Serum Glucose, Insulin, Growth Hormone, Free Fatty Acids and Lipids Responses to High Carbohydrate and to High Fat Isocaloric Diets in Patients with Chronic, Non-nephrotic Renal Failure[*]

 

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Abstract

In 16 patients with chronic, non-nephrotic renal failure two isocaloric dietary periods with high carbohydrate and high fat intake were performed. The highest insulin output followed in the carbohydrate period, while the highest insulin:glucose ratio was observed in the fat period. Serum triglycerides raised following the high carbohydrate period; this elevation was more accentuated in those uremics who had a type IV hyperlipoproteinemia (5 patients) and was associated with abnormal glucose tolerance and elevated insulin levels. An impaired triglyceride removal from plasma was also observed. These results show that a diet rich in carbohydrates, as often used in treatment of chronic renal failure, may enhance hyperlipoproteinemia and represent a risk factor for the development of atherosclerosis and coronary heart disease, while a diet rich in fat appears more advantageous in order to improve insulin effectivity on blood glucose levels and to avoid an impairment of hypertriglyceridemia. A previous intravenous glucose tolerance test in the 16 uremics had shown a high incidence of glucose intolerance (10 patients) and the highest insulin response to glucose in two uremic groups who had either normal glucose tolerance or hypertriglyceridemia. Elevated growth hormone levels and paradoxical growth hormone rise following intravenous glucose were associated with impaired glucose tolerance in 7 of the 10 uremics with this latter clinical feature.

1 Parts of this work were presented at the 6th Congress of the German Diabetes Association, Düsseldorf, May 1971; at the 78th Congress of the German Society of Internal Medicine, Wiesbaden, April 1972, and at the 5th International Congress of Nephrology, Mexico City, October 1972.

1 Parts of this work were presented at the 6th Congress of the German Diabetes Association, Düsseldorf, May 1971; at the 78th Congress of the German Society of Internal Medicine, Wiesbaden, April 1972, and at the 5th International Congress of Nephrology, Mexico City, October 1972.