Influence of basal insulin and glucagon secretion on potassium and sodium metabolism. Studies with somatostatin in normal dogs and in normal and diabetic human beings

Ralph A Defronzo, R. S. Sherwin, M. Dillingham, R. Hendler, W. V. Tamborlane, P. Felig

Research output: Contribution to journalArticle

118 Citations (Scopus)

Abstract

To examine the role of basal insulin and glucagon secretion in potassium and sodium homeostasis, somatostatin, a potent inhibitor of insulin and glucagon secretion, was infused for 5 hr into healthy human subjects, maturity-onset diabetes, juvenile-onset diabetics, and normal dogs. Infusion of somatostatin resulted in an increase in serum potassium (0.5-0.6 mEq/l) in normal subjects and maturity-onset diabetics, but not in juvenile-onset diabetics despite equivalent reductions in plasma glucagon in all 3 groups. A similar rise in serum potassium was observed in normal conscious dogs given somatostatin and was reversed by insulin replacement. Urinary excretion of potassium was unaffected by somatostatin. In dogs given intravenous potassium chloride in doses (0.375 mEq/kg/hr) which do not alter basal insulin levels, the rise in serum potassium (0.6 mEq/l in controls) increased 100% when somatostatin was administered together with the KCl infusion. Addition of replacement doses of insulin to the somatostatin infusion resulted in increments in serum potassium which were comparable to infusion of KCl alone. Urinary potassium excretion rose after KCl administration and was unchanged by the addition of somatostatin. Serum sodium concentration was unaffected by somatostatin administration in both the human and dog studies. However, urinary sodium excretion displayed a biphasic response falling by 20-60% within the first 2 hr of somatostatin administration and then rising to values 50-80% above basal levels at 3-4 hr. Insulin and p-aminohippurate clearances were unaffected by somatostatin. It is concluded that (a) potassium homeostasis is influenced by basal insulin levels in the absence of which serum potassium concentration rises and potassium tolerance declines; (b) this effect of insulin is mediated via extrarenal mechanisms of potassium disposal; (c) somatostatin has a biphasic effect on urinary sodium secretion, the mechanism of which remains to be established.

Original languageEnglish (US)
Pages (from-to)472-479
Number of pages8
JournalJournal of Clinical Investigation
Volume61
Issue number2
StatePublished - 1978
Externally publishedYes

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Somatostatin
Glucagon
Potassium
Sodium
Dogs
Insulin
Serum
Homeostasis
Accidental Falls
p-Aminohippuric Acid
Potassium Chloride
Type 2 Diabetes Mellitus
Healthy Volunteers

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Influence of basal insulin and glucagon secretion on potassium and sodium metabolism. Studies with somatostatin in normal dogs and in normal and diabetic human beings. / Defronzo, Ralph A; Sherwin, R. S.; Dillingham, M.; Hendler, R.; Tamborlane, W. V.; Felig, P.

In: Journal of Clinical Investigation, Vol. 61, No. 2, 1978, p. 472-479.

Research output: Contribution to journalArticle

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abstract = "To examine the role of basal insulin and glucagon secretion in potassium and sodium homeostasis, somatostatin, a potent inhibitor of insulin and glucagon secretion, was infused for 5 hr into healthy human subjects, maturity-onset diabetes, juvenile-onset diabetics, and normal dogs. Infusion of somatostatin resulted in an increase in serum potassium (0.5-0.6 mEq/l) in normal subjects and maturity-onset diabetics, but not in juvenile-onset diabetics despite equivalent reductions in plasma glucagon in all 3 groups. A similar rise in serum potassium was observed in normal conscious dogs given somatostatin and was reversed by insulin replacement. Urinary excretion of potassium was unaffected by somatostatin. In dogs given intravenous potassium chloride in doses (0.375 mEq/kg/hr) which do not alter basal insulin levels, the rise in serum potassium (0.6 mEq/l in controls) increased 100{\%} when somatostatin was administered together with the KCl infusion. Addition of replacement doses of insulin to the somatostatin infusion resulted in increments in serum potassium which were comparable to infusion of KCl alone. Urinary potassium excretion rose after KCl administration and was unchanged by the addition of somatostatin. Serum sodium concentration was unaffected by somatostatin administration in both the human and dog studies. However, urinary sodium excretion displayed a biphasic response falling by 20-60{\%} within the first 2 hr of somatostatin administration and then rising to values 50-80{\%} above basal levels at 3-4 hr. Insulin and p-aminohippurate clearances were unaffected by somatostatin. It is concluded that (a) potassium homeostasis is influenced by basal insulin levels in the absence of which serum potassium concentration rises and potassium tolerance declines; (b) this effect of insulin is mediated via extrarenal mechanisms of potassium disposal; (c) somatostatin has a biphasic effect on urinary sodium secretion, the mechanism of which remains to be established.",
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