Diabetologia

, Volume 20, Issue 4, pp 475–481 | Cite as

Acute, reversible autonomic nervous system abnormalities in juvenile insulin-dependent diabetes

A pupillographic study
  • Á. B. Hreidarsson
Originals

Summary

Autonomic nervous function was studied by infrared TV-pupillography in nine insulin-dependent diabetic subjects with 0 to 3 years duration of diabetes, during poor and good metabolic control. During poor control there was no change in the latency time, the maximal contraction velocity or the amplitude of the light response, whereas the redilatation time was prolonged by 28%, from 2.26±0.27 to 2.90±0.58s (mean±SD) (2p=0.012). The pupil size after adaptation to darkness was unchanged, but the light induced pupillary unrest was reduced by 35% from 1.68±0.62 to 1.10±0.36 mm2 (2p=0.0037), and the degree of miosis in continuous illumination was reduced by 47% from 0.32±0.13 to 0.17±0.08 (2p=0.0011), during metabolic derangement. The study has thus demonstrated reversible changes in autonomic nervous function, which are related to the diabetic metabolic state and thereby analogous to the previously well established reversible functional changes in the somatic nervous system in early diabetes.

Key words

Autonomic nervous system reversible nervous abnormalities insulin-dependent diabetes diabetic neuropathy pupil pupillography 

References

  1. 1.
    Alberti KGMM, Christensen NJ, Iversen J, Ørskov H (1975) Role of glucagon and other hormones in development of diabetic ketoacidosis. Lancet I: 1307–1311Google Scholar
  2. 2.
    Campbell IW, Ewing DJ, Harrower ABD, Neilson JMM, Fraser DM, Baldwa VS, Murray A, Clarke BF (1976) Peripheral and autonomic nerve function in diabetic ketoacidosis. Lancet II: 167–169Google Scholar
  3. 3.
    Christensen NJ (1967) Notes on the glucose oxidase method. Scand J Clin Lab Invest 19: 379–384Google Scholar
  4. 4.
    Christensen NJ (1969) Spontaneous variations in resting blood flow, post-ischaemic peak flow and vibratory perception in the feet of diabetics. Diabetologia 5: 171–178Google Scholar
  5. 5.
    Christensen NJ (1979) Catecholamines and diabetes mellitus. Diabetologia 16: 211–224Google Scholar
  6. 6.
    Ellis CJK (1979) The afferent pupillary defect in acute optic neuritis. J Neurol Neurosurg Psychiatry 42: 1008–1017Google Scholar
  7. 7.
    Fraser DM, Campbell IW, Ewing DJ, Murray A, Neilson JMM, Clarke BF (1977) Peripheral and autonomic nerve function in newly diagnosed diabetes mellitus. Diabetes 26: 546–550Google Scholar
  8. 8.
    Gregersen G (1967) Diabetic neuropathy: Influence of age, sex, metabolic control and duration of diabetes on motor conduction velocity. Neurology (Minneap) 17: 972–980Google Scholar
  9. 9.
    Gregersen G (1968) Variations in motor conduction velocity produced by acute changes of the metabolic state in diabetic patients. Diabetologia 4: 273–277Google Scholar
  10. 10.
    Gundersen HJG (1974) An abnormality of the central autonomic nervous system in long-term diabetes: absence of hippus. Diabetologia 10: 366Google Scholar
  11. 11.
    Gundersen HJG (1976) A new photostimulator and videopupillograph for quantitative neuroophthalmological studies. Ophthalmologica 172: 62–68Google Scholar
  12. 12.
    Gundersen HJG (1976) Nervous and muscular dynamics of the pupil in long-term diabetics. In: Bajaj JS (ed) Current topics in diabetes research (abstracts), IX Congress of the International Diabetes Federation. Excerpta Med Int Congr Series 413: 131Google Scholar
  13. 13.
    Gundersen HJG, Neubauer B (1977) A long-term diabetic autonomic nervous abnormality. Reduced variations in resting heart rate measured by a simple and sensitive method. Diabetologia 13: 137–140Google Scholar
  14. 14.
    Hreidarsson AB (1979) Pupil motility in long-term diabetes. Diabetologia 17: 145–150Google Scholar
  15. 15.
    Jakobsen J (1978) Peripheral nerves in early experimental diabetes. Expansion of the endoneurial space as a cause of increased water content. Diabetologia 14: 113–119Google Scholar
  16. 16.
    Jakobsen J (1979) Early and preventible changes of peripheral nerve structure and function in insulin-deficient diabetic rats. J Neurol Neurosurg Psychiatry 42: 509–518PubMedGoogle Scholar
  17. 17.
    Jordan WR (1936) Neuritic manifestations in diabetes mellitus. Arch Intern Med 57: 307–366Google Scholar
  18. 18.
    Levatin P (1959) Pupillary escape in disease of the retina or optic nerve. Arch Ophthalmol 62: 768–779PubMedGoogle Scholar
  19. 19.
    Lloyd B, Burrin J, Smythe P, Alberti KGMM (1978) Enzymic fluorometric continuous-flow assays for blood glucose, lactate, pyruvate, alanine, glycerol, and 3-hydroxybutyrate. Clin Chem 24: 1724–1729Google Scholar
  20. 20.
    Lowenstein O, Loewenfeld I (1969) The pupil. In: Davson H (ed) The eye, vol III. Academic Press, New York, p 231–267Google Scholar
  21. 21.
    Lundbæk K (1968) Factors controlling blood glucose — with remarks on the effect of insulin on muscle. Proc R Soc Med 61: 807–811Google Scholar
  22. 22.
    Martin MM (1953) Diabetic neuropathy. A clinical study of 150 cases. Brain 76: 594–624Google Scholar
  23. 23.
    Müller-Jensen A, Zschocke S (1979) Possibilities of simultaneous analysis of phasic pupillary light reflex and visually evoked potentials. Electroencephalogr Clin Neurophysiol 47: 239–242Google Scholar
  24. 24.
    Page M, Watkins PJ (1976) Autonomic dysfunction in diabetic ketoacidosis. Lancet I: 963Google Scholar
  25. 25.
    Rundles RW (1945) Diabetic neuropathy. General review with report of 125 cases. Medicine (Baltimore) 24: 111–160Google Scholar
  26. 26.
    Sidenius P, Jakobsen J (1979) Axonal transport in early experimental diabetes. Brain Res 173: 315–330Google Scholar
  27. 27.
    Skillern PG, Lockhart G (1959) Optic neuritis and uncontrolled diabetes mellitus in 14 patients. Ann Intern Med 51: 468–475Google Scholar
  28. 28.
    Smith JD, Masek GA, Ichinose LY, Watanabe T, Stark L (1970) Single neuron activity in the pupillary system. Brain Res 24: 219–234Google Scholar
  29. 29.
    Smith SE, Smith SA, Brown PM, Fox C, Sönksen PH (1978) Pupillary signs in diabetic autonomic neuropathy. Br Med J II: 924–927Google Scholar
  30. 30.
    Stark L (1968) Neurological control systems. Studies in bioengineering. Plenum Press, New York, p 111–159Google Scholar
  31. 31.
    Steiness I (1961) Influence of diabetic status on vibratory perception during ischaemia. Acta Med Scand 170: 319–338Google Scholar
  32. 32.
    Steiness I (1957) Vibratory perception in diabetics. Acta Med Scand 158: 327–335Google Scholar
  33. 33.
    Terkildsen AB, Christensen NJ (1971) Reversible nervous abnormalities in juvenile diabetics with recently diagnosed diabetes. Diabetologia 7: 113–117Google Scholar
  34. 34.
    Ward JD, Barnes CG, Fisher DJ, Jessop JD, Baker RWR (1971) Improvement in nerve conduction following treatment in newly diagnosed diabetics. Lancet I: 428–431Google Scholar
  35. 35.
    Wheeler T, Watkins PJ (1973) Cardiac denervation in diabetes. Br Med J IV: 584–586Google Scholar
  36. 36.
    Yoss RE, Moyer NJ, Hollenhorst RW (1970) Pupil size and spontaneous pupillary waves associated with alertness, drowsiness, and sleep. Neurology (Minneap) 20: 545–554Google Scholar

Copyright information

© Springer-Verlag 1981

Authors and Affiliations

  • Á. B. Hreidarsson
    • 1
  1. 1.Second University Clinic of Internal MedicineKommunehospitaletDenmark

Personalised recommendations