Decreased circulatory response to hypovolemic stress in young women with type 1 diabetes
Marcus Lindenberger1, Torbjörn Lindström, Toste Länne
1Corresponding author: Marcus Lindenberger, marcus.lindenberger@liu.se.
Insights
Young women with type 1 diabetes exhibit impaired circulatory responses to hypovolemic stress, showing reduced blood volume mobilization and fluid absorption. This suggests increased risk for hemodynamic instability, particularly with poor glycemic control.
Area of Science:
- Cardiovascular Physiology
- Endocrinology
- Diabetes Research
Background:
- Type 1 diabetes is linked to hemodynamic instability during circulatory stress.
- Previous studies show impaired circulatory response to hypovolemia in young men with type 1 diabetes.
- The impact on young women with type 1 diabetes remains unclear.
Purpose of the Study:
- To investigate the cardiovascular response to hypovolemic stress in young women with type 1 diabetes.
- To compare these responses with healthy young women.
Main Methods:
- Lower body negative pressure (30 cm H2O) induced hypovolemic stress in 15 women with type 1 diabetes and 16 controls.
- Measured venous capacitance response, net fluid absorption, cardiovascular responses, and plasma norepinephrine levels.
Main Results:
- Women with type 1 diabetes showed reduced and slower venous capacitance response (0.67 vs 0.92) and halved fluid absorption.
- Vasoconstrictor response was diminished and slower in women with type 1 diabetes.
- Microvascular complications and higher HbA1c levels further impaired responses.
Conclusions:
- Women with type 1 diabetes have impaired blood volume mobilization and fluid absorption during hypovolemic stress.
- These findings indicate a predisposition to hemodynamic instability.
- Poor glycemic control and microvascular complications exacerbate this risk.
Objective:
Diabetes is associated with hemodynamic instability during different situations involving acute circulatory stress in daily life. Young men with type 1 diabetes have been shown to have impaired circulatory response to hypovolemic stress. The effect of type 1 diabetes on cardiovascular response to hypovolemia in young women is unknown, however.
Research Design And Methods:
Lower body negative pressure of 30 cm H2O was used to create rapid hypovolemic stress in 15 young women with type 1 diabetes (DW) and 16 healthy women (control subjects [C]). Compensatory mobilization of venous capacitance blood (capacitance response) and net fluid absorption from tissue to blood were measured with a volumetric technique. Overall cardiovascular responses and plasma norepinephrine levels were measured.
Results:
Capacitance response was reduced (DW, 0.67 ± 0.05; C, 0.92 ± 0.06) and developed slower in DW (P < 0.01). Capacitance response was further reduced with increasing levels of HbA1c. Fluid absorption was almost halved in DW (P < 0.01). The initial vasoconstrictor response was reduced and developed slower in DW (P < 0.05). Arterial vasoconstriction was further reduced in the presence of microvascular complications (P < 0.05).
Conclusions:
DW present with decreased and slower mobilization of venous capacitance blood and decreased net fluid absorption from tissue to blood during hypovolemic circulatory stress. Collectively, this indicates that DW are prone to hemodynamic instability, especially in the presence of microvascular complications and poor glycemic control.
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