deamino-arginine-vasopressin and Diabetes-Mellitus--Type-1

Topics: Blood Volume; Child; Craniocerebral Trauma; Deamino Arginine Vasopressin; Dehydration; Diabetes Mellitus, Type 1; Diuresis; Female; Humans; Kinetics; Male; Models, Biological; Neurophysins; Osmolar Concentration; Oxytocin; Pituitary Gland, Posterior; Postoperative Complications; Pregnancy; Pregnancy in Diabetics; Thirst; Urine; Vasopressins

The aim of the study was to evaluate whether normoalbuminuric type 1 diabetic patients with diabetic retinopathy (DR) have an impaired tubular response to desmopressin (dDAVP, a synthetic analog of vasopressin) administration, and its relationship with plasma and urine endothelin-1 (ET-1) levels.. This was an interventional case-control study.. The study was conducted at a referral center.. Fifteen normoalbuminuric type 1 diabetic patients with DR were compared with 30 normoalbuminuric type 1 diabetic patients without DR. Both groups were matched by age, gender, body mass index, glycosylated hemoglobin, and the main laboratory markers of kidney function.. After a 12-h period of water deprivation, dDAVP (0.3 microg/kg) was infused over 20 min. Urine was collected at baseline and 1, 2, and 3 h after dDAVP administration. ET-1 was assessed by ELISA.. dDAVP induced a lower rise in urine osmolality in patients with DR (from 650 +/- 206 to 754 +/- 224 mosmol/kg; P = 0.02) than in diabetic patients without DR (from 714 +/- 194 to 905 +/- 163 mosmol/kg; P < 0.0001). In addition, fractional excretion of Na+ decreased in patients without DR (from 0.45 +/- 0.30 to 0.29 +/- 0.29%; P = 0.04) but not in the diabetic patients with DR (from 0.36 +/- 0.22 to 0.36 +/- 0.40%; P = 0.96). Plasma ET-1 levels were inversely correlated with the response of urinary osmolality after dDAVP administration (r = -0.62; P = 0.008).. Normoalbuminuric type 1 diabetic patients with DR have impaired renal response to dDAVP that is related to plasma ET-1 levels. Further studies are required to elucidate whether this tubular resistance to dDAVP might favor dehydration in these patients.

Topics: Adult; Albuminuria; Creatinine; Deamino Arginine Vasopressin; Diabetes Mellitus, Type 1; Diabetic Retinopathy; Endothelin-1; Female; Humans; Kidney Tubules; Male; Middle Aged; Osmolar Concentration; Young Adult

The use of desmopressin and vasopressors in cadaveric organ donors is considered a risk factor for graft dysfunction following pancreas transplantation by influencing the microcirculation. The aim of this study was to investigate the influence of these substances on early graft function.. This single-center retrospective trial included 59 patients who underwent simultaneous or solitary pancreas transplantation. The corresponding donor charts were reviewed for the use of vasopressors and desmopressin. Impaired graft function was determined as graft thrombosis or as insulin-dependence for more then 3 days posttransplant. Daily amylase and lipase concentrations from abdominal drains were measured to quantify reperfusion pancreatitis and fistula formation.. Overall, pancreas thrombosis was observed in 4 of 59 (6.8%) recipients. There were no significant differences in thrombosis rate whether the donors received desmopressin (3/38 vs 1/21, P >.1) or the needed vasopressors (3/53 vs 1/9, P >.1). The number of patients who required insulin for more than 3 days posttransplant was comparable whether the donors received desmopressin (9/38 vs 4/21, P >.1), or vasopressors (9/46 vs 3/8, P >.1). At present all recipients with functioning pancreatic grafts (ie, 92.7%) are free of exogenous insulin therapy at 2 to 80 months posttransplant. The amylase/lipase concentrations of peritoneal fluid were independent of the administration of desmopressin or vasopressors in the donors.. In this study donor desmopressin and vasopressor administration did not influence graft function after pancreas transplantation.

Topics: Adult; Cadaver; Cause of Death; Deamino Arginine Vasopressin; Diabetes Mellitus, Type 1; Drainage; Female; Humans; Insulin; Kidney Transplantation; Male; Middle Aged; Organ Preservation; Pancreas Transplantation; Retrospective Studies; Tissue Donors; Treatment Outcome; Vasopressins

Topics: Adult; Blood Glucose; Brain Edema; Brain Neoplasms; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes Mellitus, Type 1; Diabetic Coma; Diabetic Ketoacidosis; Diagnosis, Differential; Fatal Outcome; Female; Fluid Therapy; Headache; Humans; Hypernatremia; Insulin; Polyuria; Postoperative Complications; Radiography

The fibrinolytic system was investigated in 38 patients (21 males and 17 females) affected by type 1 diabetes mellitus (18 free from complications, 10 with retinopathy, and 10 with autonomic neuropathy) and in 8 healthy controls. Two separate fibrinolysis-stimulating tests were done: standardized venous occlusion and 1-desamino-8-D-arginine vasopressin infusion. Plasma tissue plasminogen activator antigen and activity and plasma plasminogen activator inhibitor activity were measured. All the patients were in good metabolic control (mean HbA1c 7.4%, range 6.1-8.0%). No significant differences were observed either between the diabetic patients and the control subjects, nor among the subgroups of diabetic patients. The fibrinolytic system is probably not involved in type 1 diabetes mellitus.

Topics: Deamino Arginine Vasopressin; Diabetes Mellitus, Type 1; Diabetic Neuropathies; Diabetic Retinopathy; Female; Fibrinolysis; Humans; Male; Plasminogen Activator Inhibitor 1; Tissue Plasminogen Activator

Tissue plasminogen activator (t-PA), tissue plasminogen activator inhibitor, (PAI), and von Willebrand factor (vWF) were measured in 30 diabetics and 17 control subjects. These studies were performed to clarify the role of obesity in causing abnormalities of the fibrinolytic system in diabetics. The t-PA antigen response measured after the infusion of desmopressin acetate (DDAVP) was similar in all groups. Peak responses to DDAVP for controls, type I diabetics, and type II diabetics were 21.2 +/- 9.5 ng/mL, 27.5 +/- 9.0 ng/mL, and 28.8 +/- 11.0 ng/mL (NS), respectively. These responses did not correlate with the body mass index (BMI) or any other of the indices examined. A significant decrease of t-PA activity as contrasted with t-PA antigen following DDAVP occurred in type II diabetics only. The decrease of t-PA activity strongly correlated with greater basal levels of plasminogen activator inhibitor in these same subjects. The plasma level of plasminogen activator inhibitor correlated with BMI but with no other index examined. In contrast to t-PA activity and PAI, vWF responses to DDAVP inversely correlated to basal vWF concentration in all groups. Basal concentrations of vWF were increased in both type I and II diabetics and showed no relationship to degree of obesity. In summary, these results suggest that type II diabetic subjects have decreased t-PA activity, which is best explained by increased levels of PAI. The increased PAI appears related to obesity and not diabetes per se.

Topics: Adolescent; Adult; Deamino Arginine Vasopressin; Diabetes Mellitus; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Neuropathies; Female; Fibrinolysis; Humans; Immunoelectrophoresis; Male; Middle Aged; Obesity; Plasminogen Activators; Plasminogen Inactivators; von Willebrand Factor