Clinical Autonomic Research

, Volume 5, Issue 5, pp 279–288 | Cite as

Insulin resistance and autonomic function in traumatic lower limb amputees

  • E. Peles
  • S. Akselrod
  • D. S. Goldstein
  • H. Nitzan
  • M. Azaria
  • S. Almog
  • D. Dolphin
  • H. Halkin
  • M. Modan
Research Paper


This study examined plasma insulin response to oral glucose load and autonomic nervous system activity in male lower limb amputees (n = 52) aged 50–65 years, compared to matched controls (n = 53). The groups had similar body mass index, blood pressure and plasma lipid levels. The amputees had higher mean fasting plasma insulin levels (18.4 ± 9.7 (SD) versus 13.7 ± 5.1 m U/l,p = 0.005) and during an oral glucose tolerance test (OGTT) (1 h levels 88.1 ± 45.3 versus 62.1 ± 42.7,p = 0.016) with similar plasma glucose levels, indicating insulin resistance. At baseline with the subjects supine, there were no group differences in low- or high-frequency power of heart rate variability or in plasma levels of norepinephrine (NE) or epinephrine (EPI). In response to orthostasis, the groups had similarly increased plasma NE levels. During the OGTT, amputees had significantly larger increments in low-frequency power than did controls (2.2 ± 1.3 versus 1.6 ± 0.9 (beats/min)2 respectively,p < 0.01) and plasma NE levels increased significantly in amputees (1595 ± 849 versus 1941 ± 986 pM,p = 0.0008) but not in controls. At 1 h after glucose administration, plasma EPI levels were decreased significantly from baseline in both groups; at both 1 and 2 h after glucose administration, plasma EPI levels were higher in the amputees than controls. Amputees appear to have a combination of enhanced sympathoneural responsiveness and attenuated suppression of adrenomedullary secretion during glucose challenge. As catecholamines antagonize insulin effects, one possible explanation for insulin resistance in amputees is hyperglycaemia-induced sympathoneural activation and a failure of hyperglycaemia to decrease adrenomedullary secretion.


insulin resistance sympathetic nervous system catecholamines parasympathetic nervous system amputees spectral analysis 


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Copyright information

© Rapid Science Publishers 1995

Authors and Affiliations

  • E. Peles
    • 1
  • S. Akselrod
    • 2
  • D. S. Goldstein
    • 3
  • H. Nitzan
    • 1
  • M. Azaria
    • 4
  • S. Almog
    • 5
  • D. Dolphin
    • 6
  • H. Halkin
    • 5
  • M. Modan
    • 1
  1. 1.Department of Clinical EpidemiologyChaim Sheba Medical CenterTel HashomerIsrael
  2. 2.School of Physics and AstronomyTel Aviv UniversityRamat AvivIsrael
  3. 3.Clinical Neuroscience Branch, National Institute of Neurological Disorders and StrokeNational Institutes of HealthBethesdaUSA
  4. 4.Department of Orthopaedic RehabilitationSheba Medical CentreTel HashomerIsrael
  5. 5.Division of Clinical Pharmacology and ToxicologySheba Medical CentreTel HashomerIsrael
  6. 6.Ministry of DefenseIsrael

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