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.

Delhi woke up again to a thick layer of smog, with Delhi's AQI hovering over 300 on the Air Quality Index on Thursday morning under "very poor" category. After a long nine-day wait, city's AQI had slipped under "poor" category on Tuesday, but it is again back on the "very poor" category, while on Wednesday, there were strong winds that dispersed the pollutants. Yet the condition of the air quality remains bad.

As a result of this many people are leaving the city, or have at least considered leaving the city.

"I Felt Breathless And Constantly Fatigued"

Nikita Singh, 31, who runs a remote PR boutique agency was living in Delhi on and off for two years because it was two years back when she struggled to breathe during Delhi winters. "The pollution levels were so extreme that I felt breathless and constantly fatigued. That was the first time I seriously questioned whether I could continue living here long-term," she says.

For the first two years, she kept "oscillating". "I would stay in Delhi for work during peak months, then leave when pollution became unbearable, especially from November to January. Every return felt heavier. I had my eyes burning, headaches, chest tightness and a general feeling of 'I cannot do this forever'."

She has now permanent moved away from Delhi to Jodhpur, in Rajasthan, where she works remotely. However, it has not been easy on her. "Emotionally, it was tough because Delhi had become familiar, and my life and work circle were mostly based there," she says. However, thanks to her fully remote work and that fact that she had decided to prioritize her health, she was able to make the move.

She says that Jodhpur offers the cleaner air which she "never felt in Delhi". Her decision to move also came with her family uprooting from Delhi. "My family and I shifted together. AQI was a major trigger. We realized we could not keep exposing ourselves to those levels of pollution year after year," she reveals.

Migration And Pollution: More Delhiites Are Considering To Move Out Of The City

She is not alone, Vikash Makkar, a freelance linguist specialist and a journalist, who had been living in Delhi from the last 12 years, moved back to his hometown in Jamshedpur. "Since October with an unplanned journey, I moved to my hometown and have been living there. It is quite relaxed here as compared to Delhi's ongoing pollution crisis that I had faced," he shares.

29-year-old Riya Baibhawi also uprooted from the city. She had been living in Delhi from last 5 years. She is currently living in Ludhiana, Punjab, and her decision to leave city is also affected by the pollution. Though, it was not easy for her. "It was very tough because it was very difficult to find career opportunities with competitive salaries outside Delhi-NCR. It also required a cut down of my social life, which adversely affected my mental health," she says. She shares that one of her friends, who had been living in Noida for the last 20 years had also moved out as pollution exacerbated her asthma.

Another family, who have been living in Delhi's Karol Bagh for more than two decades now are considering moving out of Delhi. "They are looking for properties outside Delhi where air is cleaner," shares their 26-year-old daughter who now lives in her marital home in Noida.

As per a survey by a consumer insights platform Smytten PulseAI, about 34.6% of the residents surveyed in Delhi NCR have considered to move out of the city due to worsening air. A 2023 study published in the International Journal of Environmental Research and Public Health shows that if the level of PM2.5 increases by 10µg/m3, migrants coming into the city will be reduced by 21.2%. While migration in the city has been ongoing, pollution does show some strains of people moving out of the city.

As per the Air Quality Life Index released by the Energy Policy Institute at the University of Chicago (EPIC), the fine particulate matter or PM2.5 in air will shorten an average Indian's life expectancy by 5.3 years, and in Delhi, it could shorten a person's life span by 11.9 years. However, the Union government has said in the parliament that there is "no conclusive national data to establish a direct correlation between deaths or diseases occurring exclusively due to air pollution". This statement comes at a time when doctors themselves noted a surge in cases due to pollution and have urged people to leave the cities.

The internet is obsessing with the idea that Japan has a fat law, it fines people for being "fat". Talk about sensational headlines, mistranslations, and social media exaggerations. But what does Japan's so-called 'fat law' actually say? Does it really change anything?

Health and Me did a closer fact check on Japan's Fat Law, and here is what we found.

Japan's Metabo Law: What It Really Means?

In 2008, the Japanese Ministry of Health, Labour and Welfare introduced the Metabolic Syndrome Countermeasures Promotion Law, which was popularly nicknamed the 'Metabo Law'. the word 'metabo' comes from metabolic syndrome, a cluster of high-risk conditions that include elevated blood pressure, high blood sugar, abnormal cholesterol, and excess fat around the waist. If left untreated, this could increase the risk of heart attacks, stroke and diabetes.

The law's main focus is on identifying these risks as early as possible. As part of Japan's long-standing annual health check tradition, about 50 to 56 million adults aged 40 to 74 undergo this mandatory waist measurements every year. The waistline thresholds are:

• 85cm for men
• 90cm for women

While the numbers are not arbitrary, they match the International Diabetes Federation's guidelines used to screen metabolic risks.

Is It Illegal To Be Overweight In Japan?

The Times-Union fact check confirms: "Japanese citizens cannot be fined or imprisoned for being overweight". RosePlus Japan also reports that the term "fat tax is a mistranslation and that "it is not illegal to be fat in Japan".

The law does not:

• Fine individuals for their weight
• Send people to jail for being overweight
• Deport or deny visas based on size
• Ban obese people

How Does The Law Actually Work?

The law basically shifts the responsibility away from individuals to governments and employers.

Annual measurement: Employers and local authorities measure the waistlines of eligible adults.

If someone exceeds the limit:

• They are offered counseling, health guidance, and follow-ups.
• After three months, progress is reviewed.
• After six months, they may receive additional health education.

No individual penalties: There is no fine for not losing weight.

Employer penalties:

• If a company fails to reduce the percentage of employees at risk, it may face increased contributions to national healthcare funds.
• Companies like NEC previously estimated potential fines of up to $19 million for not meeting targets

This structure makes the Metabo Law more of a workplace wellness mandate than a personal weight regulation.

Lost In Translation

Much of the misunderstanding comes from how Japanese concepts were translated in English. With the word "law" being reported internationally, it implied a strict legal prohibition.

"Metabo" was incorrectly equated was being "fat", losing its medical meaning.

Was The Law Successful?

• Japan already had one of the lowest obesity rates in the world, around 3.5 percent in 2009, compared to over 30 percent in many Western countries.
• Life expectancy in Japan has remained among the highest globally.
• However, obesity rates among men (based on BMI 25+) reportedly continued rising, reaching 31.7 percent in 2022 according to The Japan Times, as cited in the HR Digest analysis

However, there have been things that changed since 2008. This includes companies offering nutrition workshops, physical activity support, health check programs for employees and their families. The annual health checks are now more structured. People flagged for metabolic syndrome were connected with counselling and monitoring, which can reduce long-term medical costs. The conversation has now also shifted towards body autonomy, public health and role of employers in personal wellness.

In a what doctors call an "exceptionally rare event', a Michigan man has died of rabies after receiving a kidney from a donor who was unknowingly infected with the virus. A recent report from the Centers for Disease Control and Prevention (CDC) gives information on how this rare medical event took place, with a surprising chain of exposures that vegan with a skunk scratch.

A Routine Kidney Transplant That Took a Sudden Turn

The Michigan patient underwent a kidney transplant at an Ohio hospital in December 2024. For several weeks, he seemed to be recovering normally. About five weeks after the procedure, he suddenly developed worrying symptoms such as tremors, weakness in his lower limbs, confusion and urinary incontinence. His condition deteriorated quickly and he was admitted to the hospital, soon requiring ventilation. Despite treatment, he passed away. Postmortem tests confirmed that he had rabies, a diagnosis that shocked doctors since his family said he had not been around any animals.

The Donor’s Skunk Encounter Comes to Light

The unexpected diagnosis pushed doctors to take another look at the kidney donor, a man from Idaho. In the Donor Risk Assessment Interview, he had mentioned that a skunk had scratched him. At the time, this detail did not raise major concern. When investigators spoke to the donor’s family again, they learned more about the incident. A couple of months before his death, the donor had been holding a kitten in a shed on his rural property when a skunk approached and behaved aggressively. He stepped in to protect the kitten and managed to knock the skunk unconscious. Before that happened, the animal scratched his shin deeply enough to draw blood. He believed he had not been bitten, and the incident was never viewed as a medical emergency.

The Donor’s Rapid Decline

Around five weeks after the skunk encounter, the donor began showing symptoms that closely resemble rabies. He became confused and had trouble swallowing and walking. His family said he experienced hallucinations and complained of a stiff neck. Two days later, he was found unresponsive at home after what was believed to be a cardiac arrest. He was resuscitated and hospitalized but never regained consciousness. He was declared brain dead after several days, and his organs, including his left kidney, were donated.

What Investigators Found

Once rabies was detected in the kidney recipient, authorities examined stored laboratory samples from the donor. These tests were initially negative. However, kidney biopsy samples revealed a strain that matched silver-haired bat rabies. This finding suggested that the donor had in fact died of rabies and unknowingly passed the virus to the transplant recipient.

Investigators believe a likely three step transmission occurred. A bat infected a skunk, the skunk infected the donor, and the donor’s kidney infected the recipient. The CDC noted that only three other cases of rabies transmission through organ transplantation have been reported in the United States since 1978.

Steps Taken to Protect Other Recipients

Three other people had received cornea grafts from the same donor. Once the risk was identified, the grafts were removed and all three individuals received Post Exposure Prophylaxis. They remained healthy and showed no symptoms.

A Reminder of Rare but Real Risks

Rabies is not routinely tested for in organ donors because human cases are extremely rare and difficult to diagnose. In this situation, the donor’s earlier symptoms were attributed to existing health conditions. Speaking to the New York Times, Dr Lara Danziger-Isakov said the case was exceptionally rare and reminded the public that the overall risk to transplant recipients remains very small.