Advertisement
Research Article| Volume 76, ISSUE 4, P603-615, October 1970

Download started.

Ok

Glucose metabolism and insulin secretion in uremic, prediabetic, and normal subjects

  • Edmund G. Lowrie
    Footnotes
    Affiliations
    From Peter Bent Brigham Hospital, Boston, Mass., USA

    From Elliot P. Joslin Research Laboratory, Boston, Mass., USA

    From Harvard Medical School Boston, Mass., USA
    Search for articles by this author
  • J.Stuart Soeldner
    Affiliations
    From Peter Bent Brigham Hospital, Boston, Mass., USA

    From Elliot P. Joslin Research Laboratory, Boston, Mass., USA

    From Harvard Medical School Boston, Mass., USA
    Search for articles by this author
  • Constantine L. Hampers
    Correspondence
    Reprint requests: C. L. Hampers, M.D., Director, Dialysis Facilities, Peter Bent Brigham Hospital, 721 Huntington Ave., Boston, Mass. 02115.
    Affiliations
    From Peter Bent Brigham Hospital, Boston, Mass., USA

    From Elliot P. Joslin Research Laboratory, Boston, Mass., USA

    From Harvard Medical School Boston, Mass., USA
    Search for articles by this author
  • John P. Merrill
    Footnotes
    Affiliations
    From Peter Bent Brigham Hospital, Boston, Mass., USA

    From Elliot P. Joslin Research Laboratory, Boston, Mass., USA

    From Harvard Medical School Boston, Mass., USA
    Search for articles by this author
  • Author Footnotes
    ∗ Research Fellow, Harvard Medical School.
    ∗∗ Investigator of the Howard Hughes Medical Institute.
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Glucose utilization and insulin secretion were estimated by standard intravenous glucose tolerance tests in 12 uremic patients prior to and after 2 weeks of intensive hemodialysis and were compared to those of 12 prediabetic and 10 normal control subjects. Although hemodialysis improved glucose utilization in uremic patients, it did not reach values observed in normal subjects and prediabetic patients. Insulin secretion, on the other hand, was comparable to that of control subjects prior to dialysis but was significantly greater than that of control subjects after dialysis. The data are consistent with the thesis that there is a resistance of the peripheral tissues to the action on insulin and that insulin release is relatively normal in the undialyzed uremic subject, although perhaps inappropriately low for the degree of tissue insulin resistance. A period of hemodialysis is correlated with improved but not normalized carbohydrate tolerance and insulin secretion in excess of that observed in normal control subjects.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Translational Research
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hampers C.L.
        • Schupak E.
        Long-term hemodialysis.
        Grune & Stratton, Inc, New York1967
        • Merrill J.P.
        • Hampers C.L.
        Medical progress in uremia.
        New Eng. J. Med. 1970; 282: 953
        • Cerletty J.M.
        • Enbring N.H.
        Azotemia and glucose intolerance.
        Ann. Intern. Med. 1967; 66: 1097
        • Cohen B.D.
        Abnormal carbohydrate metabolism in renal disease.
        Ann. Intern. Med. 1962; 57: 204
        • Hampers C.L.
        • Soeldner J.S.
        • Doak P.B.
        • Merrill J.P.
        Effect of chronic renal failure and hemodialysis on carbohydrate metabolism.
        J. Clin. Invest. 1966; 45: 1719
        • Hampers C.L.
        • Soeldner J.S.
        • Gleason R.E.
        • Bailey G.L.
        • Diamond J.A.
        • Merrill J.P.
        Insulin-glucose relationships in uremia.
        Amer. J. Clin. Nutr. 1967; 21: 414
        • Hutchings R.H.
        • Hegstrom R.M.
        • Scribner B.H.
        Glucose intolerance in patients on long-term intermittent dialysis.
        Ann. Intern. Med. 1966; 65: 275
        • Perkoff G.T.
        • Thomas C.L.
        • Newton J.D.
        • Sellman J.C.
        • Tyler F.H.
        Mechanism of impaired glucose tolerance in uremia and experimental hyperazotemia.
        Diabetes. 1958; 7: 375
        • Westervelt F.B.
        • Schreiner G.E.
        The carbohydrate intolerance of uremic patients.
        Ann. Intern. Med. 1962; 57: 266
        • Lindner G.C.
        • Hiller A.
        • Van Slyke D.D.
        Carbohydrate metabolism in nephritis.
        J. Clin. Invest. 1925; 1: 247
        • Williams J.R.
        • Humphries E.M.
        Clinical significance of blood sugar in nephritis and other diseases.
        Arch. Intern. Med. 1919; 23: 537
        • Horton E.S.
        • Johnson C.
        • Lebovitz H.E.
        Carbohydrate metabolism in uremia.
        Ann. Intern. Med. 1968; 68: 63
        • Speigel G.
        • Bleicher S.J.
        • Goldberg M.
        • Adesman J.
        • Goldner M.G.
        The effect of potassium on the impaired glucose tolerance in chronic uremia.
        Metabolism. 1967; 16: 581
        • Alfrey A.C.
        • Sussman K.E.
        • Holmes J.H.
        Changes in glucose and insulin metabolism induced by dialysis in patients with chronic uremia.
        Metabolism. 1967; 16: 733
        • Sagild V.
        Glucose tolerance in acute ischemic renal failure.
        Acta Med. Scand. 1962; 172: 405
        • Davidson M.B.
        • Lowrie E.G.
        • Hampers C.L.
        Lack of dialyzable insulin antagonist in uremia.
        Metabolism. 1969; 18: 387
        • Cohen B.D.
        • Horowitz H.I.
        Carbohydrate metabolism in uremia: Inhibition of phosphate release.
        Amer. J. Clin. Nutr. 1968; 21: 407
        • Tchobroutsky G.
        • Assan R.
        • Derot M.
        Etude de la glycoregulations dans l'insuffisance renal chronique.
        Diabetologica. 1965; 1: 101
        • Soeldner J.S.
        • Gleason R.E.
        • Williams R.F.
        • Garcia M.J.
        • Beardwood D.M.
        • Marble A.
        Diminished serum insulin response to glucose in genetic prediabetic males with normal glucose tolerance.
        Diabetes. 1968; 17: 17
        • Hoffman W.S.
        A rapid photoelectric method for the determination of glucose in blood and urine.
        J. Biol. Chem. 1937; 120: 51
        • Zalme E.
        • Knowles H.C.
        A plea for plasma sugar.
        Diabetes. 1965; 14: 165
        • Morgan C.R.
        • Lazarow A.
        Immunoassay of insulin: Two antibody system. Plasma insulin levels of normal, subdiabetic and diabetic rats.
        Diabetes. 1963; 12: 115
        • Soeldner J.S.
        • Slone D.
        Critical variables in the radioimmunoassay of serum insulin using the double antibody technique.
        Diabetes. 1965; 14: 771
        • Lundback K.
        Intravenous glucose tolerance as a tool in definition and diagnosis of diabetes mellitus.
        Brit. Med. J. 1962; 1: 1507
        • Steel R.G.D.
        • Torrie J.H.
        Principles and procedures of statistics.
        in: McGraw-Hill Book Company, Inc, New York1960: 173
        • Soeldner J.S.
        • Gleason R.E.
        • Rojas L.
        • Kahn C.B.
        • Marble A.
        Serum insulin and serum insulin-blood glucose relationships in genetic prediabetic males with normal glucose tolerance.
        in: Proc. VI Congr. Int. Diabetes Fed. ed. 4. Excerpta Medica Int. Congr. Series No. 172. 1967: 505
        • Rojas L.
        • Soeldner J.S.
        • Gleason R.E.
        • Kahn C.D.
        • Marble A.
        Offspring of two diabetic parents: Differential serum insulin response to intravenous glucose and tolbutamide.
        J. Clin. Endocr. 1969; 29: 1569
        • Soeldner J.S.
        • Sönksen P.H.
        • Gleason R.E.
        Influence of weight upon serum insulin and the serum growth hormone responses of male offspring of two diabetic parents.
        in: Camerini-Davalos R.A. Cole H.S. Proc. First Int. Symp. Early Diabetes. Academic Press, Inc, New York1969 (In press)
        • Lowrie E.G.
        • Soeldner J.S.
        • Hampers C.L.
        • Merrill J.P.
        Uremic carbohydrate-insulin metabolism.
        J. Clin. Invest. 1969; 48: 53
        • Bagdade J.P.
        • Porte Jr., D.
        • Bierman E.L.
        Hypertriglyceridemia—A metabolic consequence of chronic renal failure.
        New Eng. J. Med. 1968; 279: 181
        • Bagdade J.D.
        • Bierman E.L.
        • Porte Jr., D.
        The significance of basal insulin levels in the evaluation of the insulin response to glucose in diabetic and non diabetic subjects.
        J. Clin. Invest. 1967; 46: 1549
        • Garcia M.J.
        • Soeldner J.S.
        • Gleason R.E.
        • Williams R.E.
        Relationship of blood glucose (BG) and serum immunoreactive insulin (IRI) during repeated intravenous glucose tolerance tests (IVGTT) in normals.
        J. Clin. Invest. 1966; 45: 1010
        • Davidson M.B.
        • Goodner C.J.
        Assay of insulin antagonism by serial incubation of paired rat hemidiaphragms.
        Diabetes. 1966; 15: 380
        • Dzúrik R.
        • Krajc̆i-Lazáry B.
        The effect of uremia serum on carbohydrate metabolism in rat diaphragm.
        Experientia. 1967; 23: 798
        • Hampers C.L.
        • Zollinger R.M.
        • Skillman J.J.
        • Gumpert J.R.
        • Bailey G.L.
        • Merrill J.P.
        Hemodynamic and body composition changes following bilateral nephrectomy in chronic renal failure.
        Circulation. 1969; 40: 367
        • Briggs J.D.
        • Buchanan K.D.
        • Luke R.G.
        • McKiddie M.T.
        Role of insulin in glucose intolerance in uraemia.
        Lancet. 1967; 1: 462
        • O'Brien J.P.
        • Sharpe A.R.
        The influence of renal disease on the insulin I131 disappearance curve in man.
        Metabolism. 1967; 16: 76
        • Silvers A.
        • Swenson R.S.
        • Farquhar J.W.
        • Reavan G.M.
        Derivation of a three compartmental model disappearance of plasma insulin-I131 in man.
        J. Clin. Invest. 1969; 48: 1461
      1. Lowrie, E. G.: Unpublished observations.

        • Westervelt F.B.
        Abnormal carbohydrate metabolism in uremia.
        Amer. J. Clin. Nutr. 1968; 21: 423
        • Westervelt Jr., F.B.
        Insulin effect in uremia.
        J. Lab. Clin. Med. 1969; 74: 79
        • Boucot N.G.
        • Guild W.R.
        • Merrill J.P.
        Carbohydrate metabolism in rats with acute uremia.
        Amer. J. Physiol. 1958; 192: 30
        • Boucot N.G.
        • Nurser E.K.
        • Merrill J.P.
        Carbohydrate metabolism in rats with chronic uremia.
        Amer. J. Physiol. 1960; 198: 797
        • Perley M.
        • Kipnis D.M.
        Plasma insulin response to glucose and tolbutamide of normal weight and obese diabetic and non diabetic subjects.
        Diabetes. 1966; 15: 869