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.

The Black Death swept across Eurasia and North Africa between 1346 and 1353, killing an estimated 30% to 60% of Europe's population.

Plague continued to recur in Europe over subsequent centuries, causing millions of deaths. Caused by Yersinia pestis, the same bacterium responsible for plague today, the Black Death was primarily associated with bubonic plague, although pneumonic plague also occurred.

Bubonic plague typically spreads through infected flea bites, while pneumonic plague affects the lungs and can spread between people through infectious respiratory particles during close contact. All forms can be fatal without prompt treatment, but antibiotics are effective when administered early.

India's 1994 Plague Outbreak

Although often associated with medieval history, plague continues to occur in parts of the world.

In 1994, India experienced an outbreak involving both bubonic and pneumonic plague, following heavy flooding and reports of exposure to dead rats.

“When the plague outbreak happened in India, I was one of the people who investigated it. The outbreak involved bubonic plague, which can be treated with antibiotics, and Surat also saw 64 to 68 cases of pneumonic plague. We identified the plague bacillus and traced its cycle in the surrounding wildlife. Plague surveillance in rats and other animals is essential to detect outbreaks early and take preventive measures,” Dr. N.K. Ganguly, former Director General of the Indian Council of Medical Research (ICMR), told HealthandMe.

There were 693 suspected cases that tested positive for Yersinia pestis antibodies and 56 deaths nationwide.

Surveillance, hygiene and timely treatment were essential to controlling the disease, said Dr. Amitabh Banerjee, an epidemiologist and former member of the Indian Armed Forces’ mobile epidemic investigation team. He investigated the 2002 pneumonic plague outbreak in Himachal Pradesh, which caused 16 cases and four deaths.

Plague Still Exists In Africa And The US

In the US, an average of about seven human plague cases are reported annually, mostly in rural areas of the American West, according to the Centers for Disease Control and Prevention (CDC).

The continued presence of Yersinia pestis in animal populations means the disease has not been eradicated.

“People think the plague is gone, it was something that occurred 500 years ago. It's not. It's here amongst us,” Simon Clarke of the University of Reading in the UK told the Associated Press. “Unless you get rid of those wild animals, which of course is not possible, then you're not going to get rid of the bacteria.”

Russia's Plague Scare: What We Know

Russia has completed checks following the October 2 death of 28-year-old laboratory worker Darya Shipilova in Siberia. Authorities have not confirmed plague as the cause, describing her illness as pneumonia of unknown origin. Nearly 5,000 samples reportedly showed no dangerous pathogens.

Reports of a second death linked to the plague was called "fake news" by Russia, and no plague outbreak has been confirmed in Russia. The WHO and US have requested Russia for more transparency regarding the cases.

Can Plague Be Eradicated?

Plague persists because Yersinia pestis circulates naturally among wild and domestic animals, including rodents, and their fleas. Eliminating human cases in one location does not remove the bacterium from these animal reservoirs.

Dr. Banerjee said plague can be deadly, particularly when it affects the lungs, but modern antibiotics are highly effective when treatment begins early.

“Plague cannot be eradicated because it is in wildlife, it is in rodents and all. So the only thing is hygiene and, with modern antibiotics, there should not be any panic,” he told HealthandMe.

Bubonic plague does not typically spread directly between people, while pneumonic plague can spread through infectious respiratory particles during close contact. Pneumonic plague can progress rapidly and requires urgent treatment.

Dr. Banerjee cautioned against assuming that a suspected case automatically signals a wider outbreak, noting that early diagnosis and appropriate antibiotic treatment are crucial.

Indian jewelery designer Saba Ali Khan, daughter of veteran actress Sharmila Tagore and cricketer Mansoor Ali Khan Pataudi, has opened up about her brain tumor diagnosis at the age of 27.

Speaking on her sister, actress Soha Ali Khan’s podcast, Saba recalled that her diagnosis came as a surprise, without common warning signs such as headaches or vision loss.

Dr. Mazda K. Turel, the neurosurgeon who treated her at Wockhardt Hospitals, Mumbai, told HealthandMe that people with brain tumors can be “walking, talking and functioning normally” despite having a potentially serious tumor. He explained why tumors can go unnoticed and which symptoms warrant medical attention.

How Saba Ali Khan Discovered Her Brain Tumor

Saba recalled fainting while out with a friend. After losing consciousness a second time, she took around 20–25 minutes to regain consciousness.

An MRI revealed a shadow in the third ventricle of her brain. Doctors initially diagnosed a colloid cyst, a rare, non-cancerous growth.

Six months later, she underwent surgery and was diagnosed with pilocytic astrocytoma, a slow-growing, generally low-grade tumor of the brain or spinal cord.

Also read: Survival In Aggressive Brain Tumors Improves By Up To 50% in India, Say Doctors

Why Brain Tumours Go Undetected In Young Adults

“Brain tumors don’t check your age before making an appearance,” Dr. Turel said. “In young adults, symptoms are often dismissed as stress, migraines, fatigue or lack of sleep. Some tumors grow slowly, allowing the brain to adapt remarkably well.”

“The brain has an extraordinary ability to compensate, especially when a tumor grows slowly or develops in a relatively silent area,” he explained.

Early signs may include persistent headaches, subtle personality changes, difficulty concentrating, blurred vision and unexplained seizures. Other clues include forgetting familiar words, unexplained irritability, occasional imbalance and brief episodes of staring or losing awareness.

Sometimes, family members notice changes before the patient does. Dr. Turel illustrated the difference between ordinary forgetfulness and a potentially concerning change: “If you forget keys, that is OK, but if you forget what the keys are for,” it is a sign to get checked.

“The problem is that these symptoms are common, but their persistence or progression is what deserves attention,” he told HealthandMe.

How Tumor Location Affects Symptoms

Read More: Can 'Eye Strain' Lead To Brain Cancer? Experts Explain

Symptoms often depend more on where a tumor is located than on its size, Dr. Turel explained.

• Frontal lobe: Changes in personality or judgement.
• Temporal lobe: Memory problems or unusual seizures.
• Visual pathways: Blurred or double vision.
• Cerebellum: Problems with balance and coordination.

“New speech difficulties, weakness, unexplained seizures or progressive cognitive changes should never be casually dismissed,” he warned.

Brain Tumor Or Migraine: When Should A Headache Worry You?

Migraines usually follow a recognizable pattern and may involve nausea or sensitivity to light and sound, Dr. Turel said.

Tumor-related headaches are more concerning when they are new, progressively worsening, different from previous headaches or accompanied by neurological changes. They may be worse in the morning or with coughing and straining, although this is not always the case.

A persistent headache that progressively worsens, wakes someone from sleep or occurs with vomiting, visual changes or neurological symptoms warrants medical evaluation.

"A sudden, explosive headache that reaches maximum intensity within seconds—a thunderclap headache—is a medical emergency," the neurosurgeon said, noting that it can occur while "walking, talking and functioning normally"

It may indicate bleeding around the brain from a ruptured aneurysm rather than a tumor. Sudden weakness, confusion, loss of consciousness or a first seizure also require emergency assessment.

“Most headaches are not caused by brain tumors, and a headache alone rarely indicates one. The key is not to panic about every headache, but to recognize when an old familiar headache begins behaving like a stranger,” Dr. Turel said.

When was the last time you stood in a queue without looking at your phone? Or had a cup of tea without scrolling through messages? Or sat in a car, waiting for someone, without opening Instagram simply because there was nothing else to do?

Try it today. Put your phone away for 10 minutes and do absolutely nothing with it. It sounds easy. For many of us, it isn't. The first thing you may notice is not peace, but restlessness. You may wonder if someone has messaged you. You may feel like checking the news, looking at the time or opening an app without even knowing why.

As a neurologist, I find this interesting because it tells us something about how we have trained our attention. Our phones have become so closely woven into everyday life that we often reach for them before we even realize we are bored.

The problem isn't the phone. It's the constant need for stimulation. There is nothing inherently wrong with using a smartphone. We use it to work, communicate, navigate, learn and stay connected.

The problem begins when every small gap in our day has to be filled.

Waiting for the lift? Check the phone.

Waiting for your coffee? Scroll.

Watching television? Check messages.

Feeling slightly bored? Open an app.

Our brains are naturally drawn towards novelty. A notification, a new message or a fresh video gives our attention something new to respond to. When this happens repeatedly, checking the phone can become almost automatic.

That is why I sometimes ask patients not only how much time they spend on their phones, but how often they feel the need to check them. Those are two very different questions.

What Happens When The Screen Goes Away?

The first few minutes may feel surprisingly busy inside your head. An unfinished conversation may come to mind. So might tomorrow's meeting, a pending task or something that has been worrying you. You may also find yourself simply daydreaming.

We often assume that a quiet mind should mean an empty mind. It doesn't. When there is no constant stream of information coming from outside, the mind naturally moves towards memories, plans, emotions and thoughts that have been sitting in the background.

That isn't necessarily overthinking. It is part of normal mental activity. Sometimes we are so quick to distract ourselves that we don't give ourselves the opportunity to notice what we are actually thinking or feeling.

What Should Concern Us Is Fragmented Attention

There is another part of this conversation that gets overlooked. We often talk about screen time, but the way we use our screens matters too. Imagine someone working on an important task but checking WhatsApp every few minutes, responding to an email, looking at a notification and then returning to the original task. Even if the total phone usage doesn't look alarming, their attention has been repeatedly pulled away.

Over time, this can make uninterrupted concentration feel uncomfortable.

So instead of asking only, “How many hours am I on my phone?”, perhaps we should occasionally ask, “How often am I allowing my attention to be interrupted?”

Try The 10-minute Test

You don't need to give up your phone or spend an hour meditating. Start small.

Have your morning tea without a screen. Sit on the balcony. Take a short walk without headphones. Wait for five or 10 minutes without automatically reaching into your pocket.

Don't try to stop your thoughts. Just notice them. You may discover that you are more restless than you expected. Or perhaps you will find that your mind settles after a few minutes.

Either way, that is useful information. Mental wellbeing isn't only about learning how to manage stress when it becomes overwhelming. It is also about creating small pockets of time in which the brain isn't constantly being asked to consume, respond and move on.

In a world that has made every spare minute scrollable, being comfortable with a little silence may be a surprisingly valuable habit for the brain.

(Dr Neha Pandita, Senior Consultant Neurologist and Unit Head, Clinical Lead - Parkinson's disease & Movement Disorders, Fortis Hospital, Noida)