Renal Wastage of Insulin in Children with Diabetes Mellitus

Malone, John I.; Root, Allen W.

doi:10.2337/diab.25.10.989

Cited by 9 publications

(2 citation statements)

References 5 publications

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“…In contrast, combined damage to glomeruli and tubules results in the appearance of high-and low-molecular-weight proteins, including insulin, in the urine. In poorly-controlled, non-ketotic [78] and mildly ketotic [79] diabetic children, urinary loss of insulin increases. In adults with early diabetes complicated by ketoacidosis, there is a reversible defect in tubular reabsorption of insulin, and this defect may persist even after metabolic control has been regained [80].…”

Section: Effects Of Renal Insufficiency On Insulin Metabolismmentioning

confidence: 99%

The renal metabolism of insulin

1984

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The kidney plays a pivotal role in the clearance and degradation of circulating insulin and is also an important site of insulin action. The kidney clears insulin via two distinct routes. The first route entails glomerular filtration and subsequent luminal reabsorption of insulin by proximal tubular cells by means of endocytosis. The second involves diffusion of insulin from peritubular capillaries and subsequent binding of insulin to the contraluminal membranes of tubular cells, especially those lining the distal half of the nephron. Insulin delivered to the latter sites stimulates several important processes, including reabsorption of sodium, phosphate, and glucose. In contrast, insulin delivered to proximal tubular cells is degraded to oligopeptides and amino-acids by one of two poorly delineated enzymatic pathways. One pathway probably involves the sequential action of insulin protease and either GIT or non-specific proteases; the other probably involves the sequential action of GIT and lysosomal proteases. The products of insulin degradation are reabsorbed into the peritubular capillaries, apparently via simple diffusion. Impairment of the renal clearance of insulin prolongs the half-life of circulating insulin by a number of mechanisms and often results in a decrease in the insulin requirement of diabetic patients. Much needs to be learned about these metabolic events at the subcellular level and how they are affected by disease states. Owing to the heterogeneity of cell types within the kidney and to their anatomical and functional polarity, investigation of these areas will be challenging indeed.

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Section: Effects Of Renal Insufficiency On Insulin Metabolismmentioning

confidence: 99%

The renal metabolism of insulin

1984

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“…Falsely high values were obtained with inc reas ing glu cose concentrat ion (appro ximate ly a 20% increase with 10% glucose). For thi s reason , completeness of 24-h urine collections was not assessed using criteria pro po sed by others (13,14).…”

Section: Sample Preparation and Analysismentioning

confidence: 99%

Zinc Nutriture in Type I Diabetes Mellitus

Canfield,

Hambidge,

Johnson

1984

J. pediatr. gastroenterol. nutr.

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Zinc concentrations in plasma, hair, and urine from children and young adults with insulin‐requiring or Type I diabetes mellitus were significantly correlated with height, weight, and age, as well as with indices of metabolic control, i.e., fasting serum glucose, percent glyco‐sylated hemoglobin (HbA,), and 24‐h urine glucose and insulin excretion. Urinary zinc excretion was greater in subjects than in controls (p < 0.0001) and significantly correlated with urine glucose (p < 0.004, r = 0.35) and volume (p < 0.0007, r = 0.40). Urinary zinc and volume were not correlated in controls. Hyperzincuria in the subjects was not secondary to hyperinsulinuria, although zinc and insulin excretion were significantly correlated in controls (p <0.03, r = 0.63). Zinc in insulin preparations could not explain the excessive zinc excretion. Mean fasting plasma zinc was significantly higher than in controls, and positively correlated with height for age, while, being inversely correlated with age, duration of diabetes, HbA1, urine volume, and glucose excretion. Both the mean and range of hair zinc concentration in the subjects were not different from controls. Male subjects with diabetes had a significantly lower hair concentration when, compared with female subjects with diabetes (p < 0.0009). Zinc homeostasis appears to be altered as a consequence of glucose intolerance in diabetes. Continued urinary zinc losses over time may result in a zinc deficiency state not demonstrable by altered zinc concentrations in plasma and hair.

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Insulin Treatment in Diabetes

Galloway

Bressler

1978

Medical Clinics of North America

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Renal Wastage of Insulin in Children with Diabetes Mellitus

Cited by 9 publications

References 5 publications

The renal metabolism of insulin

The renal metabolism of insulin

Zinc Nutriture in Type I Diabetes Mellitus

Insulin Treatment in Diabetes

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