P-630: Glycemic control and the state of responsiveness of the renin system in type -1 diabetes mellitus

• Published in: American journal of hypertension 2005-05, Vol.18 (S4), p.236A-236A
• Main Authors: Stevanovic, Radomir D., Price, Deborah A., Lansang, Cecilia M., Fisher, Naomi D.L., Laffel, Lori M.B., Hollenberg, Norman K.
• Format: Article
• Language: English
• Subjects: Diabetes Mellitus; Glycemic Control; Renin Response
• ISSN: 0895-7061; 1941-7225; 1879-1905
• DOI: 10.1016/j.amjhyper.2005.03.647

In diabetes mellitus, hyperglycemia, risk factor for nephropathy, increases renin secretion. We investigated whether short term glycemic perturbations, measured in hours, or long term ones, measured by hemoglobin A1c (HbA1c), influence the reactive renin response to captopril. 55 type -1 diabetic subjects were enrolled. Angiotensin blockade was discontinued 2 weeks prior to study. Subjects were in high salt balance. After an all night fast and in the supine position, they received insulin I.V. starting at a rate of 0.015 U/kg/hour, and a glucose I.V to keep serum glucose between 100 and 150 mg/dL (target). When target was reached, captopril 25mg PO was given. Time needed to reach target from start of IVs varied from 0’ in the controlled, and up to 3 hours in the uncontrolled subjects. Serum glucose drawn before insulin infusion had a median of 143 mg/dl, defining two groups (table). Plasma renin assay (PRA) and finger stick glucose (FSG) were drawn serially every 45 minutes for 225 minutes. Peak drug effect occured 90 minutes (90’) after administration, defining peak PRA response. Variable Controlled (≤143 mg/dl) Uncontrolled (> 143 mg/dl) p Serum glucose at start of insulin (mg/dl) 108.1 ± 4.6 204.8 ± 8.1