Hyperinsulinuria in diabetic ketoacidosis.

Urinary insulin excretion has been measured in diabetic children. In nine well controlled diabetics urinary insulin excretion (mean and 2SD) was significantly greater than that found in healthy controls (8.8; 4.4-17.5 versus 3.8; 2.3-6.4 microU/min/1.73 m2). In ten ketoacidotic diabetic children a 50 fold increase of the urinary insulin excretion has been observed (464.8; 158.2-1363 microU/min/1.73 m2). The hyperinsulinuria proved to be reversible: significantly decreased excretion rate (12.9; 9.7-12.3) could be measured 8-10 days after recovery from coma. The hyperinsulinuria during ketoacidosis indicates severe reversible tubular dysfunction. Recurrent ketoacidotic episodes might play a role in the development of diabetic nephropathy.