Summary
Potassium homeostasis during a 50-g oral glucose tolerance test was studied in 14 newly diagnosed, untreated Type 2 (non-insulin-dependent) diabetics. They showed a rise in plasma potassium from amean ± SEM basal of 3.9±0.1 to 4.4±0.1 mmol/l at 60 min and to 4.6±0.1 mmol/l at 90 min (p < 0.01), whereas no change was seen in a group of 14 normal subjects. A possible role of mineralocorticoids was sought by measuring simultaneous serum aldosterone and deoxycorticosterone levels. Aldosterone was reduced after the glucose load in all subjects studied, falling to 73% of basal at 60 min in diabetics (p < 0.01), and to 61% of basal at 90 min in normal subjects (p < 0.001). Serum deoxycorticosterone showed a similar pattern. Thus it is unlikely that the rise in plasma potassium seen in the diabetic patients was due to abnormal levels of mineralocorticoids. Since the diabetic subjects were found to have an intact insulin response to the glucose load, it is suggested that resistance to insulin-stimulated potassium uptake into cells might be involved in the pathogenesis of the paradoxical hyperkalaemia induced by acute hyperglycaemia.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Goldfarb S, Cox M, Singer I, Goldberg M (1976) Acute hyperkalaemia induced by hyperglycaemia: hormonal mechanisms. Ann Intern Med 84: 426–432
Viberti GC (1978) Glucose-induced hyperkalaemia: a hazard for diabetics. Lancet 1: 690–691
Perez GO, Lespier L, Knowles R, Oster JR, Vaamonde CA (1977) Potassium homeostasis in chronic diabetes mellitus. Arch Intern Med 137: 1018–1022
Phelps KR, Lieberman RL, Oh MS, Carroll HJ (1980) Pathophysiology of the syndrome of hyporeninaemic hypoaldosteronism. Metabolism 29: 186–199
DeFronzo RA, Sherwin RS, Felig P, Bia M (1977) Non-uremic diabetic hyperkalemia. Arch Intern Med 137: 842–843
Cannon PJ, Ames RP, Laragh JH (1966) Relation between potassium balance and aldosterone secretion in normal subjects and in patients with hypertensive or renal tubular disease. J Clin Invest 45: 865–879
Santusanio F, Faloona GR, Knochel JP, Unger RH (1973) Evidence for a role of endogenous insulin and glucagon in the regulation of potassium homeostasis. J Lab Clin Med 81: 809–817
Hiatt N, Yamakawa T, Davidson MB (1974) Necessity for insulin in transfer of excess infused K to intracellular fluid. Metabolism 23: 43–49
Cox M, Sterns R, Singer I (1978) The defense against hyperkalaemia: the roles of insulin and aldosterone. N Engl J Med 299: 525–532
Stat Bull Metrop Life Insur Co (1959) 40: 3
Kurtz AB, Barter FH (1976) Radioimmunoassays for aldosterone and deoxycorticosterone in plasma and urine. Steroids 28: 133–142
Cope CL, Loizou S (1973) Simplification of urinary aldosterone measurement by radioimmunoassay. J Clin Pathol 26: 628–634
Cope CL, Loizou S (1975) Deoxycorticosterone excretion in normal, hypertensive and hypokalaemic subjects. Clin Sci Mol Med 48:97–105
Murphy BP, Engelberg W, Pattee CJ (1963) Simple method for the determination of plasma corticoids. J Clin Endocrinol 23: 293–300
Welborn TA, Fraser TR (1968) The double-antibody immunoassay of insulin. Diabetologia 1: 211–218
Adler S, Anderson B, Zelt B (1975) Effect of osmolarity of intracellular pH of rat diaphragm muscle. Am J Physiol 228: 725–729
Andres R, Baltzan MA, Cader G, Zierler KL (1962) Effect of insulin on carbohydrate metabolism and on potassium in the forearm of man. J Clin Invest 41:108–115
Guerra SMO, Kitabchi AE (1976) Comparison of the effectiveness of various routes of insulin injection: insulin levels and glucose response in normal subjects. J Clin Endocrinol Metab 42: 869–874
DeFronzo RA, Felig P, Ferrannini E, Wahren J (1980) Effect of graded doses of insulin on splanchnic and peripheral potassium metabolism in man. Am J Physiol 238: 421–427
Reaven GM, Bernstein R, David B, Olefsky JM (1976) Nonketotic diabetes mellitus: insulin deficiency or insulin resistance? Am J Med 60: 80–88
Olefsky JM (1976) The insulin receptor: its role in insulin resistance of obesity and diabetes. Diabetes 25: 1154–1162
Hochberg Z, Dickerman Z, Kaufman H, Laron Z (1980) Evaluation of the renin-aldosterone system during hypo- and hyperglycaemia in children and adolescents. Hormone Res 12: 16–21
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Rosenstock, J., Loizou, S.A., Brajkovich, I.E. et al. Effect of acute hyperglycaemia on plasma potassium and aldosterone levels in Type 2 (non-insulin-dependent) diabetes. Diabetologia 22, 184–187 (1982). https://doi.org/10.1007/BF00283750
Received:
Revised:
Issue Date:
DOI: https://doi.org/10.1007/BF00283750