Response of Congestive Heart Failure to Correction of Hyperglycemia in the Presence of Diabetic Nephropathy

RAPID movement of glucose across the cell membrane obligates the movement of a sufficient amount of water to maintain osmotic equilibrium. Clinically, the rapid movement of glucose from the extracellular-fluid compartment to the intracellular-fluid compartment in response to insulin therapy in hyperosmolar nonketotic diabetic coma is accompanied by an appropriate movement of water in the same direction.1 2 3 In such patients, who are already dehydrated, this fluid shift may precipitate a fall in blood pressure or even shock. Theoretically, the movement of fluid in the opposite direction, from the intracellular-fluid space to the extracellular-fluid space, in response to a sudden increase . . .