Effect of acute hyperinsulinemia on magnesium homeostasis in humans

Xu, Li Hao Richie; Maalouf, Naim M.

doi:10.1002/dmrr.2844

Cited by 18 publications

(13 citation statements)

References 50 publications

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“…Studies in rats showed that Mg 2+ reabsorptive capacity in the distal segment of the kidney is increased after glucagon and PTH infusion [58,59]. Insulin causes a shift of magnesium from the extracellular to the intracellular space, resulting in a decrease in plasma magnesium and an increase in erythrocyte magnesium content in both healthy non-diabetics and diabetic individuals [60,61]. In our study, we observed that EMPA reduced insulin/glucagon ratio ( Table 2) and increased PTH levels in plasma (Fig.…”

Section: Discussionsupporting

confidence: 59%

Effects of Sodium–Glucose Co-transporter 2 Inhibition with Empaglifozin on Renal Structure and Function in Non-diabetic Rats with Left Ventricular Dysfunction After Myocardial Infarction

Yurista

Silljé

Goor

et al. 2020

Cardiovasc Drugs Ther

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Background The use of sodium-glucose co-transporter 2 inhibitors (SGLT2i) is currently expanding to cardiovascular risk reduction in non-diabetic subjects, but renal (side-)effects are less well studied in this setting. Methods Male non-diabetic Sprague Dawley rats underwent permanent coronary artery ligation to induce MI, or sham surgery. Rats received chow containing empagliflozin (EMPA) (30 mg/kg/day) or control chow. Renal function and electrolyte balance were measured in metabolic cages. Histological and molecular markers of kidney injury, parameters of phosphate homeostasis and bone resorption were also assessed. Results EMPA resulted in a twofold increase in diuresis, without evidence for plasma volume contraction or impediments in renal function in both sham and MI animals. EMPA increased plasma magnesium levels, while the levels of glucose and other major electrolytes were comparable among the groups. Urinary protein excretion was similar in all treatment groups and no histomorphological alterations were identified in the kidney. Accordingly, molecular markers for cellular injury, fibrosis, inflammation and oxidative stress in renal tissue were comparable between groups. EMPA resulted in a slight increase in circulating phosphate and PTH levels without activating FGF23-Klotho axis in the kidney and bone mineral resorption, measured with CTX-1, was not increased. Conclusions EMPA exerts profound diuretic effects without compromising renal structure and function or causing significant electrolyte imbalance in a non-diabetic setting. The slight increase in circulating phosphate and PTH after EMPA treatment was not associated with evidence for increased bone mineral resorption suggesting that EMPA does not affect bone health.

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Section: Discussionsupporting

confidence: 59%

Effects of Sodium–Glucose Co-transporter 2 Inhibition with Empaglifozin on Renal Structure and Function in Non-diabetic Rats with Left Ventricular Dysfunction After Myocardial Infarction

Yurista

Silljé

Goor

et al. 2020

Cardiovasc Drugs Ther

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“… 21 Improved hyperinsulinemia could allow redistribution of magnesium out of cells, spuriously increasing serum magnesium levels and decreasing FE Mg . 22 However, euglycemic hyperinsulinemic clamp in humans reduced serum magnesium levels by only 0.1 mg/dL and resulted in absolute reduction in FE Mg of less than 0.5%. 22 Thus, it appears unlikely that changes in insulin or glucagon signaling fully explain the improvements we observe in magnesium handling, but studies performed under laboratory conditions could more conclusively address the contribution of this mechanism.…”

Section: Discussionmentioning

confidence: 99%

SGLT2 Inhibitors for Treatment of Refractory Hypomagnesemia: A Case Report of 3 Patients

et al. 2020

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In patients with urinary magnesium wasting, oral and intravenous supplementation often fail to adequately improve serum magnesium levels. Glucose intolerance and diabetes mellitus frequently accompany hypomagnesemia. Clinical trials examining inhibitors of the type 2 sodium glucose cotransporter (SGLT2) show small but significant increases in serum magnesium levels in diabetic patients. This report describes dramatic improvement in serum magnesium levels and associated symptoms after initiating SGLT2 inhibitor therapy in 3 patients with refractory hypomagnesemia and diabetes. Each patient received a different SGLT2 inhibitor: canagliflozin, empagliflozin, or dapagliflozin. One patient discontinued daily intravenous magnesium supplements and exhibited higher serum magnesium levels than had been achieved by magnesium infusion. 2 of the 3 patients exhibited reduced urinary fractional excretion of magnesium, suggesting enhanced tubular reabsorption of magnesium. These observations demonstrate that SGLT2 inhibitors can improve the management of patients with otherwise intractable hypomagnesemia, representing a new tool in this challenging clinical disorder.

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“…Reduced intracellular magnesium level can lead to increased calcium entry into adipocytes followed by increase oxidative stress, inflammation, and increase insulin resistance [ 58 , 59 ]. On the other hand, previous studies have shown that insulin facilitates shift of magnesium from the extracellular to the intracellular space [ 60 , 61 ] and reduces the tubular reabsorption of magnesium, which can lead to hypomagnesemia in people with poorly controlled diabetes and hyperinsulinemia [ 62 ].…”

Section: Hypomagnesemia and Endocrine Diseasesmentioning

confidence: 99%

Magnesium and Human Health: Perspectives and Research Directions

Alawi

Majoni

Falhammar

2018

International Journal of Endocrinology

321

223

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Magnesium is the fourth most abundant cation in the body. It has several functions in the human body including its role as a cofactor for more than 300 enzymatic reactions. Several studies have shown that hypomagnesemia is a common electrolyte derangement in clinical setting especially in patients admitted to intensive care unit where it has been found to be associated with increase mortality and hospital stay. Hypomagnesemia can be caused by a wide range of inherited and acquired diseases. It can also be a side effect of several medications. Many studies have reported that reduced levels of magnesium are associated with a wide range of chronic diseases. Magnesium can play important therapeutic and preventive role in several conditions such as diabetes, osteoporosis, bronchial asthma, preeclampsia, migraine, and cardiovascular diseases. This review is aimed at comprehensively collating the current available published evidence and clinical correlates of magnesium disorders.

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Effect of acute hyperinsulinemia on magnesium homeostasis in humans

Cited by 18 publications

References 50 publications

Effects of Sodium–Glucose Co-transporter 2 Inhibition with Empaglifozin on Renal Structure and Function in Non-diabetic Rats with Left Ventricular Dysfunction After Myocardial Infarction

Effects of Sodium–Glucose Co-transporter 2 Inhibition with Empaglifozin on Renal Structure and Function in Non-diabetic Rats with Left Ventricular Dysfunction After Myocardial Infarction

SGLT2 Inhibitors for Treatment of Refractory Hypomagnesemia: A Case Report of 3 Patients

Magnesium and Human Health: Perspectives and Research Directions

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