Hyperinsulinemia

[stu07]

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Hello,

I need someone expertise, if you can help I would appreciate it. How does hyperinsulinemia cause sodium retention? (Mechanism please)

 

[agranulocytosis]

Hi there,

ok here's my take on it. We know that glucose is an osmotic agent because in Type II diabetes, which is characterized by hyperglycemia, patients will tend to go into a hyperosmolar coma.

So, if there is hyperinsulinemia present, there will be hypoglycemia, and a resultant hypo-osmolar plasma which will tend to decrease plasma volume. This decreased volume will then activate the RAA system, resulting in sodium retention to correct the hypoglycemia-induced hypovolemia.

Hope that was enough.

 

[stu07]

Makes sense. Thanks, I appreciate it.

 

[SeventhSon]

Couple of warnings...

Was the hyperinsulemia primary? (i.e. someone gave themselves too much insulin, causing a hypoglycemic episode) or is the hyperinsulinemia compensating fo hyperglycemia, in which case the hyperinsulinemia is tending to compensate for a hyperosmotic state and thus would be associated with osmotic diuresis?

Also, while hypoosmolar plasma tends to contract ECV, it also tends to promote proximal tubule reabsorption (opposite of osmotic diuresis).

It seems to me there are multiple effects and situations and thus no a priori way to guess what would happen...