Effect of insulin on renal sodium handling and renal haemodynamics in insulin-dependent (type 1) diabetes mellitus patients.
The effects of insulin on renal haemodynamics and renal sodium handling were studied in eight insulin-dependent (type 1) diabetic patients (aged 30 +/- 3 years). Seven healthy men (aged 38 +/- 4 years) served as controls. The type 1 diabetic patients were resistant to insulin-stimulated glucose disposal as estimated by a 45% lower metabolic (P < 0.01) clearance of glucose as compared with controls. However, type 1 diabetic patients were still sensitive to the distal tubular antinatriuretic effect of insulin, as indicated by an increase in distal sodium reabsorption (95.5 +/- 0.5% to 96.9% +/- 0.4%; P < 0.05) during insulin infusion compared with controls (95.5% +/- 0.6% to 97.4% +/- 0.3%; P < 0.05). In control subjects insulin infusion was associated with 9% increases (P < 0.05) in lithium clearance and in renal plasma flow, whereas no significant increases in lithium clearance and in renal plasma flow were observed in the type 1 diabetic patients. In both groups, the changes in renal plasma flow in response to insulin infusion were positively correlated with that in lithium clearance (r = 0.80 and r = 0.90, respectively; P < 0.05-0.01). In conclusion, the present result demonstrates an intact distal tubular sodium retaining effect in conjunction with a blunted decrease in proximal tubular sodium reabsorption following insulin infusion, which could be the result of an impaired renal vasodilation in type 1 diabetes mellitus.
Stenvinkel
P
P
Department of Renal Medicine Huddinge University Hospital, Stockholm, Sweden.
Ottosson-Seeberger
A
A
Alvestrand
A
A
Bolinder
J
J
D000328:Adult; D001794:Blood Pressure / Q000187:drug effects; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000503:physiopathology*; D005919:Glomerular Filtration Rate / Q000187:drug effects*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007328:Insulin / Q000494:pharmacology* / Q000627:therapeutic use; D007668:Kidney / Q000098:blood supply; D007687:Kidney Tubules, Proximal / Q000187:drug effects / Q000378:metabolism; D008094:Lithium / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000494:pharmacology / Q000627:therapeutic use; D012016:Reference Values; D012039:Regional Blood Flow / Q000187:drug effects; D012079:Renal Circulation / Q000187:drug effects*; D012964:Sodium / Q000378:metabolism
D007328:Insulin; D011994:Recombinant Proteins; D008094:Lithium; D012964:Sodium