Some clinical factors contributing to the development of the diabetic foot

Clinical neurological studies, blood pressure measurements and some haematological investigations were performed on a random sample of forty-four patients, at the Diabetes Out-Patient Clinic of the University Hospital of the West Indies (UHWI), to examine some of the factors that predispose to the development of the diabetic foot. Our results revealed that 86 percent of the patients had elevated glycosylated haemoglobin (HbA > 9.0 percent), 82 percent had clinical signs of peripheral sensory neuropathy. 29 percent had signs of autonomic neuropathy in addition to peripheral sensory neuropathy. Sixty-one percent (61 percent) of the patients had ankle/arm systolic blood pressure ration less than 1.0 and were diagnosed as having peripheral vascular disease (PVD). The group with neuropathy was found to have a significantly lower diastolic blood pressure (p < 0.0005) than the group without neuropathy. We believe that hyperglycaemia-induced vasodilation (indicated by a lower diastolic blood pressure) in a significant number of diabetics resulted in compensatory shunting of blood from the deeper tissues, including nerves, to periphery. The resulting endoneural hypoxia could be responsible for the unusually high incidence of peripheral sensory neuropathy detected in this sample of diabetic patients. Metabolic factors may also play a role.(AU)

Causes of erectile impotence in type II diabetic men - abstract

About 40 per cent of diabetic males have erectile impotence. Is this vascular, neuropathic or endocrine in aetiology? Ten, Type II diabetic males with sexual dysfunction and no known neurological abnormalities were studied prospectively. Clinical results: Peripheral neuropathy symptoms and/or signs - 3. Autonomic neuropathy symptoms - 3. Orthostatic hypotension - 0. Peripheral vascular disease signs - 1. Investigative results: Peripheral vascular disease - 1. Penile-brachial blood pressure ratios abnormal - 2. Elevated prolactin levels - 0. Nerve conduction abnormalities - 3. Tests of autonomic nervous system function: Heart rate abnormalities on lying-standing and deep breathing - 5. Sympathetic skin responses absent in 7 (5 of which had the abnormal heart rates). Impotence in Type II diabetic males is infrequently associated with symptoms and signs of dysautonomia and polyneuropathy. Evidence of peripheral vascular disease is also infrequent. Penile brachial blood pressure ratios showed 2 out of 10 patients to have impaired penile arterial circulation. Autonomic testing showed neuropathy in 7 of 10 patients. Thus it is likely that the predominant cause of erectile impotence is autonomic neuropathy, but this requires specialized testing for its detection (AU)

Test for autonomic function to establish the norm: a useful tool for evaluation in various clinical disorders

Little information is available regarding the responses of the Jamaican population to the Valsalva manoevre (VM), a test to investigate the integrity of the autonomic nervous system (ANS). This study is aimed at investigating the cardiac autonomic control in the Jamaican population, to explore the range of responses and to establish the norm. Such an explorative investigation provides an important tool to uncover autonomic dysfunction in psychosomatic, cardiopulmonary, metabolic and neural disorders. Fifty male and fifty female Jamaicans, who were apparently healthy and did not indulge in any drug use and smoking, are asked to perform the VM in a semirecumbent position. A tachograph (Grass model) and standard electrocardiographic leads are used for the graphic presentation of the subjects' beat-to-beat heart rate changes. The Valsalva ratio (VR) is calculated by dividing maximum tachycardia and maximum bradycardia during the VM. The mean VR for the female (2.41ñ0.18) is greater than that for the male (1.63ñ0.27) (p<0.001). Female subjects exhibit a higher basal heart rate (88+6 as against 77ñ7 in the male) and a greater magnitude of bradycardia (33 as against 4 in the male). The values for VR are above the minimum of 1.5 proposed in the literature. Relative roles of the sympathetic and parasympathetic nervous systems may differ in the male and female subjects, thus accounting for a higher VR in the female. This test is simple, safe, noninvasive and reproducible and is useful to detect the abnormal autonomic function in various conditions, including states of pregnancy and stress (AU)