Continuous Subcutaneous Insulin Infusion in the Management of Painful Diabetic Neuropathy

Boulton, Andrew J.M.; Drury, John H.; Clarke, B. F.; Ward, J. P.

doi:10.2337/diacare.5.4.386

Cited by 202 publications

(64 citation statements)

References 15 publications

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“…However, that hyperglycemia may cause nervous functional changes in a short time has been shown by depressed pain threshold induced after intravenous glucose infusion over a few minutes," and by the symptomatic relief of painful diabetic neuropathy which has been achieved in 24 hours with insulin therapy. 28 Improvement of nerve function in long-standing diabetes is clearly related to blood glucose ~0 n t r o 1 .~~ Although no similar changes of heart rate were noticed in healthy subjects it should be stressed than only mild hyperglycemia was induced in them, as compared to the diabetic individuals. In order to induce similar glucose levels, a very large amount of intravenous solution would be necessary in nondiabetic subjects; this would increase the circulating volume and result in hemodynamic changes.…”

Section: Discussionmentioning

confidence: 97%

Influence of acute hyperglycemia on left ventricular function in diabetics assessed by echocardiography

Rivera

Espinoza

et al. 1987

Clinical Cardiology

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Summary: Myocardial dysfunction in diabetes mellitusis reversed by proper correction of metabolic changes. To assess the role of hyperglycemia on cardiac dysfunction, 50 g of dextrose were intravenously infused to 15 subjects with stable type 2 diabetes. Echocardiographic measurements were made at 0,60, 120, 180, and 240 minutes. In spite of the high levels of blood glucose reached in diabetics, left ventricular ejection fraction, fractional shortening, and stroke volume did not experience significant changes. Moreover, cardiac output significantly (p ~0 . 0 1 ) increased in diabetics secondary to an increase in heart rate. No cardiac changes were noticed in 7 healthy subjects studied in a similar fashion. However, their induced hyperglycemia was not as elevated as in the diabetic patients. These results suggest that acute induced hyperglycemia per se does not appear to impair left ventricular contractility in diabetics at resting conditions.

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Section: Discussionmentioning

confidence: 97%

Influence of acute hyperglycemia on left ventricular function in diabetics assessed by echocardiography

Rivera

Espinoza

et al. 1987

Clinical Cardiology

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“…There have been no comparable studies of autonomic function. The concept of direct metabolic damage to nerves by hyperglycaemia [5] is based on studies of motor nerve conduction velocity [15][16][17][18][19][20][21][22]. Yet it is sensory and autonomic nerve involvement, rather than damage to somatic motor fibres, which is responsible for the common and clinically serious manifestations of diabetic neuropathy [3,6].…”

Section: Discussionmentioning

confidence: 99%

Progression of subclinical polyneuropathy in young patients with Type 1 (insulin-dependent) diabetes: associations with glycaemic control and microangiopathy (microvascular complications)

Young

MacIntyre

Martyn³

et al. 1986

Diabetologia

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Summary. The progression of subclinical polyneuropathy over 2.5 years has been studied in a representative group of 75 young patients with Type I (insulin-dependent) diabetes (initial age 16-19years). The relationships between changes in nerve function, glycaemic control and concurrently developing microvascular complications (retinopathy, microproteinuria) were investigated. Deterioration of motor, sensory and autonomic nerve function, retinopathy and microproteinuria was related to poor glycaemic control. In addition, there was an association between developing neural and microvascular complications which was not diminished when their common relationship to hyperglycaemia was taken into account. These findings suggest that, although poor glycaemic control is an essential permissive factor in the early development of diabetic polyneuropathy, other influences, shared with microvascular complications, must also be important.

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“…A recent study has reported that pain is a significant medical issue with a moderate-to-substantial impact on quality of life in some patients with diabetic neuropathy [19]. The prevalence of painful diabetic neuropathy (PDN) in diabetic patients is ranging from 11% of an insulin treated population [6] to 25% in a hospital diabetic clinic population [10]. However, the definition of PDN does not take in account that there are several types of peripheral nerve damage in diabetic patients that can present as painful neuropathies.…”

Section: Diabetic Neuropathymentioning

confidence: 99%

Painful Peripheral Neuropathies

Marchettini¹,

Lacerenza²,

Mauri³

et al. 2006

128

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Peripheral neuropathies are a heterogeneous group of diseases affecting peripheral nerves. The causes are multiple: hereditary, metabolic, infectious, inflammatory, toxic, traumatic. The temporal profile includes acute, subacute and chronic conditions. The majority of peripheral neuropathies cause mainly muscle weakness and sensory loss, positive sensory symptoms and sometimes pain. When pain is present, however, it is usually extremely intense and among the most disabling symptoms for the patients. In addition, the neurological origin of the pain is often missed and patients receive inadequate or delayed specific treatment. Independently of the disease causing the peripheral nerve injury, pain originating from axonal pathology or ganglionopathy privileges neuropathies affecting smaller fibres, a clinical observation that points towards abnormal activity within nociceptive afferents as a main generator of pain. Natural activation of blood vessels or perineurial nociceptive network by pathology also causes intense pain. Pain of this kind, i.e. nerve trunk pain, is among the heralding symptoms of inflammatory or ischemic mononeuropathy and for its intensity represents itself a medical emergency. Neuropathic pain quality rekindles the psychophysical experience of peripheral nerves intraneural microstimulation i.e. a combination of large and small fibres sensation temporally distorted compared to physiological perception evoked by natural stimuli. Pins and needles, burning, cramping mixed with numbness, and tingling are the wording most used by patients. Nociceptive pain instead is most often described as aching, deep and dull. Good command of peripheral nerve anatomy and pathophysiology allows timely recognition of the different pain components and targeted treatment, selected according to intensity, type and temporal profile of the pain.

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Continuous Subcutaneous Insulin Infusion in the Management of Painful Diabetic Neuropathy

Cited by 202 publications

References 15 publications

Influence of acute hyperglycemia on left ventricular function in diabetics assessed by echocardiography

Influence of acute hyperglycemia on left ventricular function in diabetics assessed by echocardiography

Progression of subclinical polyneuropathy in young patients with Type 1 (insulin-dependent) diabetes: associations with glycaemic control and microangiopathy (microvascular complications)

Painful Peripheral Neuropathies

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