Acetate: inhibitor of growth hormone hypersecretion in diabetic and non-diabetic uraemic subjects

Abstract

Abstract. Five diabetic and 14 non-diabetic uraemic patients on long-term haemodialysis were studied during twenty-one 24 h periods including 5 to 7 h of haemodialysis against glucose-free acetate buffered dialysis fluid. Half-hourly blood samples were collected for hormonal and metabolite analysis. In addition, blood samples were analyzed in 40 experiments covering the haemodialysis and a pre-dialysis period. Before dialysis, plasma growth hormone levels were high and fluctuating, but almost always fell to low normal values within the first 2 h of haemodialysis. In the diabetic uraemic patients, the occasional severe hypoglycaemic episodes occurring during haemodialysis did not provoke growth hormone release, and hypoglycaemic reactions were not encountered. Intravenous acetate infusion studies resulted in plasma concentrations ranging from 1.3 to 2.7 mmol, i.e. about 60 per cent of the levels reached during haemodialysis and in suppression of growth hormone secretion. It is suggested that the fall in growth hormone levels and the lack of hypoglycaemic symptoms during haemodialysis is due to the use of acetate as a fuel in brain.

Marked reductions in bioactive insulin-like growth factor I (IGF-I) during hemodialysis

“…However, during a session of HD, levels appear to decrease [7,36,37], as also observed in the present study. Theoretically the gradual decline in GH during HD could be a result of an increased feedback inhibition caused by the transient increase in circulating free and bioactive IGF-I observed after the injection of low weight molecular heparin (Innohep Ò ).…”

Alcohol Intake Impairs Glucose Counterregulation During Acute Insulin-Induced Hypoglycemia in IDDM Patients: Evidence for a Critical Role of Free Fatty Acids

“…During alcohol intake, cortisol secretion was reduced, and GH was even more significantly depressed, substantiating the possible inhibitory role of acetate, an alcohol metabolite, on the brain activation of counterregulatory hormone secretion (28). However, GH and cortisol secretions do not really participate in glucose counterregulation until at least 3 h after protracted hypoglycemia (29).…”

Hypoglycemia during Hemodialysis in Diabetics Treated with Insulin

“…and by the presence of acetate in the bath. Acetate inhibits the release of an insulin-counterregulatory hormone [6], During the last 2 years, we have been routinely dialyz ing diabetics against a bath containing bicar bonate and glucose in a concentration of 11.1 mmol/l. Although the diabetics currently dialyzed by this regime are different from those included in groups A and B, the inci dence of symptomatic hypoglycemia has been very low in the past 2 years, even in diabetics with poor glycemic control, who exhibit at times predialysis hypoglycemia.…”