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February 19, 2007

Other, Type 2

Question from India:

I have a follow-up to my question about the role of potassium and magnesium in overeating. Potassium levels are to be evaluated if hyperglycemia results into more efflux of potassium which may cause more potassium into extracellular fluid (ECF) and more in blood and more loss into urine to maintain normal blood levels. It may indicate an elevated level in the blood as well as in urine, but deficient in intracellular fluid (ICF) so it may stimulate hunger for potassium intake. Another possibility is that cells are dying due to starved energy due to insulin resistance causing the leaking of potassium into ECF/blood. The opposite may be possible in the case of normal glucose level or hypoglycemia on medication/injected inulin, i.e., potassium shifted to ICF, less in ECF, less in blood so decreased excretion into urine. As such, I think pH can also be effected as potassium exchanges hydrogen across the cell membrane. In short, if urine levels of pH, potassium and other minerals have been checked, evaluated and found abnormal in diabetics, especially when glucose levels are persistently uncontrolled, will this cause an increased craving for food?

Answer:

You are correct in indicating that there may often be a difference in total body potassium and the extracellular potassium level, as reflected in the blood. High blood sugars result in higher potassium and some increase in urinary excretion. Patients who are poorly controlled can be deficient in total body potassium. This is not good for coordinating insulin secretion and for blood pressure control. I am not sure if there have been studies that have elucidated any role between urinary potassium excretion, pH, and food intake. Most of the patients that have chronic poor control have increased appetites because they are “fasting in the presence of plenty.” In other words, there are nutrients around, but the body cannot use them. As a result, there is an increase in appetite.

JTL