thirsty, fever, joint pain, confusion, digestive issues, irregular heartbeats, fatigue and changes in appetite or body weight.

Conventional Treatment
The primary treatment for diabetes insipidus involves drinking enough liquid to prevent dehydration. Depending on what type of diabetes insipidus you have, treatment for constant thirst and frequent urination will vary.

Since its introduction in 1972, desmopressin has been the most widely used drug for the treatment of diabetes insipidus. Desmopressin is a synthetic, man-made hormone that comes as an injection, nasal spray or pill. It works by replacing the vasopressin that a patient’s body would normally produce, which can control the amount of urine your kidneys make. Desmopressin helps a patient to manage her symptoms, but it does not cure the disease. (9)

Desmopressin can cause a low level of sodium in the blood. This is rare, but can be serious and possibly life-threatening. Drinking too much water or other fluids increases your risk of having low sodium levels in your blood. It’s important to follow your doctor’s directions if you are using this drug and limit your fluids as instructed. Signs of low levels of sodium in the blood include: loss of appetite, severe nausea, vomiting, severe headache, mental and mood chances, muscle weakness, cramps and spasms, shallow breathing and loss of consciousness.

Health care providers commonly prescribe diuretics to help patients’ kidneys remove fluid from the body. On the the other hand, there’s a class of diuretics called thiazides that help to reduce urine production and help patients’ kidneys concentrate urine. Patients with nephrogenic diabetes insipidus would use these. Thiazide diuretics are sometimes combined with amiloride to prevent hypokalemia, or low potassium levels in the blood. Amiloride works to increase the amount of sodium and decrease the amount of potassium.

Aspirin or ibuprofen is sometimes used to help reduce urine volume as well. Do not use these drugs on a regular basis because of the risk of overdose. Symptoms of a ibuprofen overdose to look out for include: a ringing in the ears, blurred vision, headaches, confusion, dizziness, drowsiness and skin rashes.

5 natural diabetes insipidus treatments
5 Natural Treatments
1. Change Your Diet

A diet containing nutrient-dense whole foods with plenty of water-heavy fruits and vegetables can be helpful for people with diabetes insipidus. (10) Some examples of water-based, hydrating foods to consume regularly include: cucumbers, zucchini, dark leafy green vegetables (such as spinach and kale), red cabbage, red peppers, blueberries, watermelon, kiwi, citrus fruit, pineapple and strawberries. Starchy vegetables like sweet potatoes, squash, bananas and avocados are also great options. You may also find that coconut water is hydrating and helps to balance your electrolytes.

While you focus on adding these nourishing foods into your diet, try to avoid eating processed foods that are typically high in sodium and other chemicals that are used as preservatives. Removing caffeine from your diet may also be helpful, which includes carbonated soft drinks.

2. Avoid Dehydration

It’s vital for diabetes insipidus patients to drink enough liquids to replace their urine losses and to relieve excessive thirst. You need to drink extra water to compensate for fluid loss, especially after being active or exercising. Research shows that without enough water present in the body, dehydration and deficits can cause cardiovascular complications, muscle cramping, fatigue, dizziness and confusion. (11)

Make sure to always carry water with you wherever you go. Wearing a medical alert bracelet will alert professionals of your condition and advise them of your need for fluids.

3. Keep Your Electrolytes Balanced

The major electrolytes found within the body include calcium, magnesium, potassium, sodium, phosphate and chloride. These nutrients help to stimulate nerves throughout the body and balance fluid levels. You can keep your electrolytes balanced by avoiding packaged or processed foods because of their sodium content. Sodium is an electrolyte that plays a significant role in the body’s ability to retain or release water. So if your diet is very high in sodium, the kidneys excrete more water. This can cause complications balancing other electrolytes. It’s also important to drink enough water throughout the day and to increase your water intake after exercise, when you are sick or any time you are losing fluids. (12)

4. Keep Your Mouth Moist

Sucking on ice chips or sour candies can help to moisten your mouth and increase saliva flow, reducing your desire to drink. This can be especially helpful later in the evening when you don’t want to consume as much water and be up in middle of the night to use the bathroom.

5. Check Your Medications

Some medications can impact your electrolyte balance, a complication of diabetes insipidus. These include antibiotics, diuretics, hormonal pills, blood pressure medications and cancer treatments. Cancer patients who are receiving chemotherapy usually experience the most serious forms of electrolyte imbalances. Laxatives and diuretics also change potassium and sodium levels within the blood and urine. It’s also possible to develop electrolyte imbalances due to hormonal interactions from antidiuretic hormone medications, aldosterone and thyroid hormones. Even high levels of physiological stress can impact hormones to the point that fluid and electrolyte levels can become thrown out of balance. (13)

If you begin experiencing the signs and symptoms of diabetes insipidus, be sure to consider whether a new medication or supplement can be causing fluid or electrolyte imbalances.

Precautions
A major complication of diabetes insipidus is dehydration. You can prevent dehydration by increasing the amount of liquids that you drink. If you experience the signs of dehydration, such as confusion, dizziness or sluggishness, seek immediate care.

Final Thoughts
Diabetes insipidus is a condition that disrupts normal life due to increased thirst and passing of large volumes of urine, even at night. It’s associated with inadequate vasopressin or antidiuretic hormone secretion.
Issues with the release of vasopressin lead to this rare disorder that occurs when the kidneys pass an abnormally large volume of urine that is insipid — dilute and odorless.
There are four different types of diabetes insipidus — central, nephrogenic, dipsogenic and gestational. Each type of diabetes insipidus has a different cause.
The most common signs and symptoms of diabetes insipidus are extreme thirst and the excretion of an excessive amount of diluted urine. A person’s body regulates fluid by balancing liquid intake and removing extra fluid.
Two major complications of diabetes insipidus are dehydration and an electrolyte imbalance.
Desmopressin is a synthetic form of vasopressin used to treat diabetes insipidus. To treat this condition naturally, you must be sure to drink enough water to stay hydrated, watch your medications (some may be altering fluid balance), and change your diet.
Read Next: Foods High in Phosphorus Help Your Body Detox & Strengthen


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Diabetes Insipidus
On this page:

What is diabetes insipidus?
What are the kidneys and what do they do?
How is fluid regulated in the body?
What are the types of diabetes insipidus?
What are the complications of diabetes insipidus?
Seek Immediate Care
How is diabetes insipidus diagnosed?
How is diabetes insipidus treated?
Eating, Diet, and Nutrition
Points to Remember
Clinical Trials
What is diabetes insipidus?
Diabetes insipidus is a rare disorder that occurs when a person's kidneys pass an abnormally large volume of urine that is insipid—dilute and odorless. In most people, the kidneys pass about 1 to 2 quarts of urine a day. In people with diabetes insipidus, the kidneys can pass 3 to 20 quarts of urine a day. As a result, a person with diabetes insipidus may feel the need to drink large amounts of liquids.

Diabetes insipidus and diabetes mellitus—which includes both type 1 and type 2 diabetes—are unrelated, although both conditions cause frequent urination and constant thirst. Diabetes mellitus causes high blood glucose, or blood sugar, resulting from the body's inability to use blood glucose for energy. People with diabetes insipidus have normal blood glucose levels; however, their kidneys cannot balance fluid in the body.

What are the kidneys and what do they do?
The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the kidneys normally filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid. The urine flows from the kidneys to the bladder through tubes called ureters. The bladder stores urine. When the bladder empties, urine flows out of the body through a tube called the urethra, located at the bottom of the bladder.

Frontal body diagram with kidneys and bladder
Every day, the kidneys normally filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine.
How is fluid regulated in the body?
A person's body regulates fluid by balancing liquid intake and removing extra fluid. Thirst usually controls a person’s rate of liquid intake, while urination removes most fluid, although people also lose fluid through sweating, breathing, or diarrhea. The hormone vasopressin, also called antidiuretic hormone, controls the fluid removal rate through urination. The hypothalamus, a small gland located at the base of the brain, produces vasopressin. The nearby pituitary gland stores the vasopressin and releases it into the bloodstream when the body has a low fluid level. Vasopressin signals the kidneys to absorb less fluid from the bloodstream, resulting in less urine. When the body has extra fluid, the pituitary gland releases smaller amounts of vasopressin, and sometimes none, so the kidneys remove more fluid from the bloodstream and produce more urine.

What are the types of diabetes insipidus?
The types of diabetes insipidus include

central
nephrogenic
dipsogenic
gestational

Each type of diabetes insipidus has a different cause.

Central Diabetes Insipidus

Central diabetes insipidus happens when damage to a person's hypothalamus or pituitary gland causes disruptions in the normal production, storage, and release of vasopressin. The disruption of vasopressin causes the kidneys to remove too much fluid from the body, leading to an increase in urination. Damage to the hypothalamus or pituitary gland can result from the following:

surgery
infection
inflammation
a tumor
head injury
Central diabetes insipidus can also result from an inherited defect in the gene that produces vasopressin, although this cause is rare. In some cases, the cause is unknown.

Nephrogenic Diabetes Insipidus
Nephrogenic diabetes insipidus occurs when the kidneys do not respond normally to vasopressin and continue to remove too much fluid from a person's bloodstream. Nephrogenic diabetes insipidus can result from inherited gene changes, or mutations, that prevent the kidneys from responding to vasopressin. Other causes of nephrogenic diabetes insipidus include

chronic kidney disease
certain medications, particularly lithium

low potassium levels in the blood

high calcium levels in the blood

blockage of the urinary tract

The causes of nephrogenic diabetes insipidus can also be unknown.

Dipsogenic Diabetes Insipidus
A defect in the thirst mechanism, located in a person's hypothalamus, causes dipsogenic diabetes insipidus. This defect results in an abnormal increase in thirst and liquid intake that suppresses vasopressin secretion and increases urine output. The same events and conditions that damage the hypothalamus or pituitary—surgery, infection, inflammation, a tumor, head injury—can also damage the thirst mechanism. Certain medications or mental health problems may predispose a person to dipsogenic diabetes insipidus.

Gestational Diabetes Insipidus
Gestational diabetes insipidus occurs only during pregnancy. In some cases, an enzyme made by the placenta—a temporary organ joining mother and baby—breaks down the mother's vasopressin. In other cases, pregnant women produce more prostaglandin, a hormone-like chemical that reduces kidney sensitivity to vasopressin. Most pregnant women who develop gestational diabetes insipidus have a mild case that does not cause noticeable symptoms. Gestational diabetes insipidus usually goes away after the mother delivers the baby; however, it may return if the mother becomes pregnant again.

What are the complications of diabetes insipidus?
The main complication of diabetes insipidus is dehydration if fluid loss is greater than liquid intake. Signs of dehydration include

thirst
dry skin
fatigue
sluggishness
dizziness
confusion
nausea
Severe dehydration can lead to seizures, permanent brain damage, and even death.

Seek Immediate Care
Usually, people can prevent dehydration by increasing the amount of liquids they drink. However, some people may not realize they need to drink more liquids, which can lead to dehydration. People should seek immediate care if they experience symptoms of more severe dehydration, such as

confusion
dizziness
sluggishness
How is diabetes insipidus diagnosed?
A health care provider can diagnose a person with diabetes insipidus based on the following:

medical and family history
physical exam
urinalysis
blood tests
fluid deprivation test
magnetic resonance imaging (MRI)
Medical and Family History
Taking a medical and family history can help a health care provider diagnose diabetes insipidus. A health care provider will ask the patient to review his or her symptoms and ask whether the patient's family has a history of diabetes insipidus or its symptoms.

Physical Exam
A physical exam can help diagnose diabetes insipidus. During a physical exam, a health care provider usually examines the patient's skin and appearance, checking for signs of dehydration.

Urinalysis
Urinalysis tests a urine sample. A patient collects the urine sample in a special container at home, in a health care provider's office, or at a commercial facility. A health care provider tests the sample in the same location or sends it to a lab for analysis. The test can show whether the urine is dilute or concentrated. The test can also show the presence of glucose, which can distinguish between diabetes insipidus and diabetes mellitus. The health care provider may also have the patient collect urine in a special container over a 24-hour period to measure the total amount of urine produced by the kidneys.

Blood Tests
A blood test involves drawing a patient's blood at a health care provider’s office or a commercial facility and sending the sample to a lab for analysis. The blood test measures sodium levels, which can help diagnose diabetes insipidus and in some cases determine the type.

Fluid Deprivation Test
A fluid deprivation test measures changes in a patient’s body weight and urine concentration after restricting liquid intake. A health care provider can perform two types of fluid deprivation tests:

A short form of the deprivation test. A health care provider instructs the patient to stop drinking all liquids for a specific period of time, usually during dinner. The next morning, the patient will collect a urine sample at home. The patient then returns the urine sample to his or her health care provider or takes it to a lab where a technician measures the concentration of the urine sample.
A formal fluid deprivation test. A health care provider performs this test in a hospital to continuously monitor the patient for signs of dehydration. Patients do not need anesthesia. A health care provider weighs the patient and analyzes a urine sample. The health care provider repeats the tests and measures the patient's blood pressure every 1 to 2 hours until one of the following happens:
The patient's blood pressure drops too low or the patient has a rapid heartbeat when standing.
The patient loses 5 percent or more of his or her initial body weight.
Urine concentration increases only slightly in two to three consecutive measurements.
At the end of the test, a health care provider will compare the patient's blood sodium, vasopressin levels, and urine concentration to determine whether the patient has diabetes insipidus. Sometimes, the health care provider may administer medications during the test to see if they increase a patient's urine concentration. In other cases, the health care provider may give the patient a concentrated sodium solution intravenously at the end of the test to increase the patient's blood sodium level and determine if he or she has diabetes insipidus.
Magnetic Resonance Imaging
Magnetic resonance imaging (MRI) is a test that takes pictures of the body's internal organs and soft tissues without using x-rays. A specially trained technician performs the procedure in an outpatient center or a hospital, and a radiologist—a doctor who specializes in medical imaging—interprets the images. A patient does not need anesthesia, although people with a fear of confined spaces may receive light sedation. An MRI may include an injection of a special dye, called contrast medium. With most MRI machines, the person lies on a table that slides into a tunnel-shaped device that may be open ended or closed at one end. Some MRI machines allow the patient to lie in a more open space. MRIs cannot diagnose diabetes insipidus. Instead, an MRI can show if the patient has problems with his or her hypothalamus or pituitary gland or help the health care provider determine if diabetes insipidus is the possible cause of the patient's symptoms.

How is diabetes insipidus treated?
The primary treatment for diabetes insipidus involves drinking enough liquid to prevent dehydration. A health care provider may refer a person with diabetes insipidus to a nephrologist—a doctor who specializes in treating kidney problems—or to an endocrinologist—a doctor who specializes in treating disorders of the hormone-producing glands. Treatment for frequent urination or constant thirst depends on the patient’s type of diabetes insipidus:

Central diabetes insipidus. A synthetic, or man-made, hormone called desmopressin treats central diabetes insipidus. The medication comes as an injection, a nasal spray, or a pill. The medication works by replacing the vasopressin that a patient’s body normally produces. This treatment helps a patient manage symptoms of central diabetes insipidus; however, it does not cure the disease.
Nephrogenic diabetes insipidus. In some cases, nephrogenic diabetes insipidus goes away after treatment of the cause. For example, switching medications or taking steps to balance the amount of calcium or potassium in the patient’s body may resolve the problem. Medications for nephrogenic diabetes insipidus include diuretics, either alone or combined with aspirin or ibuprofen. Health care providers commonly prescribe diuretics to help patients’ kidneys remove fluid from the body. Paradoxically, in people with nephrogenic diabetes insipidus, a class of diuretics called thiazides reduces urine production and helps patients’ kidneys concentrate urine. Aspirin or ibuprofen also helps reduce urine volume.
Dipsogenic diabetes insipidus. Researchers have not yet found an effective treatment for dipsogenic diabetes insipidus. People can try sucking on ice chips or sour candies to moisten their mouths and increase saliva flow, which may reduce the desire to drink. For a person who wakes multiple times at night to urinate because of dipsogenic diabetes insipidus, taking a small dose of desmopressin at bedtime may help. Initially, the health care provider will monitor the patient’s blood sodium levels to prevent hyponatremia, or low sodium levels in the blood.
Gestational diabetes insipidus. A health care provider can prescribe desmopressin for women with gestational diabetes insipidus. An expecting mother’s placenta does not destroy desmopressin as it does vasopressin. Most women will not need treatment after delivery.
Most people with diabetes insipidus can prevent serious problems and live a normal life if they follow the health care provider’s recommendations and keep their symptoms under control.

Eating, Diet, and Nutrition
Researchers have not found that eating, diet, and nutrition play a role in causing or preventing diabetes insipidus.

Points to Remember
Diabetes insipidus is a rare disorder that occurs when a person’s kidneys pass an abnormally large volume of urine that is insipid—dilute and odorless.
A person’s body regulates fluid by balancing liquid intake and removing extra fluid. Thirst usually controls a person’s rate of liquid intake, while urination removes most fluid, although people also lose fluid through sweating, breathing, or diarrhea. The hormone vasopressin, also called antidiuretic hormone, controls the fluid removal rate through urination.
The types of diabetes insipidus include central, nephrogenic, dipsogenic, and gestational. Each type of diabetes insipidus has a different cause.
The main complication of diabetes insipidus is dehydration if fluid loss is greater than liquid intake.
A health care provider can diagnose a person with diabetes insipidus based on a medical and family history, a physical exam, urinalysis, blood tests, a fluid deprivation test, and magnetic resonance imaging (MRI).

The primary treatment for diabetes insipidus involves drinking enough liquid to prevent dehydration.

Clinical Trials
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?
Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?
Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov .

This information may contain content about medications and, when taken as prescribed, the conditions they treat. When prepared, this content included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1-888-INFO-FDA (1-888-463-6332) or visit www.fda.gov . Consult your health care provider for more information.

October 2015
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This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

The NIDDK would like to thank:
Bessie Young, M.D., M.P.H., University of Washington; Dr. Joseph Verbalis, M.D, Georgetown University

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