Insulin and Potassium | Diabetes Library
Insulin stimulates the uptake of glucose and potassium in all cells of the body but primarily The Relationship between Insulin and Potassium. The latter may result from defect in the Na+-K+ ATPase and possibly elevated glucagon levels Even though insulin-mediated glucose uptake is impaired in uremia, the Insulin shifts potassium into cells by stimulating the activity of Na+- H+ The workgroup of the American Diabetes Association and the. Let's explore what potassium does in the body. your physician may recommend a medicine, such as sodium polystyrene sulfonate .. For the most part, blood glucose and potassium are not closely related unless you have.
The symptoms of hypoglycemia can include irritability, impaired cognitive function, seizures, coma, ventricular arrhythmias, and even death [ 222425 ].
High Blood Glucose Levels & Potassium
There are multiple risk factors for hypoglycemia. These include medications, drug-to-drug interaction, endogenous insulin deficiency with concomitant abnormal glucagon responsecritical illness, poor nutritional intake, low body weight, older age, history of recurrent hypoglycemia, liver failure, and renal failure [ 202324 ].
In this issue of Clinical Kidney Journal, Apel et al [ 26 ] reports the incidence and timing of hypoglycemia, as well as associated risk factors in inpatient ESRD patients after treatment of hyperkalemia with 10 units of IV insulin and 25 g of dextrose. Risk factors for hypoglycemia were: Hypoglycemia occurred at a median of 2 hours after insulin and persisted for a median of 2 hours.
In the setting of normal kidney function, the kidney contributes to nearly half of overall gluconeogenesis, and is therefore as important as the liver in carbohydrate metabolism [ 2930 ]. The kidney also plays a critical role in insulin metabolism. Even though evidence implies that CKD creates an insulin-resistant state, hypoglycemia can ensue due to decreased gluconeogenesis and insulin degradation [ 31 ].
Other factors such as altered drug metabolism, malnutrition, decreased hepatic gluconeogenesis, and infection also increase the risk of hypoglycemia in this population [ 2732 ]. In hemodialysis patients, the use of glucose-free dialysis solution increases the risk of hypoglycemia due to transfer of plasma glucose to the dialyzate. Addition of glucose to dialysis solution significantly decreases this risk [ 3334 ].
Apel et al do not specify in their study whether there is a difference between hemodialysis and peritoneal dialysis patients. Theoretically, the incidence of hypoglycemia is lower in peritoneal dialysis due to the presence of dextrose in the dialysis solution. The results from Apel's study emphasize the importance of intense blood glucose monitoring after insulin administration.
- Potassium as a link between insulin and the renin-angiotensin-aldosterone system.
- Insulin and Potassium
- What Is the Connection Between Diabetes and Potassium?
Since IV insulin is a commonly used therapy for severe hyperkalemia in ESRD patients in the hospital setting, we agree with Apel et al that a protocol-driven approach may be able to decrease the incidence of hypoglycemia. Published literature indicates that the insulin and dextrose regimen varies from center to center. Dose of insulin ranges from 5—10 units and amount of glucose ranges from 25 to 60 g [ 35 ]. Others have recommended additional dextrose infusion after intravenous push of dextrose and insulin to prevent hypoglycemia [ 1720 ].
Due to risks of hypoglycemia, some have advocated the use of glucose alone in the treatment of hyperkalemia. The rationale is based on the theory that exogenous glucose stimulates insulin secretion which shifts potassium into the cell.
In a randomized, crossover study of 10 non-diabetic, ESRD patients on hemodialysis with hyperkalemia, dextrose alone led to a clinically significant decrease in serum potassium level.
The rates of hyperglycemia were not reported [ 36 ]. However, some concerns have been raised regarding this approach.
Endogenous insulin secretion may be unpredictable, especially in the acutely ill and in those with insulin deficiency [ 836 ]. The resultant hyperglycemia raises the plasma osmolality, which leads to movement of potassium out of the cell, worsening hyperkalemia. Conversely, some have suggested the use of insulin alone in the setting of hyperglycemia, but this is not widely accepted or practiced due to the high likelihood of inducing hypoglycemia [ 718 ].
This is an important point since patients without DM are at risk for lack of monitoring of their blood glucose levels. Hospital staff are trained to monitor blood glucose in patients with DM and the absence of this diagnosis makes the patient more vulnerable. Also, patients without DM have greater insulin sensitivity and are more prone to develop hypoglycemia after insulin administration. The protocol proposed by Apel et al in this study for glucose monitoring and dextrose support in the treatment of hyperkalemia with IV insulin is designed to prevent hypoglycemia.
We agree that the risk of hypoglycemia can be minimized by increasing the dextrose dose. However, this recommendation has not been validated in clinical studies.
At our center, the patient's body weight is taken into account before insulin and dextrose are administered. The protocol at our center is to administer 25 g of dextrose with IV insulin 0. This regimen is followed by mL of D10W infused over 2 hours. The use of a weight based insulin regimen reduces the risk of hypoglycemia in individuals with low body mass index, especially the elderly.
Limited data have suggested that the administration of dextrose before insulin is effective and safe [ 37 ]. Certain complications of diabetes, including diabetic ketoacidosis and hyperglycemia, involve both high blood glucose levels and abnormal potassium levels.
Some medications can also cause both elevated blood glucose levels and potassium imbalances. People with blood sugar disorders such as diabetes may benefit from adding potassium-rich food to their diets, as long as they choose foods that are low on the glycemic index.
Diabetes Complications and Potassium Complications of diabetes, a disease characterized by chronic high blood glucose levels, may cause potassium levels to be too low or too high. Treatment for diabetic ketoacidosis, a complication of diabetes that occurs in conjunction with uncontrolled high blood sugar and high blood levels of acids called ketones, can cause low potassium levels, which can result in in heart, muscle and nerve problems. Complications from diabetes can also cause potassium levels to rise.
Diabetics being treated for high blood glucose while on long-term dialysis treatment can develop severe hyperkalemia, or excessively high potassium levels. Magnesium and Potassium Like potassium, magnesium is another key electrolyte which may be affected by blood glucose disorders.
Potassium as a link between insulin and the renin-angiotensin-aldosterone system.
Magnesium deficiencies caused by diabetes can also upset the body's potassium levels. According to the National Institutes of Health, poorly controlled diabetes can cause magnesium deficiencies, which may in turn cause hypokalemia, or low potassium levels. Individuals with hyperglycemia resulting from poorly controlled diabetes may benefit from taking magnesium supplements, which can also help correct potassium imbalances.