Chronic intrarenal insulin replacement reverses diabetes mellitus-induced natriuresis and diuresis.
Chronic intrarenal insulin replacement reverses diabetes mellitus-induced natriuresis and diuresis.
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DOI：
10.1161/hypertensionaha.111.185215
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发表时间：
2012-02
期刊：
影响因子：
--
通讯作者：
Brands MW
中科院分区：
文献类型：
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作者：
Manhiani MM;Duggan AD;Wilson H;Brands MW
We recently showed that sustained natriuresis in Type I diabetic dogs was due to the decrease in insulin rather than the hyperglycemia alone. The sodium retaining action of insulin appeared to require hyperglycemia and it completely reversed the diabetic natriuresis and diuresis. This study tested whether the sodium retaining effect was due to direct intrarenal actions of insulin. Alloxan-treated dogs (D; n=7) were maintained normoglycemic using 24hr/day i.v. insulin replacement. After control measurements, i.v. insulin was decreased to begin a 6-day diabetic period. Blood glucose increased from 84±6 to an average of 428 mg/dL on days 5 and 6, sodium excretion increased from 74±8 to 98±7 mEq/day over the 6 days, and urine volume increased from 1645±83 to 2198±170 mL/day. Other dogs (DIr, n=7) were subjected to the same diabetic regimen, but in addition, insulin was infused continuously into the renal artery at 0.3 mU/kg/min during the 6-day period. This did not affect plasma insulin. Blood glucose increased from 94±10 to an average of 380 mg/dL on days 5 and 6, but sodium excretion averaged 76±5 and 69±8 mEq/day during control and diabetes, respectively. The diuresis also was prevented. GFR increased only in Dir dogs, and there was no change in MAP in either group. This intra-renal insulin infusion had no effect on sodium or volume excretion in normal dogs. Intra-renal insulin replacement in diabetic dogs caused a sustained increase in tubular reabsorption that completely reversed diabetic natriuresis. Insulin+glucose may work to prevent salt wasting in uncontrolled Type II diabetes.
