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.

HbA1c, also known as hemoglobin A1c or glycated hemoglobin, is a widely used blood test to diagnose and monitor diabetes. However, ahead of World Diabetes Day, experts have warned that the test may not be accurate for everyone.

HbA1c measures how much glucose is attached to hemoglobin in red blood cells, providing an estimate of average blood sugar levels over the previous two to three months.

Certain medical conditions and blood disorders can affect its accuracy, making readings appear higher or lower than actual blood sugar levels.

Who May Get Inaccurate HbA1c Results?

Conditions such as anemia and hemoglobin disorders can affect HbA1c readings by altering the lifespan of red blood cells.

"HbA1c can be misleading when conditions alter red blood cell lifespan. Iron, B12 or folate deficiency may falsely elevate HbA1c. Conversely, hemolytic anemia, certain hemoglobinopathies, chronic blood loss, recent transfusion and some kidney conditions can lower it falsely," Dr Manisha Arora, Director of Internal Medicine at CK Birla Hospital, Delhi, told HealthandMe.

Dr Sandeep Kharb, Senior Consultant – Endocrinology at Asian Hospital, added that iron-deficiency anemia can also lead to falsely high HbA1c readings.

Experts also cautioned that HbA1c is not a direct measure of insulin resistance. A person may be insulin resistant even before their HbA1c reaches the prediabetes threshold.

What Medical Conditions And Medications Can Affect HbA1c?

Iron, vitamin B12 and folate deficiencies, chronic alcohol use, high-dose aspirin and severe hypertriglyceridemia may contribute to falsely elevated readings.

Falsely low results can occur with hemolytic anemia, hemoglobin disorders, blood loss, transfusions, pregnancy, kidney disease and erythropoietin therapy.

Certain medicines, including dapsone, ribavirin and some antiretroviral drugs, can also affect HbA1c interpretation. The direction of the error depends on the underlying condition and the testing method.

Can Fasting Blood Sugar Be Normal While HbA1c Is High?

Dr Himika Chawla, Senior Consultant, Endocrinology and Diabetology at PSRI Hospital, told HealthandMe HbA1c reflects average blood sugar over two to three months, while fasting blood sugar measures glucose at a particular point in time.

A person may have normal fasting glucose but experience repeated blood sugar spikes after meals, pushing their HbA1c higher. The reverse mismatch can also occur.

Doctors therefore consider both results and the patient's overall clinical picture before making a diagnosis.

What Test Should Be Used To Diagnose Diabetes?

When HbA1c may not be reliable, doctors can use blood glucose-based tests, including fasting plasma glucose and the oral glucose tolerance test (OGTT).

"First test it should be oral glucose tolerance test," Dr Anoop Misra told NDTV.

For the test, a person eats their usual meals for three days and then fasts for eight to 10 hours before their fasting blood glucose is measured. They then drink 75 grams of glucose mixed in water, followed by another blood test two hours later.

Misra explained that fasting glucose below 100 mg/dL and a two-hour reading below 140 mg/dL are normal. Fasting levels of 100–125 mg/dL or two-hour readings of 140–199 mg/dL indicate prediabetes. Fasting glucose of 126 mg/dL or higher, or a two-hour reading of 200 mg/dL or higher, falls in the diabetes range.

A new review of studies has found that people living with type 2 diabetes have a significantly higher risk of developing Alzheimer's disease.

Researchers from Curtin University conducted a systematic review and meta-analysis of 40 studies. They estimated that if 1,000 people with type 2 diabetes were followed for a year, an average of 4.7 would develop Alzheimer's disease.

Published in Alzheimer's Research & Therapy, a separate analysis found that type 2 diabetes was associated with a 53% higher adjusted relative risk of Alzheimer's disease compared with people without the condition.

How Does Blood Sugar Affect Memory?

Ahead of World Diabetes Day, Dr Sudhir Kumar, neurologist at Apollo Hospitals, Hyderabad, in a post on X, explained that several overlapping mechanisms may link type 2 diabetes to Alzheimer's disease. These include:

• Brain insulin resistance: Brain cells become less responsive to insulin, potentially impairing their ability to use glucose for energy and clear amyloid and tau proteins.
• Vascular damage: High blood sugar can damage large and small blood vessels in the brain, increasing the risk of strokes and vascular dementia.
• Chronic inflammation: Peripheral inflammation and lipid abnormalities can weaken the blood-brain barrier and trigger neuroinflammation.

How Does Diabetes Increase The Risk Of Dementia?

According to Alzheimer's Society UK, diabetes is an established risk factor for dementia. The risk also increases with the duration and severity of diabetes. However, having diabetes does not mean a person will necessarily develop dementia.

With diabetes and Alzheimer's disease cases rising globally, understanding the link between the two conditions is becoming increasingly important.

Insulin helps regulate blood sugar by enabling the body's cells to use glucose for energy. In people with diabetes, the body either does not produce enough insulin or cannot use it effectively, causing blood sugar levels to rise.

Studies have linked type 2 diabetes to an increased risk of dementia. In people with type 1 diabetes, severe and repeated episodes of high or low blood sugar have also been associated with a higher risk.

Diabetes and Alzheimer's disease may share certain underlying mechanisms. In both conditions, brain cells can become less responsive to insulin, potentially affecting brain function and contributing to the accumulation of amyloid and tau proteins associated with Alzheimer's disease.

How Can People With Diabetes Protect Their Brain Health?

Dr Kumar recommended the following measures for people living with type 2 diabetes:

• Maintain blood sugar levels: Aim to keep glucose within your target range.
• Avoid extreme fluctuations: Prevent prolonged high blood sugar (HbA1c of 7% or higher) and severe, repeated episodes of low blood sugar (hypoglycemia).
• Manage other health conditions: Keep blood pressure and cholesterol under control.
• Prioritise a healthy lifestyle: Eat whole foods, including vegetables, fruits and whole grains, and engage in regular physical activity to improve insulin sensitivity.

"Early detection, consistent blood sugar management, and working closely with your healthcare team can help safeguard your cognitive future," he said.

Four-year-old Deborah started school this year full of excitement. But she is struggling to understand why she now has to attend classes on a screen. The nursery student misses the school bus, chatting with friends and running around the classroom. Despite the appeal of screens, she finds it difficult to sit still for online lessons.

Coughing badly, she asks what pollution is and pleads with her family to let her play in the park.

Deborah is not alone. Across Delhi-NCR, children are facing similar disruptions as schools shift classes online amid deteriorating air quality, keeping them indoors for longer.

Air pollution in India is no longer just a winter problem. Although levels peak during the colder months, poor air quality has increasingly become a year-round concern, with Delhi-NCR experiencing severe pollution episodes.

Beyond its well-documented respiratory and developmental effects, pollution and the disruption it brings to children's daily lives may also affect their emotional well-being. HealthandMe spoke to health experts, who warned that reduced outdoor play, disrupted social interactions and increased screen time could add to children's psychological stress.

How Air Pollution Can Affect Children's Mental Health

Air pollution should not be viewed as an isolated exposure when examining its impact on children's mental health, said Dr. Pradeep B.S., a Professor of Epidemiology and Deputy Medical Superintendent at the National Institute of Mental Health and Neuro Sciences (NIMHANS) in Bengaluru.

"Air pollution is a macro-level effect. If we reduce it to individual-level effects, we are scientifically wrong," he told HealthandMe on the sidelines of the 11th Together Against Stigma (TAS) Conference, held in the national capital.

He said air pollution is associated with several broader changes, including increased traffic, population growth, climate disturbances and unpredictable weather patterns. Together, these can have a silent effect on people's psychological well-being, including that of children and adolescents.

The effects may not always be direct. Respiratory and gastrointestinal problems, for instance, can prevent children from going outdoors and participating in activities. Losing the opportunity to play can itself become a source of distress.

He also pointed to urbanisation and road expansion, which not only contribute to pollution but also reduce green spaces, playgrounds and community recreational areas. The combination can limit children's opportunities to play, interact and socialise.

Environmental Stress Can Also Affect Children's Emotional Well-Being

Dr. Pallab K. Maulik, the Director of Research at The George Institute for Global Health India said air pollution is one of the contributors to mental health concerns, with both Indian and international research examining the association.

He told HealthandMe that pollution and environmental disasters can create anxiety and stress among children, particularly those whose everyday lives are disrupted by these conditions.

Citing an example from one of his study sites, he recalled speaking to a child living in a slum area whose home gets flooded whenever municipal tankers wash the streets. The child has to spend two days drying her books after the water enters the house.

Dr Pallab also referred to children in the Sundarbans who regularly experience flooding and salinity-related problems.

He said some adolescents are now using platforms such as adolescent parliaments to bring their concerns to local administrators. While children are becoming more aware of environmental challenges, he said, much more needs to be done to understand how environmental changes affect their mental health.

Staying Indoors, Screen Addiction And Anxiety

Dr Syed Hubbe Ali - Health Specialist (RMNCHA) at UNICEF highlighted another possible consequence of pollution-related restrictions on outdoor activities: increased screen exposure among children and adolescents.

When children cannot go outside, they tend to spend more time indoors, often turning to mobile phones, social media and online content. This can create a cycle of screen dependence, he explained.

He described how the pursuit of dopamine, associated with the brain's reward system, can encourage children to keep scrolling through social media content.

The cycle can become more complicated when children begin posting content and seeking validation through likes and engagement.

"Once you start developing your roles, the next stage comes when you see how many likes I got. I got the likes, I don't get the likes. Then the anxiety, you know, it starts," Dr Ali told HealthandMe.

He explained that not receiving the expected engagement can cause distress and, in some cases, contribute to depressive feelings and risky behaviour.

Dr Ali also raised concerns about children spending more time on screens for online learning. Referring to an NCERT survey conducted after the COVID-19 pandemic among 3.7 lakh children, he said only 51% were able to understand online content.

He suggested that learning methods need to move beyond conventional online teaching and incorporate more games and interactive approaches to improve children's engagement.

Why Outdoor Play And Social Spaces Matter

Dr Pradeep emphasised that the impact of pollution cannot be separated from the wider changes taking place in children's surroundings.

Reduced access to green spaces and recreational areas can affect opportunities for physical activity, social interaction and play. When children are unable to participate in these activities, the effects can extend beyond physical health.

Dr Ali also highlighted the importance of outdoor activities and sunlight exposure in children's everyday lives. He said keeping children indoors for prolonged periods can increase their dependence on digital platforms as a source of entertainment and stimulation.