Diabetes insipidus (DI) is a rare medical condition that disrupts the body's ability to regulate water, resulting in excessive thirst and an unusually high volume of urine. This condition affects the kidneys' ability to concentrate urine and causes individuals to produce between 3 and 20 quarts of dilute, colourless urine daily, compared to an average of 1 to 2 quarts. It is pertinent to note that DI is not related to diabetes mellitus, which disrupts the body's insulin production.

Types Of Diabetes Insipidus

This condition results from damage to the hypothalamus or pituitary gland, which impairs the production or release of vasopressin, a hormone responsible for water retention. When vasopressin levels are inadequate, the kidneys fail to conserve water, leading to excessive urination. It can result from Brain injuries or surgeries, tumours, infections or inflammation and aneurysms.

Nephrogenic Diabetes Insipidus

This type occurs when the kidneys fail to respond to vasopressin, causing excessive fluid loss. Common triggers include chronic kidney disease, and electrolyte imbalances, such as high calcium or low potassium levels. Additionally, medications like lithium

and urinary tract blockages can also cause Nephrogenic DI.

Gestational Diabetes Insipidus

A rare condition seen only during pregnancy, this occurs when the placenta produces an enzyme that breaks down vasopressin or increases prostaglandin levels, reducing kidney sensitivity to the hormone. Symptoms of this are usually mild and often resolve postpartum but can recur in future pregnancies.

Symptoms And Warning Signs

• Severe thirst, often leading to the consumption of over a gallon of water daily
• Frequent urination (polyuria), sometimes exceeding 20 quarts per day
• Nighttime urination and bed-wetting
• Weakness, muscle pain, and preference for cold drinks

In severe cases, dehydration may develop, manifesting as fatigue, dizziness, dry mouth, confusion, nausea, or fainting. Infants and children with DI may exhibit crankiness, poor feeding, slow growth, fever, or vomiting.

Causes And Risk Factors

DI stems from issues with vasopressin production or response. Central DI arises from damage to brain structures, while nephrogenic DI relates to kidney dysfunction. Risk factors include:

- Genetic mutations affecting water regulation

- Certain medications like diuretics or lithium

- Metabolic disorders that alter calcium or potassium levels

- Brain injuries or surgeries

Diagnosis And Testing

Diagnosing DI involves a combination of medical history, physical exams, and specialized tests:

- Urinalysis: Evaluates urine concentration and glucose levels to distinguish DI from diabetes mellitus.

- Blood tests: Check electrolyte, glucose, and vasopressin levels.

- Water deprivation test: Measures changes in weight, blood sodium, and urine concentration during fluid restriction.

- MRI: Detects abnormalities in the hypothalamus or pituitary gland.

- Genetic screening: Identifies inherited risk factors.

Although DI is rare, affecting about 1 in 25,000 people, early diagnosis and targeted treatment can significantly improve quality of life. Researchers continue to explore its causes and treatments to better support those living with this challenging condition.

Our role as cardiologists involves observing young athletes train hard to become the next footballer or cricket player. Maintaining a strong and healthy heart requires more than just lung capacity for endurance in tasks like completing '90-minute pitch sprints' or preparing to go through gruelling five-day test matches.

Although uncommon, young athletes often face serious cardiac events that can be prevented. Why? Start your day with habits that can protect your heart.

Vital Heart Habits For Aspiring Athletes

Before competing in a competitive sport, it is important to conduct introductory cardiac evaluations. Set priorities accordingly. If a family history includes sudden cardiac death, cardiomyopathy, unexplained fainting, or inherited heart disease, hypertrophic cardiomyopathies can be detected early on by examining the body through symptom-specific ECG and personal/family history testing.

The process of dehydration causes your heart to pump faster and requires a much greater amount of blood. Consuming water on a daily basis and using electrolyte solutions during intense sweat sessions can prevent arrhythmias.

Don't overlook symptoms like chest tightness, sudden shortness of breath, or faintness when exercising; these are not just fatigue but signs of fatigue. Go and see a medical professional without delay.

Prosperity for recovery and sleep: Deep sleep is characterized by a decrease in heart rate, a settling of blood pressure, and relaxation of cardiac muscle tissue. By sacrificing 8-9 hours of sleep, your heart will become affected, and stress hormones such as cortisol are elevated.

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Avoid consumption of energy drinks that contain harmful stimulants and high levels of caffeine, as it can lead to heart palpitations. Consume whole foods high in lean protein and complex carbohydrates.

“Dreaming big requires training smart. If you listen carefully and respect your heart today, it will be enough for years to make sure you can continue playing sports.”

Dr. Anshu Kumar Jha, Consultant – Cardiology, Manipal Hospitals, Dhakuria, Kolkata.

Worldwide, more than 57 million people live with dementia, experiencing symptoms such as short-term memory loss, difficulty finding words, confusion about time or place, trouble with complex tasks, and changes in mood or personality. Around 10 million new cases are diagnosed every year.

Recent studies suggest that the average lifetime risk of developing dementia after age 55 is about 42%.

A new study has found that maintaining healthy blood pressure, controlling blood sugar, and avoiding smoking during middle age could significantly reduce the risk of developing dementia.

People who maintained these three health measures between the ages of 48 and 68 lived, on average, nearly 13 additional years without dementia, according to the study published in the journal Neurology Open Access.

"Our findings argue that people need to actively avert these factors in midlife as a strategy for preserving brain health for more than a decade," said study senior investigator Josef Coresh, Professor in the Department of Population Health at NYU Langone.

"Discovering new ways to delay dementia is crucial with 42% of Americans at risk for developing the condition at any time after age 55," he added.

How Was the Study Conducted?

Researchers analyzed data from the Atherosclerosis Risk in Communities (ARIC) Study, an ongoing community-based study that began in 1986. It has tracked participants for decades, measuring midlife vascular risk factors and the development of dementia.

The analysis included 12,409 adults with an average age of 56, all of whom were free of dementia at the start of the study. Researchers assessed three key risk factors:

• High blood pressure
• Diabetes
• Smoking

• 3,008 people developed dementia.
• 5,238 died without developing dementia.

Key Findings

Researchers also examined how midlife cardiovascular risk factors affected dementia-free survival across different demographic groups.

Among participants with all three risk factors:

• Women lived an average of 18.1 years without developing dementia, compared with 16.6 years for men.
• White participants lived an average of 19.6 years without dementia, compared with 16.0 years for Black participants.

"Hopefully, these results will encourage people to stop smoking and watch their vascular health closely from age 48 on."

What Is Dementia?

Dementia is an umbrella term for a significant decline in mental function that interferes with daily life. It commonly affects memory, thinking, and reasoning abilities and is caused by underlying conditions such as Alzheimer's disease or vascular dementia.

While there is currently no cure, the WHO says up to 45 per cent of dementia risk can be prevented or delayed by addressing modifiable risk factors such as tobacco and alcohol use, physical inactivity, social isolation, air pollution, and noncommunicable diseases (NCDs), including high blood pressure and diabetes.

Through the first quarter of the twenty-first century, it has been clear that the global menace of infectious diseases has become very different in terms of their causal factors and predictability.

A 2022 review in Nature Reviews Microbiology by Princeton professors Rachel Baker and Jessica Metcalf aptly pointed out how climate change, urbanization, and wider travel and trade determine when, where, and how outbreaks of infections happen. Examples of such outbreaks are numerous globally, viz. SARS, H1N1, MERS, Ebola, Zika, and COVID-19 outbreaks. It has also been realized by biomedical scientists that more than half of all known pathogenic diseases have at some point been worsened by climate-change-related events.

As a result, research on climate-disease links has surged since the recent pandemic.

Evidence supporting this climate-disease relationship is also abundant in the Indian context. A major example is our experience with dengue infections, which are clearly losing their seasonal predictability. Contrary to its usual temporal link with the monsoon, India has encountered an unusually early transmission in 2026, with nearly 7,000 cases reported by end-February, as per the National Center for Vector-Borne Diseases Control data. The vector has also expanded its geographical distribution, for example into Himalayan towns such as Darjeeling over the past decade.

Meanwhile, the Integrated Disease Surveillance Program in India also reports bimodal waves of influenza transmission and infections with respiratory syncytial virus (RSV) surge during the monsoon. These provide evidence that overlapping and compressed disease seasons are becoming more common.

Warming temperatures and erratic rainfall alter mosquito breeding cycles and pathogen incubation periods, while floods can create sudden transmission spikes in a population. On the other hand, rapid urbanization increases overlap among human, animal, and vector habitats. India is expected to have an urban population of close to 600 million by 2031. This will further intensify livestock density, land-use change, and human-wildlife contact, raising the risk of zoonotic spillovers.

As is evident globally now, global travel and trade will carry the pathogens across borders way faster than health systems can respond. Thus, reactive outbreak responses, of testing, isolating, and reporting only after cases show a surge, are strategically too slow. However, genomic and wastewater surveillance offer scalable alternatives. For example, such efforts in India could detect SARS-CoV-2 variants in sewage much before case counts rose in a population.

Similar experience has been gathered in cities like Bengaluru, wherein wastewater monitoring could track influenza and RSV circulation independent of individual testing. Artificial intelligence and machine learning models further add to the forecasting capacity. Modelling climate, land-use, and animal-movement data can flag likely zoonotic spillover risks well before an outbreak begins.

India's national zoonotic disease prioritization exercise and state-level One Health pilot studies in Gujarat and Rajasthan show that human, veterinary, and environmental data must be integrated. Such interdisciplinary cohort research, tracking populations across seasons and geolocations, can achieve usable forecasts integrating discrete data. Thus, building such predictive, One Health-oriented research and surveillance infrastructure will be imperative for India to achieve optimal pandemic preparedness.