Spontaneous Hypoglycemia Associated with Chronic Renal Failure

Abstract

Spontaneous, prolonged hypoglycemia was observed in one nondiabetic and one mildly diabetic patient, both with chronic renal insufficiency. Although both patients had abnormal oral glucose tolerance tests, half-time disappearance of glucose was usually normal during intravenous glucose tolerance tests. Both patients developed persistent hypoglycemia during the tolbutamide tolerance test, but the insulin responses were not consistent with an islet cell adenoma. The hypoglycemia did not seem to reflect increased insulin secretion, increased insulin sensitivity or impaired glycogenolysis as assessed by the blood glucose response to glucagon. Although some factor associated with chronic renal disease was probably responsible for the hypoglycemia, the underlying mechanism was not defined. DIABETES 22:493-98, July, 1973.It is well recognized that patients in chronic renal failure develop some degree of abnormal carbohydrate tolerance. 1 " 5 The disturbance in glucose homeostasis most commonly manifests itself as glucose intolerance, referred to as renal diabetes. 1 " 3 -5 ' 6 On rare occasions prolonged and refractory hypoglycemia has been observed independent of a known hypoglycemic stimulus and without adequate explanation. 7 ' 8 Diabetic patients occasionally develop improved carbohydrate tolerance and decreased insulin needs as renal insufficiency develops. 9 " 11 Episodes of severe and prolonged hypoglycemia in diabetic, uremic patients on insulin or oral hypoglycemic agents have also been reported. 12 Recently, spontaneous hypoglycemia was documented in three diabetic patients in renal failure who were being managed by diet alone 7 and in one nondiabetic with a comparable level of renal insufficiency. 8 The latter case is, to our knowledge, the first report of hypoglycemia occurring with renal insufficiency in the absence of diabetes. Recently, we observed hypoglycemia in two patients in

Abnormal Carbohydrate Metabolism in Chronic Renal Failure

“…These abnormalities most commonly include previously unrecognized carbohydrate intolerance in greater than 50% of azotemic individuals (2,3) and even overt fasting hyperglycemia (3,4). However, the development of spontaneous hypoglycemia has also been reported (5,6). On the other hand, an amelioration of the diabetic state with decreasing insulin requirements is a well-known clinical concomitant of advancing renal failure in patients with previously established diabetes mellitus (7).…”

Effects of Parathyroid Hormone on Skeletal Muscle Protein and Amino Acid Metabolism in the Rat

“…Chronic renal failure is accompanied by skeletal muscle dysfunction, muscle wasting, and a spectrum of disorders of carbohydrate metabolism ranging from carbohydrate intolerance and even fasting hyperglycemia to the occasional occurrence of spontaneous hypoglycemia (1)(2)(3)(4)(5). Markedly elevated levels of parathyroid hormone and profound secondary hyperparathyroidism are early concomitants of advancing renal insufficiency (6).…”

Management of Hyperinsulinemia with Diazoxide in an Elderly Hemodialysis Patient

“…Glucose intolerance due to peripheral resistance to insulin is common in hemodialysis patients and insulin levels may be elevated [2, 4], although levels are most often normal [2, 4, 5, 6, 7]. If peripheral insulin resistance is not sufficient to counteract the hyperinsulinemia caused by the impaired renal degradation of insulin, spontaneous hypoglycemia may occur.…”

“…Block and Rubenstein [5]first described this in 1970 and it has since been described in diabetic and nondiabetics with uremia. Mechanisms such as reduced renal gluconeogenesis, decreased caloric intake, impaired hepatic glycogenolysis and gluconeogenesis, and impairment of conterregulatory mechanisms have all been implicated [2, 4, 5, 6, 7, 8, 9, 10, 11, 12]. The hemodialysis procedure itself may be associated with hypoglycemia due to alanine losses contributing to deficient gluconeogenesis and through hyperinsulinemia induced by the high dialysate glucose concentration [2].…”