The Carbohydrate Intolerance of Uremic Patients

Article1 August 1962The Carbohydrate Intolerance of Uremic PatientsFRED B. WESTERVELT JR., M.D., GEORGE E. SCHREINER, M.D., F.A.C.P.FRED B. WESTERVELT JR., M.D.Search for more papers by this author, GEORGE E. SCHREINER, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-57-2-266 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptDuring the past half century a substantial number of clinical investigators have observed hyperglycemia in patients with renal failure and azotemia (1-3).The present investigation of this biochemical aberration, termed "azotemic pseudodiabetes," was undertaken with 3 objectives:1. To reconfirm the existence of impaired glucose tolerance in azotemic subjects;2. To attempt to characterize the abnormality in a fashion which would be of clinical utility in differentiating true diabetes in an azotemic subject from azotemic pseudodiabetes; and3. To approach, if possible, a tenable biochemical explanation for its existence.CLINICAL MATERIALHospital staff and patients without metabolic disease served as...References1. MYERSBAILEY VCCV: The Lewis and Benedict method for the estimation of blood sugar, with some observations obtained in disease. J. Biol. Chem. 24: 147, 1916. CrossrefGoogle Scholar2. LINDERHILLERVAN SLYKE GCADD: Carbohydrate metabolism in nephritis. J. Clin. Invest. 1: 247, 1924. CrossrefGoogle Scholar3. PERKOFFTHOMASNEWTONSELLMANTYLER GTCCJDJCFH: Mechanism of impaired glucose tolerance in uremia and experimental hyperazotemia. Diabetes 7: 375, 1958. CrossrefMedlineGoogle Scholar4. PATTERSONLAZAROW JWH: Determination of glutathione by alloxan complexing. Meth. Biochem. Anal. 2: 256, 1955. Google Scholar5. GENTZKOW CJ: An accurate method for the determination of blood urea nitrogen by direct nesslerization. J. Biol. Chem. 143: 531, 1942. CrossrefGoogle Scholar6. VAN SLYKE DD: Determination of carbon dioxide in plasma. J. Biol. Chem. 30: 347, 1917. CrossrefGoogle Scholar7. KAPLAN NM: Tolbutamide tolerance test in carbohydrate metabolism evaluation. Arch. Intern. Med. 107: 212, 1961. CrossrefMedlineGoogle Scholar8. LAZARUSVOLK SSBW: Functional and morphologic studies of the effect of Orinase on the pancreas. Endocrinology 62: 292, 1958. CrossrefMedlineGoogle Scholar9. GUESTMACKLERKNOWLES GMBHC: Effects of acidosis on insulin action and on carbohydrate and mineral metabolism. Diabetes 1: 276, 1952. CrossrefMedlineGoogle Scholar10. WILDERCOTTON CERT: Reabsorptive hyperchloremic acidosis following ureterosigmoidostomy; report of a case showing disturbed carbohydrate metabolism. Amer. J. Med. 15: 423, 1953. CrossrefMedlineGoogle Scholar11. HALDANEWIGGLESWORTHWOODROW JBVBCE: Effect of reaction changes on human carbohydrate and oxygen metabolism. Proc. Roy. Soc. 96: 15, 1924. Google Scholar12. BAIRD CW: Glucose tolerance in metabolic acidosis. I. Non-diabetic subjects. Med. J. Aust. 47 (1): 41, 1960. CrossrefMedlineGoogle Scholar13. WALSERBODENLOS MLJ: Urea metabolism in man. J. Clin. Invest. 38: 1617, 1959. CrossrefMedlineGoogle Scholar14. SCHREINERMAHER GEJF: Uremia: Biochemistry, Pathogenesis and Treatment, Charles C Thomas, Springfield, Illinois, 1961, 487 pp. Google Scholar15. SELIGSON D: Personal communication. Google Scholar16. DU VIGNEAUDFITCHPEKAREKLOCKWOOD VAEWW: The inactivation of crystalline insulin by cysteine and glutathione. J. Biol. Chem. 94: 233, 1931-32. Google Scholar17. WINTERSTEINER O: The action of sulfhydryl compounds on insulin. J. Biol. Chem. 102: 473, 1933. CrossrefGoogle Scholar18. NARAHARATOMIZAWAWILLIAMS HTHHRH: Sulfhydryl factors in degradation of insulin-I131 by liver extract. Proc. Soc. Exp. Biol. Med. 92: 718, 1956. CrossrefMedlineGoogle Scholar19. STRASSLEPLETSCHER RA: Uber Hemmung von Insulinase durch Sulfonylharnstoffe. Klin. Wschr. 35: 719, 1957. CrossrefMedlineGoogle Scholar20. CONNLOUISWHEELER JWLHCE: Production of temporary diabetes mellitus in man with pituitary adrenocorticotropic hormone; relation to uric acid metabolism. J. Lab. Clin. Med. 33: 651, 1948. MedlineGoogle Scholar21. HESSKYLEDOOLAN WCLHPD: Effect of administration of ACTH and cortisone upon blood glutathione levels. Proc. Soc. Exp. Biol. Med. 76: 418, 1951. CrossrefMedlineGoogle Scholar22. CONN JW: Hormonal factors in carbohydrate metabolism, in Ciba Foundation Colloquia on Endocrinology 6: 166, 1953. Google Scholar23. MUIRHEADJONES EEF: Lowered glucose utilization, phosphate uptake and reduced glutathione following uretero-caval anastomosis. Proc. Soc. Exp. Biol. Med. 102: 351, 1959. CrossrefMedlineGoogle Scholar24. WILLIAMS RH: Textbook of Endocrinology, 2d Ed., W. B. Saunders Co., Philadelphia, 1955, p. 713. Google Scholar25. GREENBLATT RB: Office Endocrinology, 4th Ed., Charles C Thomas, Springfield, Illinois, 1952, p. 432. Google Scholar26. ALLGOOD JW: Renal clearance of I131 during infusion of NaI131 and insulin-I131. Diabetes 10: 7, 1961. CrossrefMedlineGoogle Scholar27. MAUSOWROBLEWSKI CF: Glutathione reductase activity in blood and body fluids. J. Clin. Invest. 37: 214, 1958. CrossrefMedlineGoogle Scholar28. ZUBRODEVERSOLEDANA CGSLGW: Amelioration of diabetes and striking rarity of acidosis in patients with Kimmelstiel-Wilson lesions. New Engl. J. Med. 245: 518, 1951. CrossrefMedlineGoogle Scholar29. RUNYANHURWITZROBBINS JWDSL: Effect of Kimmelstiel-Wilson syndrome on insulin requirements in diabetes. New Engl. J. Med. 252: 388, 1955. CrossrefMedlineGoogle Scholar30. KALANTCLAMENHOFFMAN NMMM: Effect of experimental nephrosis on alloxan diabetes in rats. Diabetes 7: 140, 1958. CrossrefMedlineGoogle Scholar31. COHENSPRITZRUBINSLUCKEY BDNALEH: Hyperguanidinemia and hypoglycemic unresponsiveness in renal disease. (Abstract) Ann. Intern. Med. 54: 1062, 1961. LinkGoogle Scholar32. BENESCHBENESCHROGERS RREWI: in Glutathione Symposium, Academic Press, Inc., New York, 1954, p. 31. CrossrefGoogle Scholar33. WILLIAMSHAYTJADEN RHJSMB: Degradation of insulin-I131 and glucagon-I131 and factors influencing it. Ann. N. Y. Acad. Sci. 74: (3), 513, 1959. CrossrefMedlineGoogle Scholar34. LAHMANNSCHLOSSMANN HHJ: The cation of cell-free muscle extract on insulin. J. Physiol. 95: 15P, 1939. Google Scholar35. NARAHARAWILLIAMS HTRH: Reduction of insulin by an extract of rat liver. Quoted in reference 33. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Washington, D. C.From the Department of Medicine, Georgetown University School of Medicine, and the Renal and Electrolyte Division, Georgetown University Hospital, Washington, D. C.Dr. Westervelt is a research fellow in renal disease, supported in part by grant AT-446, National Institute of Arthritis and Metabolic Diseases.This work was facilitated by support of the John Hartford Foundation and Georgetown University Kidney Research Fund.Requests for reprints should be addressed to George E. Schreiner, M.D., Renal and Electrolyte Division, Georgetown University Hospital, 3800 Reservoir Road, N. W., Washington 7, D. C. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByCarbohydrate metabolism in chronic renal diseaseEndocrine and Growth Abnormalities in Chronic Kidney DiseaseIs insulin resistance a useful predictor of outcomes in diabetic kidney disease?Endocrine and Growth Abnormalities in Children with Chronic Renal DiseaseCarbohydrate Metabolism in Kidney Disease and Kidney FailureEndocrine and Growth Disorders in Chronic Kidney DiseaseLipoprotein metabolism in chronic renal insufficiencyParathyroid Hormone Toxicity in Chronic Renal FailureLipid Metabolism and Cardiovascular Morbidity and Mortality in Hemodialysis Patients: Role of Factors Modulating Cytosolic CalciumImproved Biochemical Variables, Nutrient Intake, and Hormonal Factors in Slow Nocturnal Hemodialysis: A Pilot StudyEffects of parathyroid hormone infusion on glucose tolerance and glucose-stimulated insulin secretion in normal and uremic ratsDoes uremia interfere with HbA1c results in the FPLC method with Mono S cation exchanger?Is?-endorphin an uremic toxin??-Endorphin isolated from filtrate of uremic patients with carbohydrate intoleranceInsulin Management of a Diabetic Patient on HemodialysisGlycated Haemoglobin Measurement in Uraemic PatientsINutritional Support in Acute Renal Failure in the Critically IIIInsulin Resistance of UremiaCarbohydrate Intolerance and Impaired Pancreatic Insulin Release in Chronic Renal Failure: Role of Excess Blood Levels of Parathyroid HormoneThe untoward effects of the anions of dialysis fluidsThe medical and metabolic consequences of administration of sodium acetateParathyroid Hormone: A Uremic ToxinPathogenesis and Consequences of the Alteration of Glucose Metabolism in Renal InsufficiencyAdipocyte insulin binding and insulin action in chronic renal failure before and during continuous ambulatory peritoneal dialysisBromocriptine and the Hypothalamic Hypophyseal Function in Patients With Chronic Renal Failure on Chronic HemodialysisPostbinding defects of insulin action in human adipocytes from uremic patientsB-cell response to a standardized breakfast in end-stage renal failureEndurance Exercise Training: An Effective Therapeutic Modality for Hemodialysis PatientsOligomycin toxicity in intact ratsLong-Term Metabolic Consequences of Continuous Ambulatory Peritoneal DialysisInsulin resistance in uremia mediated by postbinding defectsChronic renal failureThe response to intravenous glucose of patients on maintenance hemodialysis: Effects of dialysisHyperlipidämie bei Erkrankungen der NierePattern of growth hormone response to insulin, arginine and haemodialysis in uraemic childrenGlucose intolerance in uremia (A- and B-cell function during conservative and dialytic management)Possible sites of interaction of acute renal failure with amino acid utilization for gluconeogenesis in isolated perfused rat liverMicrocalorimetric Measurements of Heat Production in Erythrocytes of Patients with Chronic UraemiaDiabetes und NierenLipids and Lipoproteins in Chronic Uraemia. A Study of the Influence of Regular HaemodialysisEvidence that hemodialysis does not improve the glucose tolerance of patients with chronic renal failurePathobiochemie und Pathophysiologie der chronischen NiereninsuffizienzUntersuchungen über die Beziehung zwischen urämischer Polyneuropathie, urämischer Glucoseverwertungsstörung und Schweregrad der urämischen Intoxikation bei DialysepatientenThe PancreasInteraction between serum calcium concentration and glucose tolerance in normal and azotaemic patientsEffect of acute uremia on various aspects of carbohydrate metabolism in dogsChanges in glucose tolerance, insulin, serum lipids and lipoproteins in patients with renal failure on intermittent haemodialysisEnhanced response to tolbutamide in uremiaInhibition of glucose utilization in rat diaphragm by peptides of uraemic serum isolated by high-voltage electrophoresisHYPERLIPOPROTEINEMIA IN PATIENTS WITH CHRONIC RENAL FAILUREAbnormal carbohydrate metabolism in uraemiaMetabolic Abnormalities in UremiaParenteral nutrition for the surgical patient.Diabetic Glomerulosclerosis in the Absence of Glucose IntoleranceFRANK G. STRAUSS, M.D., WILLIAM P. ARGY JR., M.D., F.A.C.P., GEORGE E. SCHREINER, M.D., F.A.C.P.Belastungsteste mit Hormonen und SulfonylharnstoffenGrowth hormone levels in severe renal failureLack of dialyzable insulin antagonist in uremiaAcetoacetate and d-β-hydroxybutyrate concentrations in chronic renal insufficiencyGlucose intolerance in uraemiaGLYCOGEN CONTENT OF SKELETAL MUSCLE IN PATIENTS WITH RENAL FAILUREBLOOD LEVELS OF INSULIN IN URAEMIC PATIENTSThe Renal Excretion of Nitrogen Containing MetabolitesEFFECT OF POTASSIUM ON BLOOD-SUGAR AND PLASMA-INSULIN LEVELS IN PATIENTS UNDERGOING PERITONEAL DIALYSIS AND HÆMODIALYSISLiver glycogen concentration in patients with chronic uremiaREMOVAL OF REFRACTORY ŒDEMA FLUID BY PERITONEAL DIALYSISNeurologic disorders in renal failureMedical management of chronic renal failureThe effect of prolonged starvation on blood glucose and plasma free fatty acids in nephrectomized rats with acute uremic syndromeCarbohydrate Metabolism in UremiaEDWARD S. HORTON, M.D., CHARLES JOHNSON, M.D., HAROLD E. LEBOVITZ, M.D.Untersuchungen zur urämischen KohlenhydratstoffwechselstörungDie NiereninsuffizienzNiere bei EndokrinopathienThe effect of uremic serum on carbohydrate metabolism in rat diaphragmHyperglycemia and Hyperosmolality Complicating Peritoneal DialysisJAMES BOYER, M.D., GORDON N. GILL, M.D., FRANKLIN H. EPSTEIN, M.D.Changes in glucose and insulin metabolism induced by dialysis in patients with chronic uremiaThe effect of potassium on the imparired glucose tolerance in chronic uremiaAzotemia and Glucose IntoleranceJAMES M. CERLETTY, M.D., NORMAN H. ENGBRING, M.D.ROLE OF INSULIN IN GLUCOSE INTOLERANCE IN URÆMIAParenteral nutrition in renal failure.Diabetes and Renal DiseaseEtude de la glycor�gulation dans l'insuffisance r�nale chronique 1Abnormal carbohydrate metabolism in renal failureHazards and Complications of DialysisIsolation of N-methyl-2-pyridone-5-carboxamide from hemodialysis fluid obtained from uremic patientsElliptocytosis with Haemolytic AnaemiaInsulin inhibition and antagonismReports of SocietiesManagement of chronic renal failureConsiderations in the patient with diminished renal functionUntersuchungen zum Kohlenhydratstoffwechsel bei Niereninsuffizienz 1 August 1962Volume 57, Issue 2_Part_1Page: 266-276KeywordsGlucose intoleranceHospital medicineHyperglycemiaInsulinKidneysMetabolic disordersPatientsRenal diseasesRenal failureResearch funding Issue Published: 1 August 1962 PDF DownloadLoading ...