Effect of short-term hyperglycaemia on haemodynamics in type 1 diabetic patients
Article first published online: 9 OCT 2003
Journal of Internal Medicine
Volume 254, Issue 5, pages 464–471, November 2003
How to Cite
Jacobsen, P., Rossing, K., Hansen, B. V., Bie, P., Vaag, A. and Parving, H.-H. (2003), Effect of short-term hyperglycaemia on haemodynamics in type 1 diabetic patients. Journal of Internal Medicine, 254: 464–471. doi: 10.1046/j.1365-2796.2003.01216.x
- Issue published online: 9 OCT 2003
- Article first published online: 9 OCT 2003
- Received 1 April 2003; revision received 20 May 2003; accepted 22 May 2003.
- diabetes mellitus;
- renin–angiotensin system;
- systemic blood pressure;
- type 1
Abstract. Jacobsen P, Rossing K, Hansen BV, Bie P, Vaag A, Parving H-H (Steno Diabetes Center, Gentofte; University of Aarhus, Aarhus; and University of Southern Denmark, Odense, Denmark). Effect of short-term hyperglycaemia on haemodynamics in type 1 diabetic patients. J Intern Med 2003; 254: 464–471.
Objectives. Mechanisms underlying glucose-mediated development and progression of diabetic complications are incompletely understood. We tested the impact of short-term hyperglycaemia on systemic blood pressure and regulatory hormones in type 1 diabetic patients.
Design and methods. We included 18 patients [13 men, mean (SEM) diabetes duration 10 (1) years] without signs of autonomic neuropathy or renal complications in a randomized single-blinded cross-over trial using insulin–glucose clamp technique. Patients were clamped for 90 min to blood glucose of 5 mmol L−1 (euglycaemia) and 15 mmol L−1 (hyperglycaemia) in random order. Blood pressure was measured noninvasively every 5 min (Takeda TM2421 device). Regulatory hormones were determined at the end of each clamp period.
Results. Systolic blood pressure increased [mean (95% CI)] 3 (1, 5) mmHg during hyperglycaemia from 123 (SEM 2) during euglycaemia, P = 0.01. Diastolic blood pressure remained unchanged at 78 (2) mmHg. Hyperglycaemia reduced plasma concentrations of: renin [14 (4, 23)%, P = 0.02], angiotensin II [17 (8, 25)%, P < 0.01] and adrenaline [20 (10, 29)%, P < 0.01]. Plasma concentration of atrial natriuretic peptide increased by 11 (6, 17) pg mL−1 (P < 0.01) from 43 (2) pg mL−1. We calculated a median (range) increase in extracellular volume and plasma volume (PV) of 2.6 (0.7–5.3)% and 5.0 (−4.7 to 8.6)%, respectively.
Conclusions. In type 1 diabetic patients without signs of autonomic neuropathy short-term hyperglycaemia induced a modest increase in systolic blood pressure and suppression of the renin–angiotensin system, possibly caused by PV expansion because of fluid shift from intra- to extracellular compartment.