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.

A mammogram is routinely used to detect early signs of breast cancer, but the imaging test may also provide clues about a woman’s cardiovascular health.

Cardiovascular disease is a major cause of death among women. Yet, experts say heart disease in women can be overlooked because symptoms and risk factors may differ from the patterns traditionally associated with men.

Why Heart Disease Can Be Missed In Women

Prof Rob Galloway of University Hospitals Sussex NHS Foundation Trust, writing in the Daily Mail, highlighted the need to identify cardiovascular disease in women earlier.

Citing a 2021 The Lancet study, he noted that women with cardiovascular disease remain “understudied, under-recognized, underdiagnosed, and undertreated.”

Galloway said he regularly sees women, particularly those in their 60s, arriving in emergency care with heart attacks after earlier symptoms were attributed to less serious causes.

“If that had been recognized, she could have been admitted, and if needed, had a stent (a mesh tube) inserted to open the artery before it was blocked,” he wrote.

“The truth is doctors are not as good as we should be at recognizing heart disease in women, or understanding their risk,” he added.

Also read: New Breast Cancer Guidelines Recommend Mammograms Every Two Years for Women

Heart Attack Symptoms May Look Different In Women

Women may experience heart attacks differently, with symptoms such as breathlessness, nausea, fatigue, or back, neck and jaw pain. Galloway also highlighted female-specific risk factors, which include:

• Preeclampsia or high blood pressure during pregnancy
• Gestational diabetes
• Premature menopause
• Polycystic ovary syndrome (PCOS)

He said these factors are not always routinely included when assessing a woman’s long-term cardiovascular risk.

What Can A Mammogram Reveal About Heart Risk?

Read More: World Heart Day: You Feel Healthy. But Plaque May Already Be Building In Your Arteries In Your 20s

Prof Galloway suggested that routine breast screening could potentially offer another opportunity to identify cardiovascular risk.

When blood vessels are damaged, calcium can accumulate in their walls. Mammograms can sometimes detect calcium deposits in the arteries of the breast, known as breast arterial calcification (BAC).

BAC is different from calcium buildup in the coronary arteries, but its presence has been associated with a higher risk of cardiovascular events such as heart attack and stroke. Some radiologists may therefore flag the finding to the treating doctor.

Could AI Detect Heart Risk From Mammograms?

Prof Galloway also discussed the potential role of artificial intelligence in identifying and measuring breast arterial calcification.

A European Heart Journal study used AI to assess mammograms from over 123,500 US women. Compared with no calcification, mild breast arterial calcification was linked to a 30% higher cardiovascular event risk, moderate to 75–80% higher risk, and severe to roughly three times higher risk.

The association persisted even after researchers accounted for established cardiovascular risk factors such as obesity and smoking.

Could Mammograms Become A Cardiovascular Screening Tool?

Prof Galloway said that the potential advantage is that the mammogram has already been performed for breast screening. If arterial calcification is identified, that information could potentially be included with the screening result and prompt a broader cardiovascular risk assessment.

Depending on the woman's overall risk, doctors could then consider measures such as more intensive management of blood pressure or cholesterol.

A coronary artery calcium scan is another way to assess calcium buildup in the arteries supplying the heart. It uses a CT scan to detect and measure coronary artery calcium and can help inform cardiovascular risk assessment in appropriate patients.

One may dismiss a recurring ache in the calf or thigh while walking may as a muscle problem, especially if it settles after sitting or resting. But leg pain that repeatedly appears while walking and eases after resting can sometimes be due to a circulation problem called peripheral artery disease (PAD).

The condition occurs when arteries that carry blood to the legs become narrow, usually because of atherosclerosis, which is the buildup of fatty deposits inside blood vessels. PAD can be a major sign that the same process is also affecting arteries in the heart and brain, signalling a major cardiovascular risk.

Women May Overlook The Symptoms

PAD can be difficult to identify as it comes with ordinary symptoms that could be tied to ageing or injury.

Women may neglect it as they may experience less obvious symptoms, including leg fatigue or weakness rather than cramping. This is because the condition is affected by ageing, fitness, or a musculoskeletal issue.

Apart from pain during walking, possible symptoms include:

• Coldness in one foot or leg
• Numbness or weakness
• Changes in the colour of the skin
• Shiny skin or loss of hair on the legs
• Slow-growing toenails
• Sores on the feet or legs that heal slowly
• Pain in the feet or toes, particularly at rest in more advanced disease

Some people may have no noticeable symptoms, which can allow PAD to progress without being recognised, leading to serious complications.

Also read: Pomegranate Compound Improves Heart Function By Up To 80% In Early Heart Failure Study

Canada Is Focusing On PAD

The disease has prompted a new Canadian National Action Plan for Peripheral Artery Disease, developed by vascular medicine experts with the Canadian Society of Vascular Medicine and Prevention.

The plan calls for greater public awareness, early diagnosis, better access to ankle-pressure testing, supervised exercise programmes and specialised care for people with PAD.

The Canadian authors also said that PAD can be difficult to diagnose in rural and remote communities and among Indigenous Peoples and other underprivileged populations, where access to preventive care and vascular specialists may be limited.

Delayed diagnosis can mean that people are only identified after complications like non-healing wounds or in severe cases, amputation.

Also read: 100% Blockage At 18, 25% Patients Under 40: On World Heart Day, Cardiologists Reveal An Alarming Heart Attack Pattern

PAD Is Linked To Heart Attack And Stroke

PAD happens when narrow and blocked arteries reduce the blood flow to the legs. When the muscles need more oxygen during walking or exercise, the reduced circulation can lead to uncomfortable pain.

This symptom is called intermittent claudication. The pain usually develops in the calf, thigh or buttocks while walking. It subsides or improves after sitting down or resting the legs.

But not everyone experiences this symptom. Some may instead face tiredness in the legs, weakness, numbness or just discomfort, making it easier to dismiss the symptom.

The arteries in the legs are not isolated from the rest of the circulatory system. PAD is usually caused due to atherosclerosis, the same underlying process that could lead to thinner arteries supplying blood to the heart and brain.

As a result, having PAD can indicate a higher risk of heart attack, stroke and other cardiovascular complications. PAD risk increases with age, but several other lifestyle factors can contribute. These include:

• Smoking
• Diabetes
• High blood pressure
• High cholesterol
• Family history of vascular disease

Diabetes is most likely to contribute to PAD because persistently high blood sugar can damage blood vessels and increase the risk of atherosclerosis.

When To Seek Medical Intervention?

If leg pain or unusual tiredness keeps interrupting your life, it is worth getting evaluated, particularly if you have diabetes, smoke or have high blood pressure or cholesterol.

Doctors may assess circulation using an ankle-brachial index (ABI), which compares blood pressure in the ankle with blood pressure in the arm.

Treatment may include lifestyle changes like increasing physical activity, quitting smoking and medicines to manage cholesterol, blood pressure, and blood clotting risk. Severe blockages may also require medical procedures.

There are many patients with CKD and CKD touches more than just the kidneys. CKD also influences parts of the body and as kidney function falls changes in the body can affect the brain. This may raise the chance of memory problems trouble concentrating and other types of impairment. For people living with CKD, those whose disease is advanced protecting cognitive health can become an important part of overall care.

CKD can arise from causes with diabetes as a leading one. In some groups diabetes accounts for than half of CKD cases. When diabetes meets CKD, the risk of vascular disease rises. This disease builds fatty deposits inside blood vessels. If those vessels feed the brain blood flow can drop. Reduced brain blood flow can lead to problems and raise the risk of dementia.

Waste Build-Up And Electrolyte Changes May Affect Thinking

Another important factor is the build‑up of waste in the blood. Healthy kidneys waste and excess substances. When CKD lowers kidney function these substances linger. The lingering waste can disturb brain function. Symptoms may include trouble paying attention, slower thinking, confusion or memory problems.

Electrolyte disturbances can also play a role especially when CKD changes the balance of minerals in the body.

Hyponatremia or abnormally low levels of sodium in the blood is relatively common in people with CKD. It can disturb brain function.

Depending on severity and how fast it appears hyponatremia can cause confusion, difficulty concentrating, drowsiness and in cases more serious neurological symptoms.

Also read: Diabetes Linked To 55% Risk Of Kidney Disease, Heart Failure Or Death Within 10 Years: Study

How Dialysis And Treatment History Can Influence Cognitive Health

Treatment‑related factors may also be relevant for some patients.

In the past dialysis patients who received aluminium‑containing medicines, such as some antacids or phosphate‑binding preparations faced a risk of aluminium build‑up. High levels of aluminium were linked to problems, including cognitive impairment. Today dialysis practices and medicines have cut this risk dramatically so aluminium is now an issue rather than a common cause of cognitive problems in dialysis patients.

Why Early Recognition Of Cognitive Changes Matters

As CKD moves forward into advanced stages the risk of cognitive impairment grows. Many factors can act together: disease, metabolic and electrolyte changes, anaemia, inflammation, heart complications and the build‑up of toxins that healthy kidneys would normally flush away.

Not every person with CKD will develop dementia. Cognitive changes should not be brushed off as normal ageing. New problems, with memory, concentration orientation or daily tasks need to be talked about with a doctor.

Early recognition is important because some of these factors can be treated or reversed.

Keeping diabetes and blood pressure under control managing heart risk factors correcting electrolyte imbalances and getting kidney care all help protect both kidney and brain health.