Hormonal changes in severely uncontrolled type 1 (insulin-dependent) diabetes mellitus

Abstract

To investigate endocrinological changes associated with severely uncontrolled type 1 (insulin-dependent) diabetes mellitus 27 patients (19 men, eight women) with ketoacidosis or severe ketonuria (=group 1) were examined on admission and after recovery. For comparison 13 non-ketotic patients (seven men, six women), admitted for adjustment of treatment because of poor diabetic control (=group 2), and 20 healthy controls were studied. On admission, the serum testosterone levels in men were lower in group 1 (15.1 ± 2.0 nmol l^-1) (mean ± SEM) than in group 2 (27.2 ± 2.8 nmol l^-1) (p<0.01) and healthy controls (20.6 ± 2.0 nmol 1^-1) (p<0.05). During treatment the testosterone levels in group 1 rapidly rose to the control level. The serum oestradiol levels in women were low in group 1 both on admission and discharge. The serum prolactin levels were low in female patients in group 1 (119 ± 17 mlU I^-1) compared with the women in group 2 (315 ± 75 mlU l^-1) (p<0.05). On admission the serum Cortisol levels were higher and their response to 1 mg of dexamethasone was weaker in group 1 than in group 2 and healthy controls. After recovery the serum Cortisol levels fell by 15% (p<0.01) and the response to 1 mg of dexamethasone returned to normal in group 1. In group 1 during treatment the serum free T₄ and reverse T₃ levels fell, and the T₃ and free T₃ levels rose, whereas the thyroid stimulating hormone (TSH) levels and their responses to TRH remained unchanged. In conclusion, in diabetic patients hormonal homeostasis is not influenced by hyperglycaemia but is profoundly altered by severe metabolic decompensation owing to insulin deficiency.

Key Words:

• Cortisol
• ketoacidosis
• luteinizing hormone
• oestradiol
• prolactin
• testosterone
• thyrotropin
• thyroid hormones