Insulin resistance in the uremic patient: effects of hemodialysis

The carbohydrate metabolism abnormalities present in uremia have been attributed to a combination of peripheral resistance to insulin and inhibition of insulin release secondary to beta cells insensitivity. Previous studies evaluated the chronic effects of hemodialysis on glucose metabolism, while acute effects were not examined. In 12 uremic subjects undergoing hemodialysis (3 times a week) the fasting serum levels of glucose, insulin and C-peptide were measured, and the glucose/insulin ratio was calculated as an index of peripheral sensitivity to insulin before and after dialysis. While glucose did not change, insulin and C-Peptide rose significantly after dialysis. The rise in insulin and C-Peptide was directly correlated with the fall in body weight due to the fluid loss. This might indicate that the increase in insulin and C-peptide was due to a concentration phenomenon. However, it could reflect a reaction to hypoglycemia. The glucose/insulin ratio exhibited trend towards a fall after hemodialysis. Although not significant, this might indicate an acute worsening of the peripheral sensitivity to insulin, induced by the procedure.