People living with this disease must regularly monitor their blood sugar levels, inject or infuse insulin, and carefully regulate doses with eating and activity throughout the day. Polyuria occurs when your body urinates more frequently—and often in larger amounts—than normal.
Frequent urination is also a symptom of undiagnosed type 1 diabetes that can lead to extreme dehydration and eventually affect your kidney function. Polyuria in diabetes occurs when you have excess levels of sugar in the blood. Normally, when your kidneys create urine, they reabsorb all of the sugar and direct it back to the bloodstream. With type 1 diabetes, excess glucose ends up in the urine, where it pulls more water and results in more urine.
Frequent urination may be one of the first signs that you have high blood sugar , a hallmark sign of diabetes. When you have diabetes, your body is unable to regulate blood sugar levels.
Excess sugar causes more fluids to pass through the kidneys and increases urinary frequency, known as polyuria. Polyuria is not as serious as many other complications commonly associated with diabetes , such as blindness, heart disease, stroke, kidney failure, amputation, and premature death.
Frequent urination is not the only bladder problem that occurs in people with diabetes. They may experience a frequent urge to urinate even if only a small amount of urine comes out , a loss of bladder control that results in leaking urine, and urinary tract or fungal infections.
Such infections can also lead to an increase in urinary frequency and incontinence, especially in the elderly. Any mechanism of hepatic dysfunction that occurs in pregnancy pre-eclampsia, HELLP, acute fatty liver will augment this normal physiology by reducing vasopressinase clearance, and can subsequently lead to transient DI Primary nephrogenic DI occurs as a result of genetic mutations affecting either the vasopressin 2 receptor or aquaporin-2 water channels; typically, such conditions present in infancy.
Lithium enters the principal cell in the collecting duct via epithelial sodium channels, and is thought to impair urinary concentrating ability via reduction in the number of principal cells and interference in signalling pathways involved in aquaporin. Polycystic kidney disease causes anatomic disruption of the medullary architecture. Polyuria in sickle cell disease results from a similar mechanism, as sickling in the vasa recta interferes with the countercurrent exchange mechanisms In some cases, polyuria can be caused by a combination of both mechanisms.
The linear relationship between solute excretion and urine output described above is strongly influenced by ADH. In the setting of a solute diuresis, absence or deficiency of ADH can augment the degree of polyuria quite dramatically.
Polyuria has a broad range of causes and can be a diagnostic challenge for clinicians. Understanding the pathophysiology that underpins the different mechanisms of polyuria is essential to appropriate workup, diagnosis, and treatment of this condition. If this is a complaint, the first step is to quantitate the hour urine volume.
We recommend referral to endocrinology when there is evidence of hypothalamic or pituitary disease, when a water deprivation test is required, or in cases where the diagnosis is unclear.
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