Peripheral blood flow and metabolic control in juvenile diabetes

Gundersen, H. J. G.

doi:10.1007/bf00423039

Cited by 88 publications

(27 citation statements)

References 12 publications

(12 reference statements)

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“…Recent evidence indicates that there are marked abnormalities of blood flow in such legs, suggesting increased velocity of flow and raising the possibility of arterio-venous shunting [27,28]. Forearm blood flow has been shown to be increased in juvenile diabetic patients, this increase being more marked at times of poor metabolic control [29].…”

Section: Blood Flow Abnormalitiesmentioning

confidence: 99%

The diabetic leg

Ward

1982

Diabetologia

100

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Summary. Many clinical problems arise as a result of tissue pathology in the diabetic leg. Neuropathic or vascular ischaemic syndromes are readily identified but on occasions differentiation of the two may be difficult. This survey reviews the aetiological background of neuropathy and ischaemia, examines the relationship of physiological blood flow abnormalities to both areas and comments on management of the clinical states encountered, including the common problem of the ulcerated diabetic foot.

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Section: Blood Flow Abnormalitiesmentioning

confidence: 99%

The diabetic leg

Ward

1982

Diabetologia

100

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“…Despite this apparently adequate blood supply these patients sometimes develop non-healing foot ulcers. In agreement with these observations several studies have shown that diabetic patients have an increased blood flow in the extremities [22][23][24], and also an increase of the total skin microcircuIation [25,26]. Peripheral neuropathy, in combination with repeated mechanical stress, is considered the main reason why chronic foot ulcers develop in skin areas with an increased or normal blood flow, but another contributing factor may be a maldistribution of blood between the nutritional capillaries and the deeper subpapillary vessels.…”

Section: Discussionmentioning

confidence: 54%

“…Long-term hyperglycaemia causes endothelial and metabolic disturbances leading to an elevated blood circulation, capillary hypertension and increased vascular leakage [24,36,37,26,38], which may progress to irreversible structural changes [39], such as a thickening of the capillary basement membrane [40]. An increased capillary blood pressure, which has been demonstrated in both the toe and finger nailfolds of diabetic patients [26,38], may be a consequence of an opening of arteriovenous shunt vessels with a transformation of the arteriolar pressure out into the subpapillary venular plexus, resulting in a decreased arteriovenous pressure difference.…”

Section: Discussionmentioning

confidence: 99%

Skin capillary circulation severely impaired in toes of patients with IDDM, with and without late diabetic complications

1995

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SummaryWe have recently shown that the skin microcirculation of toes is significantly impaired in patients with diabetes and peripheral vascular disease, and this may be one major reason why these patients are highly susceptible to developing skin ulcers. The aim of the present study was to investigate whether the skin microcirculation is impaired also in diabetic patients free from macroangiopathy. One foot in each of 20 patients with insulin-dependent diabetes was investigated: 10 patients with and 10 patients without late complications. All patients had normal arterial circulation of their lower extremities. Two groups of age-and sex-matched healthy subjects served as controls. The capillary blood cell velocity in the nailfold of the great toe was investigated by computerised videophotometric capillaroscopy, and the total microcirculation within the same area evaluated by laser Doppler fluxmetry. The capillary blood cell velocity and the total skin microcirculation were studied during rest, and during postocclusive reactive hyperaemia. The total microcirculation was similar in patients and control subjects, whereas the capillary circulation was markedly reduced (p < 0.01) in the patients. The ratio between the capillary and total microcirculation was significantly decreased (p < 0.05 0.01) in the patients as compared to the control subjects, indicating a local maldistribution of blood in the skin microcirculation of the diabetic patients. The results of the present study show that in spite of a normal total skin microcirculation in the toes of insulin-dependent diabetic patients, both with and without late complications, the nutritional capillary circulation is severely impaired. These findings indicate that a chronic ischaemia is present in the skin capillaries of diabetic feet, and is related to the diabetic disease per se and not to late diabetic complications, and may be a cause for these complications. [Diabetologia (1995) 38:474-4801

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“…It may be suggested that it is in connection with the increased circulatory demands of the periphery and there fore the increased blood flow in the peripheral tissues [35] and kidney [36]. The other reason is probably the domi nant sympathetic tone [14].…”

Section: Discussionmentioning

confidence: 99%

Increased Myocardial Contractility in Young Newly Diagnosed Type 1 (Insulin-Dependent) Diabetics Free of Diabetic Complications: An Echocardiographie Study

Raev¹,

Vakov²

1993

Am J Noninvas Cardiol

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One hundred and fifty-seven young cardiac asymptomatic type 1 diabetics and 54 control subjects were examined with M-mode echocardiography to elucidate the early changes in left ventricular systolic function (LVSF) in diabetes mellitus. Out of 157 diabetics a group of 40 newly diagnosed diabetics without diabetic complications was formed (retinopathy, nephropathy, autonomic neuropathy). They had ejection fraction (71.3 ± 3.3%), fractional shortening (FS = 40.5 ± 2.3%) and corrected mean velocity of circumferential fiber shortening (1.23 ± 0.11 circ/s) significantly higher than those of the control subjects (65.7 ± 3.0, 36.3 ± 2.3, 1.08 ± 0.09), but end-diastolic volume index (as preload, 72.9 ± 11.7 ml/m2), end-systolic meridional wall stress (MWSs, as afterload, 65.7 ± 12.4kdyn/cm2) and heart rate (HR = 72.8 ± 10.0 bpm) were unchanged significantly compared to the control values (68.6 ± 10.8, 70.9 ± 15.0, 74.4 ± 11.0). In 90% of the newly diagnosed diabetics the FS was above the 95% confidence limits of the control FS/MWSs relation, on the background of a significant difference (p < 0.001) in the frequency distribution between diabetics and control group (37%). These changes were probably due to increased myocardial contractility, rather than the changes in the loading condition since the other determinants of LVSF, such as preload, afterload and HR, were unchanged. In conclusion, our data impose the hypothesis that one of the early manifestations of the noncoronary diabetic cardiopathy is the increased myocardial contractility.

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Peripheral blood flow and metabolic control in juvenile diabetes

Cited by 88 publications

References 12 publications

The diabetic leg

The diabetic leg

Skin capillary circulation severely impaired in toes of patients with IDDM, with and without late diabetic complications

Increased Myocardial Contractility in Young Newly Diagnosed Type 1 (Insulin-Dependent) Diabetics Free of Diabetic Complications: An Echocardiographie Study

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