John Cassella⁽¹⁾, Joseph Kelly^(2)
(1)(2)School of Radiography & Podiatry. University of Central England - Birmingham. United Kingdom

	[Physiology]	[Neurology]	[Nutrition & Diabetics]

INTRODUCTION

• many aspects of the normal response of the foot to injury are reduced or absent in diabetes.

• diabetic neuropathy is thought to have a direct effect on the functioning of the microcirculation

• endothelial cell and smooth muscle integrity in arterioles combined with neuropathic changes have been proposed as a mechanism involved in the pathogenesis of foot ulceration

Aims:

• to study the involvement of peripheral sensory neuropathy in endothelial dependent and endothelial independent vasodilation

• to assess the maximum hyperaemic response to neurogenic stimuli induced by iontophoresis in patients with symmetrical peripheral sensory diabetic neuropathy

• the hypothesis is

– patients with peripheral sensory diabetic neuropathy demonstrate s reduced hyperaemic endothelium dependent and independent vasodilatory response to stimuli

MATERIAL & METHODS

• iontophoresis device (figure 1) for transdermal induction of

– 1% acetylcholine ACh (endothelial dependent response)

– 1% sodium nitroprusside NaNP (non-neurogenic endothelial independent response)

• laser Doppler

– to measure the mean number of red blood cells in an area of the microcirculation of the left hallux

• 18 age/sex matched subjects

– 6 non-insulin dependent diabetics with diabetic neuropathy

– 6 NIDDM subjects without neuropathy

– 6 non diabetic controls

RESULTS

• laser Doppler employs arbitrary units

• the data (figure 2) shows that

– normal subjects had a positive long lasting vasodilatory response to ACh and NaNP

– NIDDM with neuropathy had a greatly reduced baseline to peak blood flow response

DISCUSSION

• baseline to peak flow readings for microcirculation of the left hallux are reduced in diabetic neuropaths in response to both acetylcholine and sodium nitroprusside

– both

• endothelial dependent (axon reflex) vasodilation

• non neurogenic endothelial independent vasodilation

responses are affected by NIDDM neuropathy

BIBLIOGRAPHY

Discussion Board

Any Comment to this presentation?

[ABSTRACT] [INTRODUCTION] [MATERIAL & METHODS] [RESULTS] [IMAGES] [DISCUSSION] [BIBLIOGRAPHY] [Discussion Board]

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	[Physiology]	[Neurology]	[Nutrition & Diabetics]

John Cassella, Joseph Kelly
Copyright © 1999-2000. All rights reserved.

Last update: 6/01/00