Summary Impaired c0-6 essential fatty acid metabolism and exaggerated polyol pathway flux contribute to the neurovascular abnormalities in streptozotocin-diabetic rats. The potential interactions between these mechanisms were examined by comparing the effects of threshold doses of aldose reductase inhibitors and evening primrose oil, alone and in combination, on neurovascular deficits. In addition, highdose aldose reductase inhibitor and evening primrose oil treatment effects were challenged by co-treatment with the cyclo-oxygenase inhibitor, flurbiprofen, or the nitric oxide synthase inhibitor, N%nitro-L-arginine. Eight weeks of diabetes caused an 18.9 % reduction in sciatic motor conduction velocity (p < 0.001). This was only modestly ameliorated by a 0.1% dietary supplement of evening primrose oil or the aldose reductase inhibitors ZD5522 (0.25 mg. kg -1. day ~) and WAY121509 (0.2 mg. kg -1. day -t) for the final 2 weeks. However, joint treatment with primrose oil and ZD5522 or WAY121509 caused marked 71.5 and 82.4 % corrections, respectively, of the conduction deficit. Sciatic nutritive blood flow was 43.1% reduced by diabetes (p < 0.001) and this was corrected by 67.8 % with joint ZD5522 and primrose oil treatment (p < 0.001). High-dose WAY121509 (10 rag. kg -1 9 day -1) and primrose oil (10 % dietary supplement) prevented sciatic conduction velocity and nutritive blood flow deficits in 1-month diabetic rats (p < 0.001). However, these effects were abolished by flurbiprofen (5 mg. kg -1. day -1) and NG-nitro-Larginine (10 mg. kg -1 9 day -1) co-treatment (p < 0.001). Thus, the data provide evidence for synergistic interactions between polyol pathway/nitric oxide and essential fatty acid/cyclo-oxygenase systems in the control of neurovascular function in diabetic rats, from which a potential therapeutic advantage could be derived. [Diabetologia (1996) 39: 172-182] Key words Neuropathy, nerve conduction, endoneurial blood flow, ischaemia, essential fatty acid, prostacyclin, aldose reductase, nitric oxide, vascular endothelium, diabetic rat.Impaired nutritive blood flow is the major factor contributing to early peripheral nerve dysfunction in experimental diabetes mellitus [1,2]. This is likely to be relevant to complications in patients, as direct and indirect investigations have provided strong evidence for nerve perfusion deficits associated with diabetic neuropathy [3]. In diabetic rats, neurovascular defects can be prevented or corrected by a number of therapeutic strategies that target the metabolic changes in diabetes or compensate for them by a direct vasodilator action on vasa nervorum [2]. Vascular endothelium appears particularly vulnerable to hyperglycaemia-driven metabolic changes in diabetes. Increased synthesis/action of angiotensin II [4] and endothelin 1 [5] promote vasa nervorum vasoconstriction. This is strongly exacerbated by deficits in prostacyclin synthesis [6] and nitric oxide (NO) release/action [7] which reduce local vasodilation. Prostacyclin changes appear to be caused by defecti...