Volume Homeostasis and Blood Pressure in Diabetic States

  • James A. O’Hare
  • J. Barry Ferriss


Extra-cellular sodium and fluid volume expansion as measured using the isotopic technique of Total Exchangeable Sodium measurements is commonly seen in patients with both IDDM and NIDDM. The exact cause is not known but plausible factors include increased capillary permeability and subtle renal alterations in sodium handling. Intravascular volume is not expanded.

In IDDM patients with nephropathy and hypertension Total Exchangeable Sodium is further increased and positively related to Blood Pressure. By contrast Total Exchangeable Sodium is not clearly expanded in NIDDM patients with hypertension ab initio and is not related to blood pressure. In IDDM patients free of complications the renin-angiotensin-aldosterone system behaves normally. In nephropathy angiotensin 11 may be playing a role in hypertension in some patients. In NIDDM patients without nephropathy plasma renin is suppressed in both normotensive and hypertensives.


Diabetic Nephropathy Atrial Natriuretic Peptide Plasma Renin Activity Sodium Retention Exchangeable Sodium 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Guyton AC. The body’s approach to arterial pressure regulation. In: Circulatory Physiology III. Arterial pressure regulation. Philadelphia: WB Saunders. 1980; 1–9.Google Scholar
  2. 2.
    Ferriss JB, O’Hare JA, Kelleher CCM, Sullivan PA, Cole MN, Ross HF, O’Sullivan DJ. Diabetic control and the angiotensin system, catecholamines and blood pressure. Hypertension 1985; (supplement 11) 7:58–63.CrossRefGoogle Scholar
  3. 3.
    Allen TJ, Cooper ME, O’Brien RC, Bach LA, Jackson B, Jerums G. Glomerular filtration rate in streptozocin-induced diabetic rats. Diabetes 1990; 39: 1182–90.PubMedCrossRefGoogle Scholar
  4. 4.
    Bell GM, Bernstein RK, Laragh JH, Atlas SA, James GD, Pecker MS, Sealey JE. Increased plasma atrial natriuretic factor and reduced plasma renin in patients with poorly controlled diabetes mellitus. Clin Sci 1989; 77: 177–82.PubMedGoogle Scholar
  5. 5.
    Weidmann P, Beretta-Picolli C, Trost BN. Pressor factors and responsiveness in hypertension accompanying diabetes mellitus. Hypertension 1985;7: Suppl 11:33–42.Google Scholar
  6. 6.
    O’Hare JA, Ferriss JB, Brady D, Twomey B, O’Sullivan DJ. Exchangeable sodium and renin in hypertensive diabetic patients with and without nephropathy. Hypertension 1985; (Suppl 11)7: 43–48.CrossRefGoogle Scholar
  7. 7.
    Feldt-Rasmussen B, Mathiesen ER, Deckert T, et al. Central Role for sodium in the pathogenesis of blood pressure changes independent of angiotension, aldosterone, and catecholamines in type 1 (insulin-dependent) diabetes mellitus. Diabetologia 1987; 30: 610–17.PubMedGoogle Scholar
  8. 8.
    Brennan BL, Roginsky MS, Conn S. Increased total body sodium as a mechanism for suppressed plasma renin activity in diabetes mellitus. Clin Res 1979; 27: 591a.Google Scholar
  9. 9.
    Fioretto P, Sambataro M, Cipollina MR et al. Role of atrial natriuretic peptide in the pathogenesis of sodium retention in ID with and without nephropathy.Diabetes 1992; 41: 936–945.PubMedCrossRefGoogle Scholar
  10. 10.
    Fisher BM, Gillin G, Ong-Tone L, Dargie HJ, Frier BM Cardiac Function and insulin-dependant diabetes: radionuclide ventriculopathy in young diabetics. Diabetic Med 1985; 2: 251–256.PubMedGoogle Scholar
  11. 11.
    Drury PL, Smith GM, Ferriss JB. Increased vasopressor responsiveness to angiotensin II in type 1 (insulin-dependent) diabetic patients without complications. Diabetologia 1984; 27:174–179.PubMedGoogle Scholar
  12. 12.
    O’Hare JA, Ferriss JB, Twomey B, O’Sullivan DJ. Poor metabolic control, hypertension and microangiopathy independently increase the transcapillary escape rate of albumin in diabetics. Diabetologia 1983; 25: 260–263.PubMedCrossRefGoogle Scholar
  13. 13.
    Norgaard K, Jensen T, Feld-Rasmussen B. Transcapillary escape rate of albumin in hypertensive patients with type 1 (insulin dependent) diabetes mellitus. Diabetologia 1993; 36: 57–61.PubMedCrossRefGoogle Scholar
  14. 14.
    Jaap AJ, Shore AC, Gardside IB, Gamble J, Tooke JE. Increased microvascular fluid permeability in young type 1 (insulin dependent) diabetic patients. Diabetologia 1993; 36: 648–52.PubMedCrossRefGoogle Scholar
  15. 15.
    O’Hare JA, Ferriss JB. Transcapillary escape rate of albumin and extracellular fluid volume in diabetes. Diabetologia 1985; 28:937–938.PubMedCrossRefGoogle Scholar
  16. 16.
    O’Hare JP, Anderson JV, Millar ND, Dalton N, Tymms DJ, Blood SR, Corral RJ. Hormonal responses to blood volume expansion in diabetic subjects with and without autonomic neuropathy. Clin Endocrinol (Oxf) 1989; 30: 571–9.CrossRefGoogle Scholar
  17. 17.
    Skott P, Hother-Nielsen O, Brum NE, et al. Effects of insulin on kidney function and sodium excretion in healthy subjects. Diabetologia 1989; 32: 694–99.PubMedCrossRefGoogle Scholar
  18. 18.
    Finch D, Davis G, Bower J, Kirshner K. Effect of insulin, on renal sodium handling in hypertensive rats. Hypertension 1990; 15: 514–518.PubMedCrossRefGoogle Scholar
  19. 19.
    Brible A, Corrall RJM, Mattocks J, O’Hare JP, Roland JM. Insulin and the renal response to volume expansion in man. J. Physiol 1985; 364:66.Google Scholar
  20. 20.
    Rocchini AP, Katch V, Kvesel D, et al. Insulin and renal sodium retention in obese adolescents. Hypertension 1989; 14: 367–74.PubMedCrossRefGoogle Scholar
  21. 21.
    Norgaard K, Feld-Rasmussen B. Sodium retention and insulin treatment in insulin-dependent diabetes mellitus. Acta Diabetol 1994;14:367–374.Google Scholar
  22. 22.
    Ferrari P, Weidman P. Insulin, insulin sensitivity and hypertension. Hypertension 1990; 8: 491–500.CrossRefGoogle Scholar
  23. 23.
    Nosadini R, Sambataro M, Thomaseth K, Pacini G, Cipollina MR, Brocco E, Solini A, Carraro A, Vellusi M, Frigato F, Crepaldi G. Role of hyperglycaemia and insulin resistance in determining sodium retention in non-insulin dependent diabetes mellitus. Kid Int 1993; 17:261–269.Google Scholar
  24. 24.
    Ferriss JB, Sullivan PA, Gonggrijp H, Cole M, O’Sullivan DJ. Plasma angiotensin II and aldosterone in unselected diabetic patients. Clin Endocrinol 1982; 17: 261–269.CrossRefGoogle Scholar
  25. 25.
    Cronin CC, Barry D, Crowley B, Ferriss JB. Reduced plasma aldosterone concentrations in randomly selected patients with insulin dependent diabetes mellitus. Diabetic Med 1995,12:809–15.PubMedCrossRefGoogle Scholar
  26. 26.
    Lalau JD, Wesreel PF, Tenenbaum F, et al. Natriuretic and vasoactive hormones and glomerular hyperfiltration in hyperglycaemic type 2 diabetic patients: effect of insulin treatment. Nephron 1993; 63: 296–302.PubMedCrossRefGoogle Scholar
  27. 27.
    Fioretto P, Muollo B, Faronato PF, Opocher G et al. Relationships amongst natriuresis, atrial natriuretic peptide and insulin in insulin-dependent diabetes. Kid Intern 1992; 41:813–821.CrossRefGoogle Scholar
  28. 28.
    Kumic BR, Weisberg LS, Cuttler IM, Kumic PB. Effects of atrial natriuretic peptide versus mannitol on renal blood flow during radiocontrast infusion in chornic renal failure. J Lab Clin Med 1990; 116:27–36.Google Scholar
  29. 29.
    O’Hare JA, Ferriss JB, Twomey BM, Cole M, Brady D, O’Sullivan DJ. Blood pressure may be sodium dependent in diabetic patients without overt nephropathy.Ir J Med Sci 1985; 154: 455–460.PubMedCrossRefGoogle Scholar
  30. 30.
    Coleman TG, Guyton AC. Hypertension caused by salt loading in the dog Cir Res 1969; 25: 153–160.Google Scholar
  31. 31.
    Christlieb AR, Kaldany A, D’Elia JA. Plasma renin activity and hypertension in diabetes mellitus. Diabetes 1976; 25:969–974.PubMedCrossRefGoogle Scholar
  32. 32.
    Moss S, Oster JR, Perez GO, Katz FH, Vaamonde CA. Renin-aldosterone responsiveness in uncomplicated juvenile-type diabetes mellitus. Horm Res 1978; 9: 130–136.PubMedCrossRefGoogle Scholar
  33. 33.
    Drury PL, Bodansky HJ, Oddie CJ, Edwards CRW. Factors in the control of plasma renin activity and concentration in type 1 (insulin-dependent) diabetes. Clin Endocrinol 1984; 20:607–618.CrossRefGoogle Scholar
  34. 34.
    O’Hare JA, Ferriss JB, Twomey BM, Brady D, O’Sullivan DJ. Essential hypertension and hypertension in diabetic patients without nephropathy. J. Hypertension {Suppl 2} 1983: 1: 200–203.Google Scholar
  35. 35.
    Fuller JH: Epidemiology of hypertension associated with diabetes mellitus. Hypertension (Suppl II) 1985: 7: 3–7.Google Scholar
  36. 36.
    United Kingdom Prospective Diabetes Study. Prevalence of hypertension and hypotensive therapy in patients with newly diagnosed diabetes.Hypertension [Suppl II] 1985; 7: 8–13.CrossRefGoogle Scholar
  37. 37.
    O’Hare JA. Insulin resistance and hypertension. Current Opinion in endocrinology and Diabetes 1994; 1:147–152.CrossRefGoogle Scholar
  38. 38.
    Beretta-Piccoli C, Davies DL, Boddy K, Browne JJ, Cumming AMM, East BW, Fraser R, Lever AF, Padfield PL, Semple PF, Robertson JIA, Weidmann P, Williams ED. Relation of arterial pressur e with body sodium, body potassium and plasma potassium in essential hypertension.Clin Sci 1982; 63: 257–270.PubMedGoogle Scholar
  39. 39.
    Watkins PJ, Edmonds ME. Sympathetic nerve failure in diabetes. Diabetologia 1983; 25:73–77.PubMedCrossRefGoogle Scholar
  40. 40.
    D’Elia JA, Weinrauch LA, Healy RW, Libertino JA, Bradley RF, Leyland OS. Myocardial dysfunction without coronary artery disease in diabetic renal failure. Am J Cardiol 1979; 43: 193–199.PubMedCrossRefGoogle Scholar
  41. 41.
    Beretta-Piccoli C, Weidmann P, Chatel R, Reubi F. Hypertension associated with early stage kidney disease. Am J Med 1976; 61: 739–747.PubMedCrossRefGoogle Scholar
  42. 42.
    Christlieb AR, Kaldany A, D’Elia JA, Williams GH. Aldosterone responsiveness in patients with diabetes mellitus. Diabetes 1978; 27: 732–727.PubMedCrossRefGoogle Scholar
  43. 43.
    Tuck ML, Sambhi MP, Levin L. Hyporeninemic hypoaldosteronism in diabetes mellitus. Diabetes 1979; 28: 237–241.PubMedGoogle Scholar
  44. 44.
    O’Donnell MJ, Lawson N, Bamett MJ. Activity of the unstimulated renin-aldosterone system in type 1 diabetes patients with and without proteinuria. Diabetic Med 1989; 6: 422–425.PubMedCrossRefGoogle Scholar
  45. 45.
    Leutscher JA, Kraemer FB, Wilson DM, Schwartz Hc, Bryer-Ash M. Increased plasma inactive renin in diabetes mellitus: a marker of microvascular complications. N Eng J Med 1985; 312: 1412–1417.CrossRefGoogle Scholar
  46. 46.
    Lieberman JS, Parra L, Newton L, Scandling JD, Loon N, Myers BD. Atrial natriuretic peptide response to changing plasma volume in diabetic nephropathy. Diabetes 1991; 39: 893–901.CrossRefGoogle Scholar
  47. 47.
    O’Hare JP, Anderson JV, Millar ND, Bloom SR, Corral RGM. The relationship of the renin-angiotensin-aldosterone system to atrial natriuretic peptide and the natriuresis of volume expansion in diabetics with and without proteinuria Postgrad Med J 1988; 64 (Suppl 3): 35–38.PubMedGoogle Scholar
  48. 48.
    Dathan JRE, Johnson DB, Goodwin FJ. The relationship between body fluid comprtment volumes, renin activity and blood pressure in chronic renal failure. Clin Sci Mol Med 1985; 45: 77–88.Google Scholar
  49. 49.
    Ferriss JB, O’Hare JA, Cole M, Kingston SM, Twomey BM, O’Sullivan DJ. Blood pressure in diabetic patients: relationships with exchangeable sodium and renin activity. Diabetic nephropathy 1986; 5: 27–30.Google Scholar
  50. 50.
    Mulec H, Blohme G, Kullenberg K, Nyberg G, Bjork S. Latent overhydration and nocturnal hypertension in diabetic nephropathy. Diabetologia 1995;38:216–220.PubMedCrossRefGoogle Scholar
  51. 51.
    Colhoun H, Stevens LK Collodo Messa F, Fuller J and the EURODIAB IDDM Complications study. The relationshop of sodium and potassium excretion in the EURODIAB IDDM Diabetologia 1997;40: Suppl. 1 A366Google Scholar
  52. 52.
    Dobson PM, Beevers M, Hallworth R, Webberley MJ, Fletcher RF, Taylor KG. Sodium restriction and blood pressure in hypertensive type II diabetics: randomised blind controlled and crossover studies of moderate sodium restriction and sodium supplementation. BMJ 1989; 298: 227–230.CrossRefGoogle Scholar
  53. 53.
    Weidmann P, Beretta-Piccoli C, Keusch G, Gluck Z, Mujagic M, Grimm M, Mener A, Ziegler WH. Sodium-volume factor, Cardiovascular reactivity and hypotensive mechanism of diuretic therapy in mild hypertension associated with diabetes mellitus. Am J Med 1976; 67: 779–784.CrossRefGoogle Scholar
  54. 54.
    Nielsen FS, Rossing P, Gall M Skott P, Smidt UM, Parving H-H. Impact of lisinopril and atenolol on kidney function in hypertensive subjects with diabetic nephropathy. Diabetes 1994;43:1108–1113PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1998

Authors and Affiliations

  • James A. O’Hare
    • 1
  • J. Barry Ferriss
    • 2
  1. 1.Diabetes UnitLimerick Regional General HospitalLimerickIreland
  2. 2.Department of MedicineUniversity HospitalCorkIreland

Personalised recommendations