Influence of glucose and insulin on transcapillary fluid absorption from the arm during lower body negative pressure in man

Olsen, Henrik; Groop, Leif; Länne, Toste

doi:10.1007/s00421-003-0894-3

Cited by 3 publications

(6 citation statements)

References 34 publications

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“…Finally, insulin is known to affect various cardiovascular responses. However, the difference in daily insulin dose or blood glucose level was not correlated with the studied cardiovascular parameters, in corroboration with a previous study with no effect of insulin infusion on fluid mobilization ( 40 ).…”

Section: Discussionsupporting

confidence: 90%

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

2013

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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.

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Section: Discussionsupporting

confidence: 90%

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

2013

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“…Capillary fluid absorption is dependent on both high hydrodynamic conductivity as well as a decline in capillary pressure caused by autonomic reflex adjustments of both α-and β-adrenergic receptors, affecting the pre-to post-capillary resistance ratio, creating a net driving force over the capillary wall. 31,32 Reduced net capillary fluid absorption during hypovolaemic circulatory stress has earlier been found in type 1 diabetes patients without microvascular complications, 16 and seemed linked to a reduction in capillary filtration coefficient (CFC) rather than differences in the regulation of capillary hydrostatic pressure or changed metabolic milieu caused by changes in insulin and glucose concentrations, as discussed in Olsen and Lanne 14 and Olsen et al 15 Furthermore, there are indications of reduced precapillary resistance in type 1 diabetes patients, possibly reducing transcapillary driving force. 33 The attenuated FVR response in DMR+ during hypovolaemia could thus further aggravate the reduction in fluid absorption ( Table 1).…”

Section: Discussionmentioning

confidence: 96%

“…They had normal urinary albumin excretion, no retinopathy, no clinical symptoms or signs of peripheral or autonomous neuropathy, including normal tendon reflexes. The third group included eight type 1 diabetes patients with retinopathy (DMR+) (seven background retinopathy, one proliferative retinopathy) (25 years, range 22-28), diabetes duration 19 years (range [12][13][14][15][16][17][18][19][20][21][22][23][24]. All were on four-dose insulin regime, but with poor metabolic control (HbA1c 8.8 ± 0.7 %).…”

Section: Methodsmentioning

confidence: 99%

“…[10][11][12][13] Diabetes patients without microvascular complications demonstrate decreased capillary fluid absorption (due to reduced capillary filtration capacity) in response to acute hypovolaemic stress, leading to defective plasma volume control. [14][15][16] Reduced venous compliance in diabetes patients 17,18 as well as deteriorated blood flow regulation evident in CAN 19 could have a negative impact on capacitance response. Collectively, it seems that decreased haemodynamic stability is positively correlated to diabetes severity.…”

Section: Introductionmentioning

confidence: 99%

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Impaired compensatory response to hypovolaemic circulatory stress in type 1 diabetes mellitus

Lindenberger

Olsen

Länne

2011

Diabetes and Vascular Disease Research

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Diabetes mellitus is associated with decreased haemodynamic stability and reduced tolerance to hypovolaemia. Compensatory haemodynamic responses during experimental hypovolaemia in type 1 diabetes patients with (DMR+) and without (DMR-) retinopathy as well as healthy controls (C) were studied. Lower body negative pressure created hypovolaemic circulatory stress. Volumetric techniques were used to assess the compensatory capacitance response (redistribution of peripheral venous blood to the central circulation) and to assess capillary fluid absorption from tissue to blood. The compensatory capacitance response was 1/3 lower in DMR+ compared with C (p = 0.002) and DMR-(p = 0.01). Net capillary fluid absorption was reduced by one-third in DMR-and DMR+ compared with C (each p < 0.05). Type 1 diabetes patients with retinopathy demonstrate reduced mobilisation of peripheral venous blood to the central circulation. Furthermore, type 1 diabetes patients present with impaired capillary fluid absorption, which in combination with potentially decreased sympathetic vasoconstriction impedes cardiovascular homeostasis during acute hypovolaemic stress.

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“…Estimates of haemodilution based on changes in red blood cell count represent actual haemodilution, as the blood reserves in the spleen are largely unaffected by haemorrhage and sympathetic stimulation [18,19]. Alternatively, the volume of extravascular fluid mobilized to the circulation may be related to the plasma level of glucose, as hyperglycaemia increases transcapillary fluid absorption from, for example, the arm during lower body negative pressure [20].…”

Section: Discussionmentioning

confidence: 99%

Coagulation competence and fluid recruitment after moderate blood loss in young men

Zaar

Mørkeberg

Pott

et al. 2014

Blood Coagulation &Amp; Fibrinolysis

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The coagulation system is activated by a reduction of the central blood volume during orthostatic stress and lower body negative pressure suggesting that also a blood loss enhances coagulation. During bleeding, however, the central blood volume is supported by fluid recruitment to the circulation and redistribution of the blood volume. In eight supine male volunteers (24 ± 3 years, blood volume of 6.9 ± 0.7 l; mean ± SD), 2 × 450 ml blood was withdrawn over ∼ 30 min while cardiovascular variables were monitored. Coagulation was evaluated by thrombelastography, and fluid recruitment was estimated by red blood cell count. Withdrawing 900 ml blood increased heart rate (62 ± 7 to 69 ± 13 bpm, P < 0.05; mean ± SD) and reduced stroke volume (113 ± 12 to 96 ± 14 ml, P < 0.05) leaving cardiac output, mean arterial pressure, and total peripheral resistance unchanged and, furthermore, reduced red blood cell count (4.80 ± 0.33 to 4.64 ± 0.37 × 10(12) cells l(-1), P < 0.05) indicating that 218 ± 173 ml fluid was recruited to the circulation. Withdrawing 450 ml blood reduced the time until initial fibrin formation (R: 6.5 ± 0.9 to 5.1 ± 1.0 min, P < 0.01), whereas the rate of clot formation increased after withdrawal of 900 ml blood (α-Angle: 66 ± 4 to 70 ± 3 deg, P < 0.01). Clot strength (maximal amplitude: 57 ± 4 mm), clot lysis 30 min after maximal amplitude (LY30: 0.8% [0-3.5%] (median [range])), and platelet count (218 ± 25 × 10(9) l(-1)) were unaffected. For supine males, ∼ 25% of a moderate blood loss is compensated by fluid recruitment to the circulation, which may explain the minor cardiovascular response. Yet, a blood loss of 450 ml accelerates coagulation, and this is further accentuated when blood loss is 900 ml.

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Influence of glucose and insulin on transcapillary fluid absorption from the arm during lower body negative pressure in man

Cited by 3 publications

References 34 publications

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

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

Impaired compensatory response to hypovolaemic circulatory stress in type 1 diabetes mellitus

Coagulation competence and fluid recruitment after moderate blood loss in young men

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