Petrie JR, Minamisawa K, Morris AD, Elliott HL, Small M,
Connell JMC
Salt depletion impairs insulin sensitivity in NIDDM
16th Scientific Meeting of the International Society of Hypertension
ISH Abstract Book
(Jun) 16: 1996
It has been suggested that angiotensin converting enzyme inhibitors
increase insulin sensitivity in diabetic patients, possibly via
angiotensin II (ANG II) withdrawal. However, acute administration of
ANG II increases insulin sensitivity in patients with
non-insulin-dependent diabetes mellitus (NIDDM). The authors
therefore studied the effect of more chronic activation of the
renin-angiotensin system on insulin-mediated glucose uptake in these
patients.
Nine normotensive patients with diet-controlled NIDDM
underwent hyperinsulinaemic euglycaemic clamp studies in a
sodium-deplete (D) and replete (R) state in a double-blind
placebo-controlled crossover design. Patients were studied after two
four-day periods of low sodium diet (40 mmol/24 hours) during which
they took either 120 mmol/24 hours of sodium tablets or placebo. 24
hour urinary sodium was 197 ñ SD 76.0 mmol (R) and 67 ñ 19.5 mmol
(D), p < 0.01. Baseline ANG II levels were 4.9 ñ 5.8 (R) and 16.0 ñ
15.6 (D) pg/ml, p < 0.05. A reproducible insulin stimulus was
achieved. Insulin sensitivity (M-value) was 7.8 ñ 2.0 mg kg-1 min-1
(R) and 6.5 ñ 2.2 mg kg-1 min-1 (D), p < 0.05. There were no
significant differences in hepatic glucose production between the two
conditions. Blood pressure was 130 ñ 20.6/78 ñ 11 mmHg (R) and 128 ñ
12/73 ñ 10 mmHg (D).
Comment: These data suggest that chronic activation of the
renin-angiotensin system by sodium depletion leads to a deterioration
in insulin sensitivity in normotensive patients with NIDDM. As insulin
sensitivity is an important pathophysiological feature of NIDDM,
larger studies should be performed examining the effect of following
current dietary sodium recommendations (restriction to 40-mmol daily)
on glycaemic control in hypertensive patients with NIDDM (Carmine
Zoccali, M.D, Reggio Calabria, Italy).
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16th Scientific Meeting of the International Society of Hypertension
H: Pathophysiology :
Salt (sodium, chloride) sensitivity
H: Special problems :
Obesity, Insulin Resistance