Glucose Intolerance in Patients on Long-term Intermittent Dialysis

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Abstract
Patients with chronic renal failure treated by repetitive dialysis were used to study the effect of uremia on glucose metabolism, without the influence of factors which usually complicate uremia, such as infection, starvation or inactivity. That an abnormality in glucose metabolism due to one or more features of uremia exists is demonstrated with conventional oral and intravenous glucose tolerance tests. Other tests of carbohydrate metabolism were performed, including intravenous glucose-insulin tolerance tests, glucagon tests, tolbutamide tolerance tests and measurement of insulin levels. By correlating the results of these tests with clinical indices of renal function such as BUN [blood urea nitrogen], it was possible to conclude that azotemia per se and not some complicating element of uremia results in glucose intolerance. That urea itself may play a role was shown by specifically elevating BUN by adding urea to the dialysate during dialysis. It was demonstrated that insulin levels increase in the usual fashion after a glucose load in azotemia despite glucose intolerance. Normal sensitivity to exogenous insulin was found in most patients. The reason for glucose intolerance in these patients is explained by a slowed rate of glyco-genolysis.