Hypoglycemia Associated with Renal Failure

Arem, Ridha

doi:10.1016/s0889-8529(18)30391-8

Cited by 158 publications

(97 citation statements)

References 91 publications

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“…This observation thus provides a possible explanation of why people with chronic renal failure are prone to develop hypoglycaemia [60][61][62][63]. Moreover, the stimulation of glucose release by epinephrine suggests an important role of the kidney in glucose counterregulation [64].…”

Section: Implications For the Understanding Of Human Carbohydrate Metmentioning

confidence: 95%

Renal glucose production and utilization: new aspects in humans

et al. 1997

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Summary According to current textbook wisdom the liver is the exclusive site of glucose production in humans in the postabsorptive state. Although many animal and in vitro data have documented that the kidney is capable of gluconeogenesis, production of glucose by the human kidney in the postabsorptive state has generally been regarded as negligible. This traditional view is based on net balance measurements which, other than after a prolonged fast or during metabolic acidosis, showed no significant net renal glucose release. However, recent studies have refuted this view by combining isotopic and balance techniques, which have demonstrated that renal glucose production accounts for 25 % of systemic glucose production. Moreover, these studies indicate that glucose production by the human kidney is stimulated by epinephrine, inhibited by insulin and is excessive in diabetes mellitus. Since renal glucose release is largely, if not exclusively, due to gluconeogenesis, it is likely that the kidney is as important a gluconeogenic organ as the liver. The most important renal gluconeogenic precursors appear to be lactate, glutamine and glycerol. The implications of these recent findings on the understanding of the physiology and pathophysiology of human glucose metabolism are discussed. [Diabetologia (1997) 40: 749-757].

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Section: Implications For the Understanding Of Human Carbohydrate Metmentioning

confidence: 95%

Renal glucose production and utilization: new aspects in humans

et al. 1997

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“…Conceivably, this role of the kidney could explain why patients with renal failure have a propensity to develop hypoglycemia (65). Furthermore, patients with type 1 diabetes lose their glucagon response to hypoglycemia and become dependent on catecholamine responses (63).…”

Section: Hormonal Control Of Renal Glucose Release -mentioning

confidence: 99%

Renal Gluconeogenesis

et al. 2001

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Renal GluconeogenesisIts importance in human glucose homeostasis R E V I E W A R T I C L EStudies conducted over the last 60 years in animals and in vitro have provided considerable evidence that the mammalian kidney can make glucose and release it under various conditions. Until quite recently, however, it was generally believed that the human kidney was not an important source of glucose except during acidosis and after prolonged fasting. This review will summarize early work in animals and humans, discuss methodological problems in assessing renal glucose release in vivo, and present results of recent human studies that provide evidence that the kidney may play a significant role in carbohydrate metabolism under both physiological and pathological conditions. R e v i e w s / C o m m e n t a r i e s / P o s i t i o n S t a t e m e n t s

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“…nsulin therapy in type 1 diabetic patients with overt diabetic nephropathy is characterized by two features: while suffering from a considerably increased risk of severe hypoglycemic episodes (1,2), they show poorer metabolic control than diabetic patients with normal renal function (3). The increased hypoglycemic risk may be partially explained by the decline in renal insulin clearance, as 30 -80% of systemically circulating insulin is removed by the kidneys (4).…”

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confidence: 99%

Impact of Diabetic Nephropathy on Pharmacodynamic and Pharmacokinetic Properties of Insulin in Type 1 Diabetic Patients

et al. 2001

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OBJECTIVE -To quantify pharmacokinetic and pharmacodynamic properties of regular insulin and insulin lispro in type 1 diabetic patients with and without overt diabetic nephropathy.RESEARCH DESIGN AND METHODS -In this double-blind, two-way cross-over, euglycemic (5 mmol/l) glucose clamp study, we investigated the metabolic response to subcutaneous injections of regular insulin and insulin lispro (0.2 U/kg) in 12 type 1 diabetic patients with overt diabetic nephropathy (proteinuria Ͼ500 mg/24 h and/or serum creatinine Ͼ1.5 mg/dl; NP group) and in a control group of 12 type 1 diabetic patients with normal renal function (DC group). [DC]). The overall metabolic effect of regular insulin but not of insulin lispro was lower in patients with diabetic nephropathy than in diabetic control patients (967 vs. 1,510 mg/kg, respectively). RESULTSCONCLUSIONS -Although insulin levels are higher in patients with overt diabetic nephropathy, the metabolic response to regular insulin is reduced. Insulin lispro maintains its characteristic pharmacokinetic and pharmacodynamic properties in patients with overt diabetic nephropathy. Diabetes Care 24:886 -890, 2001I nsulin therapy in type 1 diabetic patients with overt diabetic nephropathy is characterized by two features: while suffering from a considerably increased risk of severe hypoglycemic episodes (1,2), they show poorer metabolic control than diabetic patients with normal renal function (3). The increased hypoglycemic risk may be partially explained by the decline in renal insulin clearance, as 30 -80% of systemically circulating insulin is removed by the kidneys (4). A reduction of insulin clearance has been described in nondiabetic patients with end-stage renal failure (5,6) and mild to moderate renal impairment (7); however, until now, it has not been studied in patients with diabetic nephropathy.Insulin sensitivity, on the other hand, is attenuated in patients with renal impairment, not only in those with endstage renal failure, but also in patients in earlier stages of renal impairment (7-9). However, to date the metabolic consequences of reduced insulin clearance and diminished insulin sensitivity on pharmacokinetic and pharmacodynamic properties of regular insulin or rapid acting insulin analogues have never been studied in type 1 diabetic patients.In view of the diminished clearance of insulin in patients with altered renal function, the use of a rapid-acting insulin analogue might theoretically be advantageous because of its shorter duration of action, leading to a reduced incidence of hypoglycemic episodes (10,11). Therefore, the aim of this study was to quantify pharmacokinetic and pharmacodynamic summary measures for regular insulin and insulin lispro in type 1 diabetic patients with and without overt diabetic nephropathy. RESEARCH DESIGN AND METHODS PatientsFor this study, 12 type 1 diabetic patients fulfilling the following inclusion criteria were recruited: age 20 -50 years; GHb Ͻ10%; overt diabetic nephropathy (defined according to the modified Mogensen criteria...

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Hypoglycemia Associated with Renal Failure

Cited by 158 publications

References 91 publications

Renal glucose production and utilization: new aspects in humans

Renal glucose production and utilization: new aspects in humans

Renal Gluconeogenesis

Impact of Diabetic Nephropathy on Pharmacodynamic and Pharmacokinetic Properties of Insulin in Type 1 Diabetic Patients

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