Hypoglycaemia and insulin resistance in uraemia associated with insulin fragments

The pathogenetic role of insulin fragments in spontaneous hypoglycaemia and insulin resistance in chronic renal failure is discussed. Four different evidences are presented. In our studies, a dialysable 'toxin' with insulin-like actions was found in uraemia. Indeed small polypeptide fragments of hormones with potent activities have been recently identified in uraemic plasma. The varying bioactivities of different insulin fragments can explain the coexistence of insulin resistance and hypoglycaemia in these patients. As shown by our studies, removal of these fragments by haemodialysis results in normalisation of metabolic disturbances. However actual proof is difficult with the present technological problems.