Effects of insulin and lipid emulsion on renal haemodynamics and renal sodium handling in IDDM patients

Abstract

To evaluate the role of insulin and hypertriglyceridaemia in the regulation of renal haemodynamics and sodium handling in insulin-dependent diabetes mellitus (IDDM), 11 IDDM patients without microalbuminuria and 13 weight-, age-, protein intake- and sex-matched healthy control subjects were studied. Clearances of inulin (Cin), para-amino-hippuric acid (CPAH), sodium (CNa), and lithium (CLi) were measured in four 60-min clearance periods (periods I, II, III and IV) during isoinsulinaemia with lipid emulsion infusion (study 1), a hyperinsulinaemic isoglycaemic clamp with Intralipid infusion (study 2), and during time-controlled isoinsulinaemia (study 3). We found that Cin, CPAH and filtration fraction were comparable in IDDM and control subjects, whereas CNa was decreased in diabetic subjects (2.01 +/- 1.11 vs 3.03 +/- 1.32 ml/min; p < 0.05) due to elevations of proximal tubular fractional and absolute reabsorptions of sodium (p < 0.05). Insulin infusion did not affect Cin, increased CPAH (p < 0.05) and, consequently, lowered the filtration fraction (p < 0.01) in both groups. While acute hyperinsulinaemia resulted in increases in distal tubular fractional and absolute reabsorptions of sodium (p < 0.01) contributing to a fall in CNa (p < 0.01) in control subjects, in diabetic subjects the sodium-retaining effect of insulin was not significant. The lipid emulsion did not alter any of the estimated parameters. We conclude that IDDM without microalbuminuria is associated with a tendency to sodium retention which is not aggravated by insulin when compared to control subjects. Acutely induced hypertriglyceridaemia does not alter renal haemodynamics or renal sodium handling.

Eating two larger meals a day (breakfast and lunch) is more effective than six smaller meals in a reduced-energy regimen for patients with type 2 diabetes: a randomised crossover study

“…The hyperinsulinaemic (1 mU kg −1  min −1 ) isoglycaemic clamp, lasting 3 h, was conducted as previously described [19]. Insulin sensitivity was estimated as the metabolic clearance rate of glucose (MCR) [19].…”

The metabolic syndrome and uric acid nephrolithiasis: Novel features of renal manifestation of insulin resistance

“…Acute renal effects of insulin have included suppression of renal glucose release and stimulation of glucose uptake [32][33][34], alterations in filtration rate [35][36][37][38], and natriuresis [15][16][17]. We now show that acute hyperinsulinemia induces elevation in urinary pH in the non-stone formers.…”

Improvement in β-cell function after diet-induced weight loss is associated with decrease in pancreatic polypeptide in subjects with type 2 diabetes

“…Hyperinsulinemic (1 mU.kg − 1 .min − 1 ) isoglycemic clamp, lasting 3 h, was conducted as previously described (Pelikánová, Smrcková, Krízová, Stríbrná & Lánská, 1996) to measure insulin sensitivity and to induce steady-state hyperinsulinemia to measure the concentrations of gastrointestinal peptides during hyperinsulinemia.…”

“…Insulin sensitivity was estimated as the metabolic clearance rate of glucose (MCR) calculated during the last 20 min of the clamp after correction for changes in glucose pool size as described previously (Pelikánová et al, 1996).…”