Decreased Circulatory Response to Hypovolemic Stress in Young Women With Type 1 Diabetes

Abstract

OBJECTIVEDiabetes is associated with hemodynamic instability during different situations involving acute circulatory stress in daily life. Young men with type 1 diabetes have been shown to have impaired circulatory response to hypovolemic stress. The effect of type 1 diabetes on cardiovascular response to hypovolemia in young women is unknown, however.RESEARCH DESIGN AND METHODSLower body negative pressure of 30 cm H2O was used to create rapid hypovolemic stress in 15 young women with type 1 diabetes (DW) and 16 healthy women (control subjects [C]). Compensatory mobilization of venous capacitance blood (capacitance response) and net fluid absorption from tissue to blood were measured with a volumetric technique. Overall cardiovascular responses and plasma norepinephrine levels were measured.RESULTSCapacitance response was reduced (DW, 0.67 ± 0.05; C, 0.92 ± 0.06) and developed slower in DW (P < 0.01). Capacitance response was further reduced with increasing levels of HbA1c. Fluid absorption was almost halved in DW (P < 0.01). The initial vasoconstrictor response was reduced and developed slower in DW (P < 0.05). Arterial vasoconstriction was further reduced in the presence of microvascular complications (P < 0.05).CONCLUSIONSDW present with decreased and slower mobilization of venous capacitance blood and decreased net fluid absorption from tissue to blood during hypovolemic circulatory stress. Collectively, this indicates that DW are prone to hemodynamic instability, especially in the presence of microvascular complications and poor glycemic control.

Preoperative risk factors for haemodynamic instability during pheochromocytoma surgery in Chinese patients

“…It was also reported that cardiovascular autonomic neuropathy was involved in HI in patients with diabetes . Additionally, decreased capacitance response and decreased net fluid absorption from tissues to blood during hypovolaemic circulatory stress were associated with the pathophysiology of HI in diabetes …”

Cardiovascular regulation in women with vasovagal syncope : With special reference to the venous system

“…Increased blood pooling in the splanchnic beds, possibly leading to increased central hypovolemia has also been detected in VVS patients (75). The central hypovolemia that occurs during orthostatic stress is compensated by mobilization of blood from peripheral capacitance vessel towards the central circulation, as well as by net capillary fluid absorption from tissue to blood in order to increase venous return to the heart and thus defend central blood volume (24,28,31,76). However, compensatory mechanisms have not been studied in VVS.…”

“…Reduced venous compliance at the low pressure range may also contribute to the decreased mobilization of peripheral venous blood in VVS. Compensatory redistribution of blood and fluid towards the central circulation during hypovolemic stress is a crucial defense mechanism to preserve homeostasis (24,28,30,31). Due to its large tissue mass, skeletal muscle and skin represent an important reservoir for mobilization of venous capacitance blood and net fluid absorption.…”

“…Further, the slower but continuous net capillary absorption of extra-vascular fluid is also dependent on a reflex decline in capillary pressure due to adjustment of pre-and postcapillary resistance (25,26) and act as a powerful mechanism to increase plasma volume (27)(28)(29)(30). Thus, the combined effect of mobilizing venous capacitance blood and net capillary absorption serve as important factors for preserving venous return and act momentarily to maintain cardiovascular homeostasis (24,28,29,31).…”

Reduced Venous Compliance in Young Women with Type 1 Diabetes – Further Aggravated by Prolonged Elevated Levels of HbA1c

“…However, reduced venous compliance could also be detrimental. High vessel wall compliance is mandatory for efficient mobilization of peripheral venous capacitance blood to the central circulation to uphold venous return, cardiac output, and blood pressure during an orthostatic challenge ( 12 , 13 ), We have recently presented reduced mobilization of peripheral capacitance blood in both men and women with type 1 diabetes ( 8 , 14 ), aggravated with the severity of the disease, i.e., presence of microvascular disease ( 8 ) and level of Hb A1c ( 14 ). Female gender seems especially predisposed to diabetes-associated reduction in compliance with major elastic arteries ( 15 ).…”