Insulin secretion and growth failure in uremia

Glucose and insulin metabolism was studied in 16 adolescents with uremia on hemodialysis. Glucose tolerance was measured by i.v. glucose tolerance tests (IVGTT). Insulin sensitivity was measured by the euglycemic clamp technique. Insulin secretion during constant hyperglycemia was measured by the hyperglycemic clamp technique. Controls consisted of eight healthy young adults. These patients could be further subdivided into two groups with respect to their growth velocity SD score (GVSDS). Group one consisted of eight patients with GVSDS more than -2. This group had normal 1,25(OH)2D3 and demonstrated insulin resistance, hyperinsulinemia, and normal glucose tolerance when compared with adult controls. Group two consisted of eight patients with GVSDS less than -2. This latter group had low 1,25(OH)2D3, insulin resistance, but normoinsulinemia and glucose intolerance compared with adult controls. Published data in the literature showed that normal pubertal adolescents demonstrated insulin resistance and hyperinsulinemia compared with normal adults. Compared with normal values of insulin sensitivity in adolescents, both groups of patients on hemodialysis were still insulin resistant. The insulin secretion values in group one was similar to reported values for normal adolescents, whereas the values in group two were lower. GVSDS correlated significantly only with insulin secretion and not with glucose tolerance, insulin sensitivity, 1,25(OH)2D3, or PTH. Normal adolescents demonstrate an increase in insulin secretion as they go into puberty. It seems that the puberty growth spurt in adolescents both with normal health and renal failure may require increased insulin secretion as one of its hormonal requirements.