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- Title
Glucose-induced insulin secretion in uremia: Effects of aminophylline infusion and glucose loads.
- Authors
Allegra, Vincenzo; Mengozzi, Glacomo; Martimbianco, Lucia; Vasile, Alfonso
- Abstract
To explain mechanisms responsible for derangement of insulin release in uremia, we investigated glucose metabolism through three different tests in 14 patients with end-stage chronic renal failure. These tests were: intravenous glucose tolerance test with 0.33 g/kg of glucose solution (IVGTT); IVGTT with 0.5 g/kg of glucose solution (IVGTT2): IVGTT during aminophylline infusion (IVGTT + A). Twelve of the patients had IVGTT repeated after two to four months of thrice-weekly regular hemodialysis (IVGTT3). In each lest we measured plasma glucose (G), immunoreactive insulin (IRI) and C-peptide. We also calculated glucose constant decay (K), insulin production (IRI area), insulinogenic index (IGI), and insulin resistance index (RI). Twenty-nine healthy volunteers formed the normal controls for IVGTT. As compared to controls, during IVGTT uremic patients showed significantly lower values in K, IRI area and IGI, and showed a significant RI value increase. During IVGTT2, IRI area values were higher than during IVGTT but IGI and K values were unchanged. During IVGTT+A both IRI area and IGI values were higher than during IVGTT. After hemodialysis treatment (IVGTT3) K, IRI areas and IGI increased significantly as compared to the predialysis period. K increase after hemodialysis correlated directly to IGI increase and inversely to RI changes. IGI increase during IVGTT3 was directly correlated to IGI rise during IVGTT+A. From these data we infer that defective insulin release in uremia is due to a decrease of β-cell glucose sensitivity rather than to their functional exhaustion. An impaired adenyl cyclase-cAMP system may have an important role in the pathogenesis of this abnormality.
- Subjects
GLUCOSE; INSULIN; UREMIA; CHRONIC kidney failure; HEMODIALYSIS; KIDNEY diseases
- Publication
Kidney International, 1990, Vol 38, Issue 6, p1146
- ISSN
0085-2538
- Publication type
Article
- DOI
10.1038/ki.1990.325