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Insulin Improves Alveolar-Capillary Membrane Gas Conductance in Type 2 Diabetes

From the Institute of Cardiology, University of Milan, Milan, Italy

OBJECTIVE—In type 1 diabetes, lung diffusing capacity for carbon monoxide (DL_CO) may be impaired, and insulin has been shown to be beneficial in cases in which near-normal metabolic control is achieved. An influence of insulin, per se, on the alveolar-capillary membrane conductance is unexplored. We aimed at testing this possibility.

RESEARCH DESIGN AND METHODS—We studied 19 life-long nonsmoking, asymptomatic patients with type 2 diabetes and normal cardiac function, whose GHb averaged 6.2 ± 0.3% with diet and hypoglycemic drugs. DL_CO and its subcomponents (alveolar capillary membrane conductance [D_M] and pulmonary capillary blood volume available for gas exchange [Vc]), vital capacity (VC), forced expiratory volume 1 s (FEV₁), cardiac output (CO), ejection fraction (EF), pulmonary wedge pressure (WPP), and pulmonary arteriolar resistance (PAR) were determined before and within 60 min after infusion of 50 ml saline + 10 IU of regular insulin or after saline alone on 2 consecutive days (random block design). Glycemia was kept at baseline levels during experiments by dextrose infusion.

RESULTS—Percent of normal predicted DL_CO averaged 84.2 ± 7.9% and in 14 patients was <100%. Insulin infusion, not saline alone, improved (P < 0.01) DL_CO (12%) and D_M (14%) and raised DL_CO to 98% of the normal predicted value. There were no variations in VC, FEV_1, CO, EF, WPP, or PAR, suggesting that the influences of the hormone on gas transfer were not mediated by changes in spirometry, volumes, and hemodynamics of the lung.

CONCLUSIONS—Several cases of type 2 diabetes present with increased impedance to gas transfer across the alveolar-capillary membrane, and hypoglycemic drugs do not prevent this inconvenience. Insulin, independently of the metabolic effects, acutely improves gas exchange, possibly through a facilitation of the alveolar-capillary interface conductance.

Abbreviations: CO, cardiac output • CV, coefficient of variation • DL_CO, lung diffusing capacity for carbon monoxide • D_M, alveolar capillary membrane conductance • EF, ejection fraction • FEV₁, forced expiratory volume 1 s • SVR, systemic vascular resistance • PAR, pulmonary arteriolar resistance • Va, alveolar volume • Vc, pulmonary capillary blood volume available for gas exchange • VC, vital capacity, WPP, pulmonary wedge pressure

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