Effects of Insulin on Vascular Tone and Sympathetic Nervous System in NIDDM
Open accessAbstract
Chronic activation of the sympathetic nervous system may be a pathogenetic mechanism by which hyperinsulinemia induces cardiovascular damage in insulin-resistant NIDDM patients. The influence of physiological hyperinsulinemia (∼ 700 pmol/l) on basal and stimulated sympathetic outflow was studied in 12 lean normotensive subjects with well-controlled NIDDM without complications and in 13 matched control subjects. Forearm blood flow (FBF) was measured with forearm plethysmography; sympathetic nervous system activity was assessed by the [3H]norepinephrine (NE) tracer method. NIDDM patients were insulin resistant (glucose infusion rates 31.8 ± 3.8 vs. 48.7 ± 2.0 mumol·kg−1 · min−1 in control subjects, P < 0.01). After a mixed meal, NIDDM patients showed a hyperinsulinemic response (2-h insulin levels: NIDDM patients 324 ± 34 pmol/l, control subjects 165 ± 19 pmol/l, P < 0.001). Insulin infusion induced a vasodilator response (not significantly different between the groups). Arterial plasma NE levels and total-body NE spillover increased significantly (total spillover in NIDDM patients from 0.77 ± 0.09 to 1.18 ± 0.16 nmol · m−2 · min−1, in control subjects from 0.98 ± 0.14 to 1.23 ± 0.18 nmol · m−2 · min−1 P < 0.01 for all, not different between groups). Total-body NE clearance did not change. Sympathetic stimulation (lower-body negative pressure [LBNP] 15 mmHg) induced forearm vasoconstriction and increased arterial and venous plasma NE and total NE spillover. Responses of FBF and NE kinetics to LBNP were not significantly different between groups and were not altered by hyperinsulinemia. Although these nonobese subjects with uncomplicated NIDDM showed postprandial hyperinsulinemia and resistance to the effect of insulin on glucose metabolism, this group was not resistant to the vasodilator and sympathetic stimulant effects of insulin. Responses to sympathetic stimuli (LBNP) were normal and unaffected by physiological hyperinsulinemia. Therefore, because of daily life hyperinsulinemia, chronic sympathetic stimulation could be operative in these patients and may explain the increased incidence of hypertension and/or cardiovascular complications.
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Insulin resistance may contribute to hypertension by increasing sympathetic activity, peripheral vascular resistance, renal sodium retention, and vascular smooth muscle tone and proliferation.
“and may contribute to hypertension by increasing sympathetic activity, peripheral vascular resistance, renal sodium retention [107], and vascular smooth muscle tone and proliferation [108,109].”
From Metformin: An Old But Still the Best Treatment for Type 2 Diabetes (2013) · cites this paper as [108]
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- Authors
- Tack, C. J. J., Smits, P., Willemsen, J. J., Lenders, J. W. M., Thien, T., & Lutterman, J. A.
- Affiliations
- Department of Internal Medicine, Division of General Internal Medicine, University Hospital Nymegen Nymegen, The Netherlands
- Department of Experimental and Chemical Endocrinology, University Hospital Nymegen Nymegen, The Netherlands
- Venue
- Diabetes
- Publisher
- American Diabetes Association
- Published
- 1996-01-01
- Volume
- 45
- Issue
- 1
- Pages
- 15-22
- ISSN
- 0012-1797 (ISSN-L)
- 1939-327X
- OpenAlex
- W2165801681
- Cited by
- 117
- References
- 0
- Citations by year
- 2026: 1 · 2025: 7 · 2024: 1 · 2023: 10 · 2022: 4 · 2021: 7 · 2020: 3 · 2019: 3 · 2018: 2 · 2017: 2 · 2015: 1 · 2014: 2 · 2013: 1 · 2012: 2
- FWCI
- 6.96
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- other-oa
- Locations
- Diabetes (publishedVersion)
- PubMed (publishedVersion)
- Radboud Repository (Radboud University) (submittedVersion, other-oa)
- Radboud Repository (Radboud University) (submittedVersion)
- Funders
- Diabetes Fonds
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- type 2 diabetes, insulin resistance, hyperinsulinemia, sympathetic nervous system, vascular tone, norepinephrine spillover, forearm blood flow, lower body negative pressure, postprandial insulin response, cardiovascular risk, norepinephrine kinetics, glucose infusion
- MeSH terms
- Adult, Blood Flow Velocity, Blood Glucose, Blood Pressure, Diabetes Mellitus, Type 2, Eating, Female, Humans, Hyperinsulinism, Infusions, Intravenous, Insulin, Male, Middle Aged, Muscle, Smooth, Vascular, Norepinephrine, Sympathetic Nervous System, Vasodilation, Glucose Clamp Technique
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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