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Insulin Effect On Kidney

Role Of The Kidney In Insulin Metabolism And Excretion

Role Of The Kidney In Insulin Metabolism And Excretion

The role of the kidneys in insulin metabolism and excretion is reviewed. Removal of these organs from animals prolongs the half-life of injected labeled or unlabeled insulin. Similar findings, reversible by transplantation, are noted in patients with severe renal disease. After injection of insulin-I-131 into a peripheral vein, the concentration of radioactivity in the renal cortex of rats is nine times greater than any other tissue and 21 per cent of the administered dose is present in the kidneys at fifteen minutes. In contrast to other organs, an increase in the injected dose results in a greater proportion being localized to the kidneys. The concentration of insulin in renal venous blood is 30 to 40 per cent lower than the arterial level, and the quantity of insulin removed by the kidneys over twentyfour hours is 6 to 8 U. The renal clearance of insulin in man is approximately 200 ml. per minute. There is both direct and indirect evidence that insulin is filtered at the glomerulus and almost completely reabsorbed and degraded by cells lining the proximal convoluted tubules. This mechanism accounts for 50 to 60 per cent of the renal uptake of insulin, the remaining 40 to 50 per cent being removed from the postglomerular peritubular capillaries. The amount of insulin excreted in the urine is less than 2 per cent of the filtered load and the urinary clearance is 0.1-0.5 ml. per minute. This clearance is constant over a wide range of serum levels and is thus a useful reflection of the mean serum level over a period of time. These observations explain the fall in insulin requirements of diabetic patients who develop renal failure. Furthermore, the severe hypoglycemia which occasionally occurs in elderly subjects with uremia following the administration of oral sulfonylur Continue reading >>

Will Taking Insulin Cause Complications?

Will Taking Insulin Cause Complications?

Great question! Thanks for asking. In many areas of the country it’s widely believed that the very worst of diabetes complications are caused by insulin. People remember their grandparents being put on insulin then going blind, suffering kidney failure, amputations, and even death. No wonder many families are terrified of insulin! But here’s the deal, no you-know-what, insulin is the safest diabetes medication on the planet. After all, it is something that belongs in your body in the first place. So why does it have such a bad reputation? Is modern insulin different than old-time insulin? Actually, it is a bit different, but not by much. The truth is that we in medicine have to take much of the blame for insulin’s bad name. In times past there was a much greater emphasis in diabetes care on various diets. To keep their patients motivated and focused on these difficult diets, many doctors in the past used the threat of insulin as a form of negative reinforcement. “Follow my directions or I’ll put you on the needle!” nonsense. This was bad medicine in many different respects. First off, diabetes is a chronic, progressive illness. That means it never goes away and it gets a little worse over time, no matter how well you take care of yourself. If you have diabetes long enough, and don’t get run over by a truck, you will need insulin. So now we can see the first error, using something that is inevitable as a threat is a bad battle plan. Past patients who tried their best, but failed to the inevitable, then felt miss-placed guilt. The more serious outcome of this misguided approach, however, is that it caused insulin to be started too late in the course of the disease. Grandpa didn’t die because he was put on insulin. Grandpa died because he was not put on ins Continue reading >>

Effects Of Insulin On Kidney Function And Sodium Excretion In Healthy Subjects

Effects Of Insulin On Kidney Function And Sodium Excretion In Healthy Subjects

Summary Insulin action on kidney function was evaluated in 8 healthy subjects, (mean age 27 years) using the euglycaemic clamp technique. Insulin was infused at rates of 0, 20 and 40 mU·min−1·m−2 over consecutive periods of 120 min resulting in plasma insulin concentrations of 8±2, 29±7 and 66±14 mU/l. The renal clearance of 51Cr-EDTA, lithium, sodium and potassium was determined during the last 90 min of each period. Sodium clearance declined with increasing plasma insulin concentrations (1.3±0.4, 1.0±0.3 and 0.5±0.2 ml·min−1·1.73 m−2, p<0.001), while glomerular filtration rate (108±21, 104±21 and 108±20ml·min−1·1.73 m−2) and lithium clearance (a marker of fluid flow rate from the proximal tubules) 29±5, 29±4 and 30±4 ml·min−1·1.73 m−2) remained unchanged. Calculated proximal tubular reabsorption of sodium and water was unchanged, while calculated distal fractional sodium reabsorption increased (95.5±1.5, 96.4±1.2 and 98.1±0.7%, p<0.001). Potassium clearance and plasma potassium concentration declined, whereas plasma aldosterone and plasma renin concentrations were unchanged. In conclusion, elevation of plasma insulin concentration within the physiological range has a marked antinatriuretic action. This effect is located distally to the proximal renal tubules. Continue reading >>

Insulin Resistance In Chronic Kidney Disease: New Lessons From Experimental Models

Insulin Resistance In Chronic Kidney Disease: New Lessons From Experimental Models

Insulin resistance in chronic kidney disease: new lessons from experimental models Universit de Lyon, INSERM U1060, CarMeN, INSA de Lyon, Univ Lyon-1 Hospices Civils de Lyon, Hpital E Herriot Correspondence and offprint requests to: Laetitia Koppe; E-mail: [email protected] Search for other works by this author on: Universit de Lyon, INSERM U1060, CarMeN, INSA de Lyon, Univ Lyon-1 Hospices Civils de Lyon, Hpital E Herriot Universit de Lyon, INSERM U1060, CarMeN, INSA de Lyon, Univ Lyon-1 Hospices Civils de Lyon, Hpital E Herriot Universit de Lyon, INSERM U1060, CarMeN, INSA de Lyon, Univ Lyon-1 Hospices Civils de Lyon, Hpital E Herriot Universit de Lyon, INSERM U1060, CarMeN, INSA de Lyon, Univ Lyon-1 Hospices Civils de Lyon, Hpital E Herriot Hospices Civils de Lyon, Hpital E Herriot Universit de Lyon, INSERM U1060, CarMeN, INSA de Lyon, Univ Lyon-1 Hospices Civils de Lyon, Hpital E Herriot Nephrology Dialysis Transplantation, Volume 29, Issue 9, 1 September 2014, Pages 16661674, Laetitia Koppe, Caroline C. Pelletier, Pascaline M. Alix, Emilie Kalbacher, Denis Fouque, Christophe O. Soulage, Fitsum Guebre-Egziabher; Insulin resistance in chronic kidney disease: new lessons from experimental models, Nephrology Dialysis Transplantation, Volume 29, Issue 9, 1 September 2014, Pages 16661674, Insulin resistance (IR) is a common feature of chronic kidney disease (CKD), but the underlying mechanisms still remain unclear. A growing body of evidence suggests that IR and its associated metabolic disorders are important contributors for the cardiovascular burden of these patients. In recent years, the modification of the intestinal flora and activation of inflammation pathways have been implicated in the pathogenesis of IR in obese and diabetic patients. All these pathways u Continue reading >>

Carbohydrate And Insulin Metabolism In Chronic Kidney Disease

Carbohydrate And Insulin Metabolism In Chronic Kidney Disease

INTRODUCTION Uremia is typically associated with impaired glucose metabolism. Some patients have hyperglycemia in response to oral and intravenous glucose loads, while others are able to maintain normoglycemia by raising plasma insulin levels. Studies utilizing the euglycemic and hyperglycemic clamp techniques suggest that several disturbances in carbohydrate handling may be present. Tissue insensitivity to insulin is of primary importance, but alterations in insulin degradation and insulin secretion also may contribute [1-3]. The variable severity of these changes in individual patients explains the variable plasma levels of insulin and glucose that may be seen both fasting and following a glucose load. This topic will review the changes in carbohydrate and insulin metabolism that occur in chronic kidney disease (CKD) and the clinical implications of these abnormalities in nondiabetics. The impact of these changes on the management of hyperglycemia in diabetic patients with end-stage renal disease (ESRD) is discussed separately. (See "Management of hyperglycemia in patients with type 2 diabetes and pre-dialysis chronic kidney disease or end-stage renal disease".) NORMAL RENAL HANDLING OF INSULIN The kidney plays a central role in the metabolism of insulin in normal subjects [1,2,4]. Insulin has a molecular weight of 6000 and is therefore freely filtered. Of the total renal insulin clearance, approximately 60 percent occurs by glomerular filtration and 40 percent by extraction from the peritubular vessels. Insulin in the tubular lumen enters proximal tubular cells by carrier-mediated endocytosis and is then transported into lysosomes, where it is metabolized to amino acids [5]. The net effect is that <1 percent of filtered insulin appears in the final urine. The renal c Continue reading >>

When Your Doctor Says It's Time To Start Insulin

When Your Doctor Says It's Time To Start Insulin

If you have type 2 diabetes and your blood glucose isn't well controlled through diet and oral medicines, your provider may want you to start insulin. You may feel some of the following concerns. You don't understand what you've done wrong. Diabetes usually progresses over time. There comes a time when more and stronger treatment is needed. When the pills that have controlled your blood glucose no longer work, insulin is needed. This doesn't mean you have failed. It is expected in the course of the disease. You are not alone! Most healthy patients with diabetes can expect to live long lives after their disease is diagnosed. A large number will require insulin at some point. Many are not happy about taking injections, but most adjust to them well. You feel like your life is going to change. In some cases, insulin treatment may be temporary. In others, it is not. Whatever is needed to control your blood glucose should be used. That's what keeps you healthy. When your blood glucose is well controlled, you may have more energy, sleep better, and enjoy better moods. You can still do all of your usual activities, eat meals out, and live your life. You may need to check your blood glucose more often, but this will keep you safe, healthy, and informed. You may be surprised that this is a much smaller burden than you thought it would be. You've heard that insulin causes blindness and kidney failure. Nothing could be further from the truth. High blood glucose cause blindness, kidney failure, and other problems, such as nerve damage that can lead to amputations. But eye, kidney, and nerve damage can be delayed or prevented by good control. Insulin will NOT make your diabetes worse, and it is one of the most natural diabetes treatments available. You're afraid to take injections or Continue reading >>

Insulin Is Key To Kidney Disease

Insulin Is Key To Kidney Disease

A form of kidney disease may result from defective insulin signaling, challenging conventional wisdom Diabetic kidney disease likely results from defective insulin signaling in the kidneys, contradicting long-standing suspicions, according to findings appearing online today (October 5) in Cell Metabolism. Scientists have long attributed this type of kidney disease -- the leading cause of renal failure -- to high glucose levels in the blood and defects in the kidney microvasculature. The study "suggests there's a direct effect of insulin" on epithelial cells in the kidney, "which is really a new idea," said nephrologist linkurl:Thomas Coffman;of Duke University School of Medicine, who was not involved in the research. "I'm sure it will be a highly cited paper." Diabetes causes numerous health problems, including a form of kidney disease known as diabetic nephropathy (DN). DN is characterized by protein in the urine, enlarged kidneys, and abnormalities in the glomeruli, specialized capillaries where the urine filtration process begins, and other parts of the kidney. Researchers most often attribute the disease to defects in the microvasculature of the kidneys as a result of high blood glucose levels, which are known to be toxic to a variety of cell types. But growing evidence suggests that another cell type may be involved -- epithelial cells known as podocytes. Furthermore, some people with insulin resistance accumulate protein in their urine, even when glucose is normal. To investigate the role of podocytes and insulin signaling in the development of DN, a team led by molecular biologist and pediatrician linkurl:Richard Coward;of the University of Bristol in the UK examined two knockout mice models whose podocytes lacked the insulin receptor. Within 5 weeks of birth, th Continue reading >>

Renal Effects Of Insulin In Man.

Renal Effects Of Insulin In Man.

(1)Metabolism Unit, CNR Institute of Clinical Physiology, Pisa, Italy. We review some of the effects that insulin exerts on glomerular and tubularfunctions. In healthy subjects, insulin has little or no effect on renalhemodynamics, glomerular filtration rate, or permeability to albumin. In patientswith noninsulin-dependent diabetes, hyperinsulinemia selectively increasesurinary albumin excretion. In vivo, euglycemic hyperinsulinemia is associatedwith reduced urinary sodium excretion both under conditions of forced and normal diuresis. Whether the principal site of this action is the proximal or distaltubule remains somewhat controversial. The effect, however, is not mediated byinsulin-induced hypokalemia and antikaliuresis, as it is still observed whenplasma potassium concentrations and urinary potassium excretion are maintained.Hyperglycemia potentiates insulin antinatriuresis through an effect on theproximal tubule (sodium-glucose cotransport). Insulin antinatriuresis isaccompanied by a reduction in the urinary excretion of uric acid. Both theantinatriuretic and antiuricosuric effect of insulin are preserved in states ofinsulin resistance of glucose metabolism (obesity, diabetes, essentialhypertension). Thus, in insulin resistant individuals compensatoryhyperinsulinemia imposes a chronic antinatriuretic and antiuricosuric pressure onthe kidney. This may provide an explantation for the clustering of insulinresistance with hypertension and hyperuricemia. Continue reading >>

Effect Of Insulin On Ace2 Activity And Kidney Function In The Non-obese Diabetic Mouse

Effect Of Insulin On Ace2 Activity And Kidney Function In The Non-obese Diabetic Mouse

Abstract We studied the non-obese diabetic (NOD) mice model because it develops autoimmune diabetes that resembles human type 1 diabetes. In diabetic mice, urinary albumin excretion (UAE) was ten-fold increased at an “early stage” of diabetes, and twenty-fold increased at a “later stage” (21 and 40 days, respectively after diabetes diagnosis) as compared to non-obese resistant controls. In NOD Diabetic mice, glomerular enlargement, increased glomerular filtration rate (GFR) and increased blood pressure were observed in the early stage. In the late stage, NOD Diabetic mice developed mesangial expansion and reduced podocyte number. Circulating and urine ACE2 activity were markedly increased both, early and late in Diabetic mice. Insulin administration prevented albuminuria, markedly reduced GFR, blood pressure, and glomerular enlargement in the early stage; and prevented mesangial expansion and the reduced podocyte number in the late stage of diabetes. The increase in serum and urine ACE2 activity was normalized by insulin administration at the early and late stages of diabetes in Diabetic mice. We conclude that the Diabetic mice develops features of early kidney disease, including albuminuria and a marked increase in GFR. ACE2 activity is increased starting at an early stage in both serum and urine. Moreover, these alterations can be completely prevented by the chronic administration of insulin. Continue reading >>

Effects Of Insulin On Kidney Function And Sodium Excretion In Healthy Subjects.

Effects Of Insulin On Kidney Function And Sodium Excretion In Healthy Subjects.

Effects of insulin on kidney function and sodium excretion in healthy subjects. Insulin action on kidney function was evaluated in 8 healthy subjects, (mean age 27 years) using the euglycaemic clamp technique. Insulin was infused at rates of 0, 20 and 40 mU.min-1.m-2 over consecutive periods of 120 min resulting in plasma insulin concentrations of 8 +/- 2, 29 +/- 7 and 66 +/- 14 mU/l. The renal clearance of 51Cr-EDTA, lithium, sodium and potassium was determined during the last 90 min of each period. Sodium clearance declined with increasing plasma insulin concentrations (1.3 +/- 0.4, 1.0 +/- 0.3 and 0.5 +/- 0.2 ml.min-1.1.73 m-2, p less than 0.001), while glomerular filtration rate (108 +/- 21, 104 +/- 21 and 108 +/- 20 ml.min-1. 1.73 m-2) and lithium clearance (a marker of fluid flow rate from the proximal tubules) 29 +/- 5, 29 +/- 4 and 30 +/- 4 ml.min-1.1.73 m-2) remained unchanged. Calculated proximal tubular reabsorption of sodium and water was unchanged, while calculated distal fractional sodium reabsorption increased (95.5 +/- 1.5, 96.4 +/- 1.2 and 98.1 +/- 0.7%, p less than 0.001). Potassium clearance and plasma potassium concentration declined, whereas plasma aldosterone and plasma renin concentrations were unchanged. In conclusion, elevation of plasma insulin concentration within the physiological range has a marked antinatriuretic action. This effect is located distally to the proximal renal tubules. Continue reading >>

Kidneys And Diabetes

Kidneys And Diabetes

Tweet The kidneys are remarkable organs of the human body that are responsible for many essential regulatory roles, including filtering the blood to keep it clean and chemically balanced. Diabetes, however, can cause this vital filtering system to break down. High levels of blood sugar can damage the kidneys and cause them to fail, thus eliminating their ability to filter out waste, which over time can lead to kidney disease (nephropathy). What are the Kidneys? The kidneys are bean-shaped organs that are located near the middle of the back, just below the rib cage with one on each side of the spine. Of the many roles they perform, one of the most important is the removal of waste products from the blood, which come from food and the normal breakdown of active tissues, such as muscles. Other key functions of the kidneys include the secretion of three important hormones: Erythropoietin - which is released in response to hypoxia (low levels of oxygen at tissue level) to stimulate the production of red blood cells in the bone marrow. Calcitriol - the active form of vitamin D, which helps maintain calcium for bones and for normal chemical balance in the body Renin - an enzyme involved in the regulation of blood pressure The Kidneys and Blood Sugar Levels Each kidney is made up of millions of tiny blood vessels called nephrons, which act as filters to help keep the blood clean. Each nephron interlinks with a small tube to keep useful substances, such as proteins and red blood cells, in the bloodstream and allow extra fluid and waste products to pass through, where they become part of the urine. This filtration system can, however, be damaged by high levels of blood sugar. Excess glucose in the bloodstream can cause the kidneys to filter too much blood. Over time, this extra w Continue reading >>

The Impact Of Insulin Resistance On The Kidney And Vasculature

The Impact Of Insulin Resistance On The Kidney And Vasculature

The impact of insulin resistance on the kidney and vasculature Cora Weigert is Professor of Molecular Medicine at the University Hospital Tbingen, Germany. She obtained her PhD in biochemistry from Erlangen University, Germany. Her research focuses on the molecular mechanism of insulin signalling and the effect of exercise on mitochondrial function. Andreas Fritsche is Professor of Nutritional Medicine and Prevention at the University Hospital Tbingen, Germany and Department Head at the Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tbingen. He is a diabetologist and his research focus is the prevention and treatment of type 2 diabetes mellitus. Norbert Stefan is Heisenberg Professor at the University Hospital Tbingen, Germany, and Head of the Department of Pathophysiology of Prediabetes at the Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tbingen. In his research he applies a clinicalexperimental approach to understand the mechanisms that underlie metabolically healthy obesity, nonalcoholic fatty liver disease and dysregulated hepatokine production. Hans-Ulrich Hring is Professor of Medicine and Chair of the Department of Internal Medicine IV, Division of Endocrinology, Diabetology, Vascular Disease, Nephrology and Clinical Chemistry at the University Hospital Tbingen, Germany. He is also Co-Chair of the German Centre for Diabetes Research. His research focuses on the pathogenesis of insulin resistance and type 2 diabetes mellitus with an emphasis on the involvement of different organs and organ crosstalk. He conducts studies of novel antidiabetic drugs in patients with type 2 diabetes. Nature Reviews Nephrology volume 12, pages 721737 (2016) Continue reading >>

Diabetes - A Major Risk Factor For Kidney Disease

Diabetes - A Major Risk Factor For Kidney Disease

Diabetes mellitus, usually called diabetes, is a disease in which your body does not make enough insulin or cannot use normal amounts of insulin properly. Insulin is a hormone that regulates the amount of sugar in your blood. A high blood sugar level can cause problems in many parts of your body. The most common ones are Type 1 and Type 2. Type 1 diabetes usually occurs in children. It is also called juvenile onset diabetes mellitus or insulin-dependent diabetes mellitus. In this type, your pancreas does not make enough insulin and you have to take insulin injections for the rest of your life. Type 2 diabetes, which is more common, usually occurs in people over 40 and is called adult onset diabetes mellitus. It is also called non insulin-dependent diabetes mellitus. In Type 2, your pancreas makes insulin, but your body does not use it properly. The high blood sugar level often can be controlled by following a diet and/or taking medication, although some patients must take insulin. Type 2 diabetes is particularly prevalent among African Americans, American Indians, Latin Americans and Asian Americans. With diabetes, the small blood vessels in the body are injured. When the blood vessels in the kidneys are injured, your kidneys cannot clean your blood properly. Your body will retain more water and salt than it should, which can result in weight gain and ankle swelling. You may have protein in your urine. Also, waste materials will build up in your blood. Diabetes also may cause damage to nerves in your body. This can cause difficulty in emptying your bladder. The pressure resulting from your full bladder can back up and injure the kidneys. Also, if urine remains in your bladder for a long time, you can develop an infection from the rapid growth of bacteria in urine that h Continue reading >>

The Effects Of Insulin On The Body

The Effects Of Insulin On The Body

Insulin is a hormone produced by the pancreas. Its function is to allow other cells to transform glucose into energy throughout your body. Without insulin, cells are starved for energy and must seek an alternate source. This can lead to life-threatening complications. The Effects of Insulin on the Body Insulin is a natural hormone produced in the pancreas. When you eat, your pancreas releases insulin to help your body make energy out of sugars (glucose). It also helps you store energy. Insulin is a vital part of metabolism. Without it, your body would cease to function. In type 1 diabetes, the pancreas is no longer able to produce insulin. In Type 2 diabetes, the pancreas initially produces insulin, but the cells of your body are unable to make good use of the insulin (insulin resistance). Uncontrolled diabetes allows glucose to build up in the blood rather than being distributed to cells or stored. This can wreak havoc with virtually every part of your body. Complications of diabetes include kidney disease, nerve damage, eye problems, and stomach problems. People with Type 1 diabetes need insulin therapy to live. Some people with Type 2 diabetes must also take insulin therapy to control blood sugar levels and avoid complications. Insulin is usually injected into the abdomen, but it can also be injected into the upper arms, thighs, or buttocks. Injection sites should be rotated within the same general location. Frequent injections in the same spot can cause fatty deposits that make delivery of insulin more difficult. Some people use a pump, which delivers insulin through a catheter placed underneath the skin of the abdomen. When you eat, food travels to your stomach and small intestines where it is broken down into nutrients. The nutrients are absorbed and distributed v Continue reading >>

Diabetes And Kidney Disease (stages 1-4)

Diabetes And Kidney Disease (stages 1-4)

What is diabetes? Diabetes happens when your body does not make enough insulin or cannot use insulin properly. Insulin is a hormone. It controls how much sugar is in your blood. A high level of sugar in your blood can cause problems in many parts of your body, including your heart, kidneys, eyes, and brain. Over time, this can lead to kidney disease and kidney failure. There are two main types of diabetes. Type 1 diabetes generally begins when people are young. In this case, the body does not make enough insulin. Type 2 diabetes is usually found in adults over 40, but is becoming more common in younger people. It is usually associated with being overweight and tends to run in families. In type 2 diabetes, the body makes insulin, but cannot use it well. What is chronic kidney disease (CKD)? Your kidneys are important because they keep the rest of your body in balance. They: Remove waste products from the body Balance the body’s fluids Help keep blood pressure under control Keep bones healthy Help make red blood cells. When you have kidney disease, it means that the kidneys have been damaged. Kidneys can get damaged from a disease like diabetes. Once your kidneys are damaged, they cannot filter your blood nor do other jobs as well as they should. When diabetes is not well controlled, the sugar level in your blood goes up. This is called hyperglycemia. Hyperglycemia (high blood sugar) can cause damage to many parts of your body, especially the kidneys, heart, blood vessels, eyes, feet, nerves. Diabetes can harm the kidneys by causing damage to: Blood vessels inside your kidneys. The filtering units of the kidney are filled with tiny blood vessels. Over time, high sugar levels in the blood can cause these vessels to become narrow and clogged. Without enough blood, the kid Continue reading >>

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