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 National Medical Commission (NMC) has issued an advisory mandating strict adherence to safe injection practices. The directive aims to curb preventable outbreaks of HIV, Hepatitis B (HBV), and Hepatitis C (HCV) caused by the unsafe reuse of syringes, needles, and other single-use medical devices.

Despite decades of evidence and repeated warnings from the World Health Organization (WHO), unsafe injection practices continue in India, often under the guise of cost-saving. This has led to avoidable infections, lifelong treatment costs, and a loss of public trust in healthcare systems.

What the NMC Advisory Says

The advisory mandates:

• Single-use devices must never be reused:Reuse of syringes, dialyzers, or vials is a direct breach of patient safety.
• Progressive adoption of safety-engineered auto-disable syringes: These devices prevent reuse and help protect healthcare workers from needle-stick injuries.
• Strict enforcement of the Biomedical Waste Management Rules, 2016: Proper segregation and disposal of sharps is mandatory.
• Mandatory training and audits: Healthcare workers must undergo regular competency assessments, and institutions must conduct strict monitoring.

Why Action Is Important

“India has the manufacturing capacity to supply safety-engineered syringes at scale. The barrier is not technology, it is willpower. Procurement administrators must prioritize patient safety over short-term cost-cutting,” said Rajiv Nath, Forum Coordinator of the Association of Indian Medical Device Industry.

“Single-use devices like syringes, dialyzers, and AV (Arteriovenous) fistula needles must not be reused. Unsafe injection practices are entirely preventable, and continuing them is indefensible,” he added.

The expert urged policymakers to act now because it is affecting

• Public Health : Treating HIV, HBV, and HCV infections acquired through unsafe injections costs far more than investing in safe injection devices.

• Global Credibility: As one of the world’s largest users of injectable medicines and vaccines, India’s leadership in safe injection, drug delivery, and blood management practices is critical to global health security.

• Patient Trust: Every reused syringe erodes confidence in healthcare institutions and undermines national health programs.

Read More: Ebola Alert In India: Rajasthan, Hyderabad Report Suspected Cases of Deadly Virus

Call to Action

The AiMeD stated that the NMC's advisory must be treated as a binding mandate, not a suggestion. Procurement administrators, hospital authorities, and policymakers should:

• Enforce zero tolerance for device reuse across all healthcare facilities.
• Allocate budgets for safety-engineered syringes, including auto-disable syringes and sharps injury-prevention devices, as a public health investment rather than a discretionary expense.
• Establish accountability mechanisms through accreditation schemes, including audits, reporting of needle-stick injuries, and penalties for non-compliance.
• Launch patient awareness campaigns to empower communities to demand safe injection practices.

"Unsafe injection practices are not a matter of affordability but of accountability. India has the capacity, technology, and cost-effectiveness evidence through Health Technology Assessment (HTA). What is needed now is decisive action to protect patients and healthcare workers alike," the AiMeD said.

Survival rates among patients with high-grade gliomas — one of the most aggressive forms of brain cancer — have improved by up to 50 per cent in India, according to leading oncologists ahead of World Brain Tumour Day 2026.

Doctors say a growing number of patients are now living significantly longer after diagnosis, with some surviving for more than a decade.

Advances Boost Survival Outcomes

Dr. Tejinder Kataria, Chairperson of Radiation Oncology at Medanta, said median survival for many high-grade glioma patients has increased from around 9–12 months to 14–18 months.

She noted that some centers are "reporting nearly 40 per cent two-year survival rates among patients with Grade III and Grade IV gliomas. In addition, about 5 per cent of patients in certain high-grade glioma groups are now surviving for more than 10 years".

Experts attribute these improvements to advances in molecular diagnostics, comprehensive genomic profiling, neuronavigation-assisted surgery, precision radiation therapy, and targeted treatments.

“Radiation oncology has evolved from open beams in the cobalt era to highly precise beam configurations using modern technologies. We are now able to deliver tumoricidal doses more accurately while also preserving quality of life,” Dr. Kataria said.

Personalized Treatment Changing Care

Also read: Ebola Alert In India: Rajasthan, Hyderabad Report Suspected Cases of Deadly Virus

Dr. R. Ranga Rao, Chairman of Medical Oncology at Paras Health, said brain tumor treatment is no longer limited to surgery and radiation.

A deeper understanding of tumor biology is enabling doctors to tailor treatment according to the molecular profile of each patient’s cancer.

“Although high-grade gliomas remain challenging to treat, the combination of precision diagnostics, modern therapies, and multidisciplinary specialist care is helping more patients live longer and maintain a better quality of life than was possible even a few years ago,” Dr. Rao said.

He also highlighted the growing role of whole genomic sequencing, which helps clinicians understand a tumor’s genetic makeup and select more personalized treatment strategies that may improve survival.

Patients Should Not Lose Hope

Dr. Shyam Agarwal, Senior Consultant in Medical Oncology at Sir Ganga Ram Hospital, said many patients fear the worst when diagnosed with a brain tumor.

“People often feel that nothing can be done once they hear the word tumor in the brain. But brain tumors are of many different types — benign and malignant — and even malignant tumors vary widely in behavior,” he said.

According to Dr. Agarwal, modern treatment options, including surgery, radiation, targeted therapies, and newer drugs, can control many brain cancers for extended periods and may even offer a cure in selected cases.

He also stressed the importance of molecular testing and comprehensive genomic profiling to identify patients who may benefit from precision medicines.

Late Diagnosis Remains a Major Challenge

Despite advances in treatment, experts say delayed diagnosis remains a significant problem in India.

“The biggest blind spot in our country is that many patients reach specialists at a late stage. Symptoms may masquerade as routine headaches, hearing deficits, or visual disturbances. We need greater awareness,” Dr. Kataria said.

Dr. Agarwal added that delayed diagnosis is due to symptoms such as persistent headaches, hearing problems, or vision disturbances which are often mistaken for stress, migraine, or other common conditions, leading to late referrals.

What Is Glioma?

As per the Johns Hopkins Medicine, glioma is a common type of tumor originating in the brain. About 33 per cent of all brain tumors are gliomas, which originate n the glial cells that surround and support neurons in the brains, including astrocytes, oligodendrocytes and ependymal cells.

Gliomas are called intra-axial brain tumors because they grow within the substance of the brain and often mix with normal brain tissue. Symptoms include

• Headaches
• Seizures
• Personality changes
• Weakness in the arms, face or legs
• Numbness
• Problems with speech
• Nausea and vomiting
• Vision loss
• Dizziness.

With advancements in medical technology, hip replacement surgery has evolved significantly over the years. One of the most promising innovations in this field is the Direct Anterior Approach (DAA) Total Hip Replacement, a modern technique that offers patients a safer procedure, reduced pain, and faster recovery.

Unlike traditional hip replacement surgeries, the DAA technique allows surgeons to access the hip joint from the front through a small incision. The biggest advantage of this approach is that muscles are not cut during the surgery. Instead, they are gently separated, which helps minimize tissue damage and reduces post-operative pain considerably.

This muscle-sparing approach has transformed patient recovery experiences. Most patients are able to stand and walk on the same day of surgery, and hospital stays are generally shorter. Recovery is smoother, allowing individuals to return to their normal routine within three to four weeks in most cases.

The DAA technique is especially beneficial for patients suffering from chronic hip pain, restricted movement, or severe joint damage. Common conditions that may require hip replacement include osteoarthritis, avascular necrosis (AVN), rheumatoid arthritis, old hip fractures, and long-standing degenerative joint conditions. When medications, physiotherapy, and injections fail to provide lasting relief, hip replacement surgery can significantly improve mobility and quality of life.

Compared to conventional hip replacement procedures, DAA offers several advantages. The surgery involves a smaller incision, less blood loss, minimal muscle damage, and lower post-surgical discomfort. Patients are able to regain movement faster and often experience greater confidence during rehabilitation.

One of the most common concerns among patients is the fear of severe pain after surgery. However, with modern pain management techniques and advanced surgical methods, discomfort after DAA hip replacement is usually minimal and manageable. Patients today recover much more comfortably than they did in the past.

Another important factor is the durability of modern implants. Advances in implant technology have significantly improved their lifespan, with many implants lasting more than 25 years. Maintaining a healthy body weight, staying physically active, and following medical advice can further improve the longevity and effectiveness of the implant.

After successful recovery, patients are generally able to resume a normal and active lifestyle. They can return to work, perform household activities independently, and participate in light exercises such as yoga, swimming, and stationary cycling. The primary goal of hip replacement surgery is not just pain relief, but restoring confidence, mobility, and independence.

Preparation before surgery also plays an important role in achieving better outcomes. Patients are advised to maintain controlled blood sugar levels, blood pressure, and overall heart health. Informing doctors about ongoing medications, performing basic physiotherapy exercises before surgery, and preparing a comfortable recovery environment at home can contribute to a smoother rehabilitation process.

Hip pain should never be ignored, especially when it begins affecting daily life and mobility. Timely treatment and the right surgical approach can make a remarkable difference. The Direct Anterior Approach has made hip replacement surgery simpler, safer, and more patient-friendly, helping individuals return to an active and pain-free life much faster than before.

Dr. Ishwar Bohra is Senior Director and Senior Joint Replacement Surgeon at BLK-Max Super Speciality Hospital, New Delhi.