American Journal of Clinical Nutrition, Vol 21, 414-422, Copyright © 1968 by The American Society for Clinical Nutrition, Inc.

Insulin-Glucose Relationships in Uremia

¹ From the Cardiorenal Laboratories and the Elliott P. Joslin Research Laboratory in the Department of Medicine, Harvard Medical School; the Peter Bent Brigham Hospital: and the Diabetes Foundation, Inc., Boston, Massachusetts

Seven chronic uremic male patients were studied with multiple determinations of blood glucose and immunoreactive insulin (IRI) following oral glucose loading (OGTT) and intravenous tolbutamide (IVTTT) before (pre-) and after (post-) intensive hemodialysis. The OGT was improved after dialysis, strikingly apparent during the early part of the test (<120 min). No significant differences were found in IRI comparing pre- and post-OGTT; comparing glucose and IRI in OGTT with a matched group of controls, multiple differences were found in glucose levels between the pre- and normal groups. Significantly higher postdialysis glucose values were only apparent in the late samples (> 90 min). The higher IRI levels in uremics when compared to normals also diminished postdialysis. The IRI-blood glucose relationship (slope of linear regression of IRI upon glucose) was not different comparing normals and uremics predialysis. There was, however, a significantly greater IRI-glucose relationship in the postdialysis group than in controls. The IVTTT in the pregroup showed higher glucose and IRI levels when compared to normals. These differences disappeared postdialysis. It is concluded that the defect in glucose utilization in uremia is different from diabetes mellitus in which a diminished IRI-glucose relationship exists. Also the uremic can respond to tolbutamide. A peripheral insensitivity to endogenous insulin would seem to be of prime importance which is partially compensated for, after dialysis, by a relatively greater insulin release.