The Relationship Between Peripheral and Autonomic Neuropathy in Insulin Dependent Diabetes: A Clinical and Instrumental Evaluation

Canal, N.; Comı, Gıancarlo; Saibene, V.; Musch, B; Pozza, G.

doi:10.1016/b978-0-444-80079-4.50027-2

Cited by 25 publications

(10 citation statements)

References 11 publications

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“…In other polyneuropathies, sympathetic activity of normal appearance could be seen with motor conduction velocity as low as 12 m/s [13] (Fig.3). A correlation between somatic nerve damage and autonomic dysfunction in diabetic polyneuropathy has been reported by other investigators [3,11,15,18,29].…”

Section: Discussionsupporting

confidence: 67%

Microneurographic findings in diabetic polyneuropathy with special reference to sympathetic nerve activity

Fagius

1982

Diabetologia

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Summary. Microneurographic recordings of naturally occurring nerve activity in the median or peroneal nerve were made in 25 patients with diabetes mellitus, 17 of whom had signs of polyneuropathy. In patients without polyneuropathy, the electrical findings did not differ from those in healthy subjects. In patients with polyneuropathy, sensory afferent impulses were always normal qualitatively, whereas muscular afferent activity was weak or entirely absent in some patients. Sympathetic activity, if found, showed normal characteristics in muscle and skin fascicles, except that it was difficult to obtain a good signal-to-noise ratio. In 16 of 25 recordings with the electrode positioned intraneurally, sympathetic activity could not be detected in patients with polyneuropathy. The failures correlated with impaired skin sympathetic effector organ responses and reduction of motor nerve conduction velocity. The results suggest that impairment of sympathetic outflow occurs frequently in diabetic polyneuropathy and that sympathetic involvement occurs earlier than in many other types of polyneuropathy.

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Section: Discussionsupporting

confidence: 67%

Microneurographic findings in diabetic polyneuropathy with special reference to sympathetic nerve activity

Fagius

1982

Diabetologia

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“…The natural history of diabetic autonomic neuropathy is of slow progression. CRR test results are abnormal in a high percentage of patients with symptoms of autonomic dysfunction but also in those who deny symptoms Canal et al 1978;Pfeifer et al 1984;Watkins and Mackay 1980). Once abnormal, CRR function remains so, often deteriorating with time (Ewing et al 1985;Watkins and Mackay 1980), as also shown in this study.…”

Section: Influence Of Pancreas Transplantation On Survival Discussionsupporting

confidence: 53%

“…Cardiorespiratory reflex (CRR) tests can detect abnormal cardiovascular function in as many as 75% of diabetic subjects (Hilsted and Jensen 1979;Dyberg et al 1981;Ewing et al 1985;Low et al 1986;Zola et al 1986;Kennedy et al 1989), often at the time diabetes is first diagnosed (Canal et al 1978;Pfeifer et al 1984), even though 27% or fewer have symptoms of autonomic dysfunction Canal et al 1978;Young et al 1983). Moreover, abnormalities on CRR testing are generally considered to be associated with an increased frequency of sudden death (Page and Watkins 1978) and an increased mortality rate (Ewing et al 1976;.…”

Section: Introductionmentioning

confidence: 99%

Autonomic neuropathy and survival in diabetes mellitus: effects of pancreas transplantation

1991

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Summary. Cardiorespiratory reflexes were studied during slow breathing and a Valsalva maneuver in 232 Type 1 (insulin-dependent) diabetic subjects. At 1 to 7 years follow-up, death occurred in 23.4% of 175 patients with abnormal reflexes and in 3.5% of 57 patients with normal reflexes. The mortality rates of diabetic subjects with abnormal reflexes were 17% at 2.5 years, 33% at 5 years and 40% at 7 years, significantly higher than for patients with normal reflexes (4.6%, 4.6% and 13.8%). Among patients with abnormal reflexes, patients with a functioning pancreas transplantation had better survival rates than patients with a failed transplantation, and in long-term follow-up better than patients without transplantation. A functioning transplantation prevented the progressive decline of cardiorespiratory reflex function that occurred over time in control patients.

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“…Postural hypotension was defined as a fall in systolic blood pressure of 20 mmHg or more 5 min after standing [7,25]. Furthermore, electroneurography, which included studies of motor and sensory nerve conduction velocity and electromyography, was carried out by the method of Buchtal et al [2,3,7], to ascertain the presence of somatic neuropathy. The clinical data for the diabetic patients with neuropathy are given in Table 1.…”

Section: Methodsmentioning

confidence: 99%

Plasma adrenaline and noradrenaline concentrations in diabetic patients with and without autonomic neuropathy at rest and during sympathetic stimulation

Caviezel

Picotti

Margonato³

et al. 1982

Diabetologia

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Summary. Plasma concentrations of adrenaline and noradrenaline were measured radio-enzymatically in nine patients with diabetic autonomic neuropathy, seven diabetic patients without autonomic neuropathy and nine normal subjects, in the recumbent position and after standing. Furthermore, in six patients with autonomic neuropathy and in the normal subjects, plasma noradrenaline and adrenaline concentrations were determined during and after cyclo-ergometer exercise. No differences in plasma adrenaline concentrations were found at any time in the study. Basal plasma noradrenaline levels were significantly lower in diabetic patients with autonomic neuropathy than in the non-neuropathic diabetics or healthy control subjects. After standing, plasma noradrenaline rose to significantly higher levels in both control and diabetic subjects without neuropathy than in the patients with autonomic neuropathy. During exercise (up to 100 W load), plasma noradrenaline rose to similar levels in healthy controls and in patients with diabetic neuropathy. These data indicate that in diabetic autonomic neuropathy there is reduced peripheral neurosympathetic tone at rest but a normal response to moderate exercise. Blunted neurosympathetic responses to standing seem to be a consistent feature of diabetic autonomic neuropathy, particularly in those patients with severe postural hypotension.Key words: Plasma catecholamines, adrenaline, noradrenaline, sympathetic nervous activity, diabetes mellitus, autonomic neuropathy, postural stimulation, orthostatic hypotension, muscular exercise.Autonomic neuropathy in diabetes mellitus produces a variety of different symptoms and signs due to variable involvement of the sympathetic and parasympathetic branches of the autonomic nervous system [6,14,16].Plasma catecholamine levels have been investigated in only a few studies in recent years, as a possible humoral index of sympathetic function in complicated or uncomplicated diabetes. While the results obtained from these studies indicate that plasma catecholamine levels in uncomplicated diabetes are normal, the frequency of sympathetic deficiency, as reflected by subnormal plasma noradrenaline concentrations, in diabetic autonomic neuropathy and its possible importance in relation to symptoms, such as postural hypotension, is less clear [1,9,10,12,19]. This uncertainty could be due, at least in part, to difficulties in the accurate measurement of catecholamine responses and also in the characterization of diabetic autonomic neuropathic syndromes.The present investigation was aimed at evaluating peripheral sympathetic function and reactivity to appropriate stimuli, such as standing and muscular exercise, in diabetic patients with autonomic neuropathy, compared with diabetics without neuropathy and normal subjects. For this purpose, the presence of diabetic autonomic neuropathy was ascertained from a series of clinical and instrumental evaluations. Plasma adrenaline and noradrenaline concentrations, measured by a sensitive and specific radio-enzymatic me...

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The Relationship Between Peripheral and Autonomic Neuropathy in Insulin Dependent Diabetes: A Clinical and Instrumental Evaluation

Cited by 25 publications

References 11 publications

Microneurographic findings in diabetic polyneuropathy with special reference to sympathetic nerve activity

Microneurographic findings in diabetic polyneuropathy with special reference to sympathetic nerve activity

Autonomic neuropathy and survival in diabetes mellitus: effects of pancreas transplantation

Plasma adrenaline and noradrenaline concentrations in diabetic patients with and without autonomic neuropathy at rest and during sympathetic stimulation

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