In order to confirm or refute the previously held view that electrocardiographic (ECG) abnormalities are frequent in diabetic ketoacidosis, we have undertaken continuous ECG monitoring for 24 h, with subsequent computer analysis, in 14 diabetic patients admitted with severe ketoacidosis. There was a steady fall in heart rate during the 24-h except in 3 severely dehydrated patients. Depression of the ST-segment was minimal and ST-segment height correlated significantly with heart rate, whereas no consistent relationship was found between T-wave amplitude and either heart rate or plasma potassium. Two patients developed short periods of supraventricular ectopic beats. Although ECG monitoring has been claimed to be a useful aid in the management of diabetic ketoacidosis, this study clearly demonstrates that significant ECG changes are rare and ECG monitoring thereafter adds little to careful clinical observation and regular biochemical assessment.

Adolescent↗

PubMedDate not supplied

Painful myocardial infarction in severe diabetic autonomic neuropathy.

Two cases are reported of painful myocardial infarction in diabetics with severe autonomic neuropathy confirmed by abnormal autonomic function tests. Painless myocardial infarction in diabetics has traditionally been attributed to damage of cardiac pain fibres by autonomic neuropathy but other factors such as microangiopathy in the myocardium may be responsible. It may simply be that diabetics come into hospital more often for other reasons and a silent myocardial infarction diagnosed incidentally.

Adult↗

PubMedDate not supplied

Testing for heart rate variation in diabetes: single or repeated deep breaths?

Heart rate variation during three periods of single deep breaths and three periods of repeated deep breathing at 6 breaths/min was compared in 14 normal and 40 diabetic subjects. There were no differences between the two methods in either normals or diabetics, but the coefficient of variation was significantly smaller using the repeated deep breaths method. When the 6 periods of breathing were analysed separately, no 'training' effect could be detected. The first breath of the repeated deep breaths consistently produced the largest heart rate variation in 29% of the normals and 17% of the diabetics. We conclude that there is no advantage in using the single deep breath method to assess cardiac parasympathetic function in diabetics over the currently used 6 repeated deep breaths/min.

Adolescent↗

PubMedDate not supplied

Unawareness of hypoglycaemia in insulin-treated diabetic patients: prevalence and relationship to autonomic neuropathy.

Three-hundred and two insulin-treated diabetic patients were questioned about hypoglycaemia using a structured questionnaire interview. Two-hundred and twenty-six patients (75%) had normal symptomatic awareness, 48 (16%) had partial awareness, 21 (7%) had absent awareness of hypoglycaemia, and 7 (2%) denied ever experiencing hypoglycaemia. Patients with complete loss of awareness of hypoglycaemia had diabetes of longer duration; none had a HbA1 concentration within the non-diabetic range. Loss of awareness of hypoglycaemia was associated with an increased incidence of severe hypoglycaemia, 19 (91%) of the patients with absent awareness, and 33 (69%) with partial awareness of hypoglycaemia experiencing severe hypoglycaemia over 1 year compared with only 41 (18%) of patients with normal awareness of hypoglycaemia (p less than 0.001). Cardiovascular autonomic function tests were performed in 226 (75% of the whole group). Of the patients who had diabetes for more than 15 years, 54% (n = 39) with normal awareness of hypoglycaemia, compared with 59% (n = 10) with absent awareness of hypoglycaemia, had evidence of cardiovascular autonomic impairment (NS). Seven (41%) of the 17 patients with absent awareness of hypoglycaemia and diabetes of greater than 15 years duration had no evidence of autonomic dysfunction. Loss of hypoglycaemia awareness is a common problem in patients with insulin-treated diabetes of long duration, is associated with an increased incidence of severe hypoglycaemia, but is not invariably associated with abnormal cardiovascular autonomic function tests.

Adolescent↗

PubMedDate not supplied

Provocation of postural hypotension by nitroglycerin in diabetic autonomic neuropathy?

The effect of nitroglycerin on heart rate and systolic blood pressure was compared in 5 normal subjects, 12 diabetic subjects without autonomic neuropathy, and 5 diabetic subjects with autonomic neuropathy. The magnitude and time course of the increase in heart rate and the decrease in systolic blood pressure after nitroglycerin were similar in the normal and diabetic subjects without autonomic neuropathy, whereas a lesser increase in heart rate and a greater decrease in systolic blood pressure occurred in the diabetic subjects with autonomic neuropathy. It is therefore suggested that caution should be exercised when prescribing vasodilator drugs in diabetic patients, particularly those with autonomic neuropathy.

Adolescent↗

PubMedDate not supplied

Small muscle wasting of the hands in diabetes mellitus.

The clinical features and peripheral somatic and autonomic nerve function were studied in 10 diabetic subjects (nine men, one woman; mean age 59 yr, range 41-68 yr; mean duration of diabetes 20 yr, range 8 mo to 33 yr) with generalized small muscle wasting of the hands. Five patients were insulin-dependent and five non-insulin-dependent. Nine had retinopathy (two proliferative, seven background), five nephropathy, two ischemic heart disease, and seven peripheral vascular disease. Nine patients had clinical evidence of sensory peripheral neuropathy and absent reflexes in the lower limbs. Eight patients had distal sensory impairment and/or absent reflexes in the upper limbs. Seven had two or more symptoms of autonomic neuropathy. Nerve conduction measurements in the median, ulnar, and lateral popliteal nerves showed that all patients had moderate to severe polyneuropathy affecting both motor and sensory fibers. Nine had one or more abnormal cardiovascular autonomic function tests. Electromyography of affected muscles in the hands showed changes of chronic partial denervation and collateral reinnervation in all cases.

Adult↗

PubMedDate not supplied

Decreased skin wrinkling in diabetes mellitus.

Skin wrinkling, which may be dependent on peripheral autonomic innervation, was assessed in 100 normal and 42 diabetic subjects using a temperature-controlled water bath with immersion of the hands for 30 min. Markedly decreased skin wrinkling was observed in diabetic subjects and in manual workers, but did not correlate with cardiovascular tests of autonomic function, control, type or duration of diabetes, or diabetic complications. The cause of decreased skin wrinkling in people with diabetes is unexplained.

Adult↗

PubMedDate not supplied

The value of cardiovascular autonomic function tests: 10 years experience in diabetes.

Five simple, noninvasive cardiovascular reflex tests have been used to assess autonomic function in one center over the past 10 yr. Seven hundred seventy-four diabetic subjects were tested for diagnostic and research purposes. In 543 subjects completing all five tests, abnormalities of heart rate tests occurred in 40%, while abnormal blood pressure tests occurred in less than 20%. Their results were grouped as normal (39%), early (15%), definite (18%), and severe (22%) involvement. Six percent had an atypical pattern of results. Two hundred thirty-seven diabetic subjects had the tests repeated greater than or equal to 3 mo apart: 26% worsened, 71% were unchanged, and only 3% improved. The worsening followed a sequential pattern with first heart rate and later additional blood pressure abnormalities. Comparison between a single test (heart rate response to deep breathing) and the full battery in 360 subjects showed that one test alone does not distinguish the degree or severity of autonomic damage. These tests provide a useful framework to assess autonomic neuropathy simply, quickly, and noninvasively.

Adolescent↗

PubMedDate not supplied

Effects of sorbinil treatment on erythrocytes and platelets of persons with diabetes.

Thirty-three diabetic subjects were given the aldose reductase inhibitor sorbinil (Pfizer, UK) for 3 wk. There was a significant fall in mean erythrocyte sorbitol concentration over this period. In all subjects erythrocyte sorbitol concentrations after treatment were within or below the range found in normal subjects. No changes in erythrocyte 2,3-diphosphoglycerate (2,3-DPG) or myo-inositol concentrations, plasma beta-thromboglobulin (beta-TG) concentration, or P50--a measure of the oxygen affinity of hemoglobin--were observed. There was a high incidence of adverse reactions to the drug.

Adult↗

PubMedDate not supplied

Bacteriuria and autonomic nerve function in diabetic women.

Significant bacteriuria (viable count greater than or equal to 10(5)/ml) was found on single testing in 10% of 400 consecutive diabetic women aged 15-65 yr routinely attending a diabetic clinic. Twenty patients with and 21 without significant bacteriuria were then randomly selected for measurement of cardiovascular autonomic reflexes, bladder ultrasound, and mictiography. There were no significant differences between these two groups in age, duration and type of diabetes, glycosylated hemoglobin, blood urea, and creatinine. Abnormalities of cardiovascular autonomic function were more common in the bacteriuric group (P less than .01). Although the bacteriuric group voided a smaller volume of urine, none had evidence of increased residual bladder volume of urine on ultrasound. Diabetic women with cardiovascular autonomic neuropathy appear to be at increased risk of developing bacteriuria. However, age is probably the most important factor influencing the prevalence of bacteriuria in diabetic and in nondiabetic women.

Adolescent↗