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Changes in Renal Function During Acute Insulin‐induced Hypoglycaemia in Patients with Type 1 Diabetes
Author(s) -
Patrick A.W.,
Hepburn D.A.,
Swainson C.P.,
Frier B.M.
Publication year - 1992
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.1992.tb01752.x
Subject(s) - medicine , endocrinology , renal function , excretion , plasma renin activity , diabetes mellitus , insulin , urinary system , renin–angiotensin system , blood pressure
The effect of acute hypoglycaemia on renal function was examined in eight male patients with Type 1 diabetes who had normal urinary albumin excretion. Insulin was given as a bolus intravenous injection (0.125 U kg −1 ) and plasma glucose fell to a nadir of 1.6 (SE 0.2) mmol I −1 , with all patients experiencing an acute autonomic reaction. Renal plasma flow fell from 674 (106) to 540 (198) ml min −1 during hypoglycaemia ( p < 0.01) and returned to 655 (181) ml min −1 (NS vs baseline). Glomerular filtration rate (GFR) declined from 143 (23) to 110 (36) ml min −1 during hypoglycaemia ( p < 0.02), rising to 150 (44) ml min −1 in the recovery period (NS vs baseline). The urinary flow rate and urinary albumin excretion rate both fell significantly in response to hypoglycaemia (10.6 (1.2) to 4.7 (1.1) ml min −1 ; p < 0.002, and 46.2 (10.6) to 26.0 (10.5) μg min −1 , respectively). Urinary dopamine excretion also declined, from 322 (37) to 211 (29) μmol min −1 ( p < 0.005) but sodium excretion was unchanged. Plasma adrenaline concentration (0.2 (0.03) to 1.7 (0.4) nmol I −1 ; p < 0.01) and plasma renin activity (0.49 (0.13) to 1.08 (0.17) ng‐Ang I ***l −1 h −1 ; p < 0.01) increased during hypoglycaemia, but changes in plasma noradrenaline and angiotensin II levels did not attain significance. These acute changes in renal function, observed during hypoglycaemia in diabetic patients, may result from direct stimulation of the efferent sympathetic nerves to the kidney, complemented by the hormonal changes induced by hypoglycaemia.