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

Diabetologia volume 39, pages 1074–1082 (1996)Cite this article

Summary

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.

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Abbreviations

IDDM:

Insulin-dependent diabetes mellitus

GFR:

glomerular filtration rate

RPF:

renal plasma flow

Cin :

clearance of inulin

CPAH :

clearance of para-amino-hippuric acid

CNa :

clearance of sodium

CLi :

clearance of lithium

APRNa :

absolute proximal tubular reabsorption of sodium

FPRNa :

fractional proximal tubular reabsorption of sodium

ADRNa :

absolute distal tubular reabsorption of sodium

FDRNa :

fractional distal tubular reabsorption of sodium

FIRI:

free plasma immunoreactive insulin

TG:

serum triglycerides

NEFA:

serum non-esterified fatty acids

MCR:

metabolic clearance rate of glucose

FF:

filtration fraction

ANOVA:

analysis of variance

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Affiliations

  1. Department of Diabetes, Postgraduate Medical School, Prague, Czech Republic

    T. Pelikánová

  2. Institute for Clinical and Experimental Medicine, Prague, Czech Republic

    T. Pelikánová, I. Smrčková, J. KŘíŽová, J. StŘíbrná & V. Lánská

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Pelikánová, T., Smrčková, I., KŘíŽová, J. et al. Effects of insulin and lipid emulsion on renal haemodynamics and renal sodium handling in IDDM patients. Diabetologia 39, 1074–1082 (1996). https://doi.org/10.1007/BF00400657

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  • DOI: https://doi.org/10.1007/BF00400657

Keywords

  • Insulin-dependent diabetes mellitus
  • insulin infusion
  • lipid emulsion
  • glomerular filtration rate
  • renal sodium reabsorption