Hypophosphatemia and Glucose Intolerance

To the Editor: The report of insulin resistance associated with hypophosphatemia by DeFronzo and Lang in the November 27 issue raises an obvious corollary question (to which the authors may already have the answer): Does hyperphosphatemia enhance insulin activity or decrease insulin resistance? Although uremia is frequently associated with glucose intolerance, some patients with end-stage renal disease become hypoglycemic, and it is typical for the diabetic patient with progressive renal failure to have decreased requirements for insulin or oral hypoglycemic agents. The explanations include reduced food intake, decreased substrate availability, decreased insulin catabolism by the kidney, decreased renal gluconeogenesis, depletion. . .