Effect of short-term hyperglycaemia on haemodynamics in type 1 diabetic patients.
OBJECTIVE
Mechanisms underlying glucose-mediated development and progression of diabetic complications are incompletely understood. We tested the impact of short-term hyperglycaemia on systemic blood pressure and regulatory hormones in type 1 diabetic patients.


METHODS
We included 18 patients [13 men, mean (SEM) diabetes duration 10 (1) years] without signs of autonomic neuropathy or renal complications in a randomized single-blinded cross-over trial using insulin-glucose clamp technique. Patients were clamped for 90 min to blood glucose of 5 mmol L(-1) (euglycaemia) and 15 mmol L(-1) (hyperglycaemia) in random order. Blood pressure was measured noninvasively every 5 min (Takeda TM2421 device). Regulatory hormones were determined at the end of each clamp period.


RESULTS
Systolic blood pressure increased [mean (95% CI)] 3 (1, 5) mmHg during hyperglycaemia from 123 (SEM 2) during euglycaemia, P=0.01. Diastolic blood pressure remained unchanged at 78 (2) mmHg. Hyperglycaemia reduced plasma concentrations of: renin [14 (4, 23)%, P=0.02], angiotensin II [17 (8, 25)%, P<0.01] and adrenaline [20 (10, 29)%, P<0.01]. Plasma concentration of atrial natriuretic peptide increased by 11 (6, 17) pg mL(-1) (P<0.01) from 43 (2) pg mL(-1). We calculated a median (range) increase in extracellular volume and plasma volume (PV) of 2.6 (0.7-5.3)% and 5.0 (-4.7 to 8.6)%, respectively.


CONCLUSIONS
In type 1 diabetic patients without signs of autonomic neuropathy short-term hyperglycaemia induced a modest increase in systolic blood pressure and suppression of the renin-angiotensin system, possibly caused by PV expansion because of fluid shift from intra- to extracellular compartment.
Jacobsen
P
P
Steno Diabetes Center, Gentofte, Denmark. pkjacobsen@dadlnet.dk
Rossing
K
K
Hansen
B V
BV
Bie
P
P
Vaag
A
A
Parving
H-H
HH
D000208:Acute Disease; D000328:Adult; D001794:Blood Pressure; D018592:Cross-Over Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000503:physiopathology*; D005260:Female; D015309:Glucose Clamp Technique; D006439:Hemodynamics; D006728:Hormones / Q000097:blood; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000503:physiopathology*; D008297:Male; D010953:Plasma Volume; D012084:Renin-Angiotensin System; D016037:Single-Blind Method
D006728:Hormones