National Library of Medicine: IGM
Full Record Screen
TITLE:
Mechanisms of altered hemodynamic and metabolic
responses to insulin in patients with insulin-dependent diabetes mellitus and autonomic
dysfunction.
AUTHOR:
Makimattila S; Mantysaari M; Schlenzka A;
Summanen P; Yki-Jarvinen H
AUTHOR AFFILIATION:
Department of Medicine, Helsinki University
Central Hospital, Finland.
SOURCE:
J Clin Endocrinol Metab 1998 Feb;83(2):468-75
NLM CIT. ID:
98128688
ABSTRACT:
Patients with autonomic neuropathy are more
susceptible to insulin-induced hypotension than normal subjects, but the mechanisms are
unclear. We quantitated the hemodynamic and metabolic effects of two doses of i.v. insulin
(1 and 5 mU/kg.min, 120 min each) and several aspects of autonomic function in 28 patients
with insulin-dependent diabetes mellitus (IDDM) and in 7 matched normal subjects under
standardized normoglycemic conditions. The autonomic function tests included those
predominantly assessing the integrity of vagal heart rate control (the expiration
inspiration ratio during deep breathing and high frequency power of heart rate
variability) and tests measuring sympathetic nervous function (reflex vasoconstriction to
cold and blood pressure responses to standing and handgrip). During hyperinsulinemia,
heart rate increased less (2 +/- 1 vs. 6 +/- 2 beats/min; P <0.04) and diastolic blood pressure fell more (-3.1 +/- 1.2 vs. 0.9 +/- 2.1; P="NS)" in the patients with IDDM than in the normal subjects. Forearm vascular resistance decreased significantly in the patients with IDDM [by 7.1 +/- 1.4 mm Hg/(mL/dL.min); P < 0.001 for high vs. low dose insulin], but not in the normal subjects (-0.1 +/- 2.5 mm Hg/(mL/dL.min; P="NS)." Reflex vasoconstriction to cold was inversely correlated with the decreases in diastolic (r="-0.51;" P < 0.005) and systolic (r="-0.59;" P < 0.001) blood pressure and forearm vascular resistance (r="-0.53;" P < 0.005), but not with the change in heart rate. The expiration inspiration ratio was, however, directly correlated with the insulin-induced change in heart rate (r="0.63;" P < 0.001), but not with diastolic or systolic blood pressure or forearm vascular resistance. Whole body (48 +/- 2 vs. 67 +/- 5 mumol/kg.min; P < 0.005) and forearm (44 +/- 4 vs. 67 +/- 8 mumol/kg.min; P < 0.05) glucose uptake were significantly lower in the IDDM patients than in the normal subjects. The latter could be attributed to a defect in the forearm glucose arterio-venous difference (1.5 +/- 0.1 vs. 2.2 +/- 0.2 mmol/L, respectively; P < 0.01), but not in blood flow. We conclude that both impaired vagal heart rate control and sympathetic nervous dysfunction exaggerate the hemodynamic effects of insulin in patients with IDDM and could contribute to insulin-induced hypotension.
MAIN MESH SUBJECTS:
Autonomic Nervous System
Diseases/*PHYSIOPATHOLOGY
Diabetes Mellitus, Insulin-Dependent/*DRUG THERAPY/ *PHYSIOPATHOLOGY
Diabetic Neuropathies/*PHYSIOPATHOLOGY
Hemodynamics/*DRUG EFFECTS
Insulin/*ADVERSE EFFECTS/THERAPEUTIC USE
ADDITIONAL MESH SUBJECTS:
Adolescence
Adult
Arm/BLOOD SUPPLY
Blood Flow Velocity/DRUG EFFECTS
Blood Glucose/METABOLISM
Blood Pressure/DRUG EFFECTS
Heart Rate/DRUG EFFECTS
Human
Male
Middle Age
Support, Non-U.S. Gov't
Vascular Resistance/DRUG EFFECTS
PUBLICATION TYPES:
JOURNAL ARTICLE
LANGUAGE:
Eng
REGISTRY NUMBERS:
0 (Blood Glucose)
11061-68-0 (Insulin)
On Sabbatical!
When my office
lease expired at the end of 2004, I decided to turn it into a
"sabbatical" from my private practice. Many years ago, in my
grandfather's 89th year of life, he told me, "John, it is important
to smell the roses while you can still smell them." His life
gave living a very good reputation. It is also true that the
pursuit of that philosophy required my grandfather to to re-open his
assay office/ore market in Wickenburg, Arizona as a 75-year-old because
he had run a little short of retirement money. Thus, if blessed with his
luck and health, I'll be back.. --jjh
