Summary
We have investigated the relationship between vagal and sympathetic lesions in 62 diabetic patients and compared the results with those from 37 healthy subjects. Vagal function was assessed by heart rate changes with forced breathing. Sympathetic control was measured by the heart rate and blood pressure changes after standing and the concomitant plasma catecholamine response. The integrity of the postganglionic sympathetic neuron was evaluated separately by testing sudomotor function. Impaired sympathetic control was found only in 15 diabetic patients with severely impaired or absent vagal heart rate control. In 12 patients the chief abnormalities consisted of a delayed and diminished heart rate increase, an excessive fall in systolic blood pressure (> 20 mmHg) in combination with an abnormally small noradrenaline increment (<120 ng/l) and a lesion of the postganglionic sympathetic neuron. Three patients with severely impaired parasympathetic heart rate control in combination with an intact postganglionic sympathetic neuron demonstrated a large noradrenaline increase on standing (> 700 ng/l). Measurement of vagal heart rate control and testing of sudomotor function makes it possible to classify a spectrum of abnormal cardiovascular responses to standing in diabetic patients.
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Mackay JD, Page MMcB, Cambridge J, Watkins PJ (1980) Diabetic autonomic neuropathy: the diagnostic value of heart rate monitoring. Diabetologia 18: 471–478
Wieling W, Brederode JFM van, Rijk LG de, Borst C, Dunning AJ (1982) Reflex control of heart rate in normal subjects in relation to age: a data base for cardiac vagal neuropathy. Diabetologia 22: 163–166
Borst C, Wieling W, Brederode JFM van, Hond A, Rijk LG de, Dunning AJ (1982) Mechanisms of initial heart rate response to postural change. Am J Physiol 243 (Heart Circ Physiol 12): H676-H681
Brederode JFM van, Wieling W, Borst C (1980) The immediate heart rate response to passive and active changes of posture in diabetic and non-diabetic subjects. Diabetologia 19: 321–322
Ewing DJ, Hume L, Campbell JW, Murray A, Neilson JMM, Clarke BF (1980) Autonomic mechanisms in the initial heart rate response to standing. J Appl Physiol 49: 809–814
Hilsted J, Parving HH, Christensen NJ, Benn J, Galbo H (1981) Hemodynamics in diabetic orthostatic hypotension. J Clin Invest 68: 1427–1434
Christensen NJ (1979) Catecholamines and diabetes mellitus. Diabetologia 16: 211–224
Cryer PE, Silverberg AB, Santiago JV, Shah SD (1978) Plasma catecholamines in diabetes: the syndromes of hypoadreneric and hyperadrenergic postural hypotension. Am J Med 64: 407–416
Tohmeh JF, Shah SD, Cryer PE (1979). The pathogenesis of hyperadrenergic postural hypotension in diabetic patients. Am J Med 67: 772–778
Leveston SA, Shah SD, Cryer PE (1979) Cholinergic stimulation of norepinephrine release in man: evidence of a sympathetic postganglionic axonal lesion in diabetic adrenergic neuropathy. J Clin Invest 64: 374–380
Gustafson AB, Kalkhoff RK (1981) Plasma epinephrine disturbances in diabetic subjects during standing and after isometric exercise. J Clin Endocrinol Metab 53: 759–763
Johnson RH, Spalding JMK (1974) Disorders of the autonomic nervous system. Blackwell Scientific Publications, Oxford, pp 53, 182
Barany FR, Cooper EH (1956) Pilomotor and sudomotor innervation in diabetes. Clin Sci 15: 533–540
Page MMcB, Watkins PJ (1978) Cardiorespiratory arrest and diabetic autonomic neuropathy. Lancet 1: 14–16
Endert E (1979) Determination of noradrenaline and adrenaline in plasma by radioenzymatic assay using high pressure liquid chromatography for the separation of the radiochemical products. Clin Chim Acta 96: 233–239
Banauch D, Brummer W, Ebeling W, Metz H, Rindfrey H, Lang H (1975) Eine glucose-dehydrogenase fur die glucose bestimmung in korperflussigkeiten. Z Klin Chem Klin Biochem 13: 101–107
Schellekens APM, Sanders GTB, Thorton W, Groenestein T van (1981) Sources of variation in the column-chromatographic determination of glycohemoglobin (HbA1). Clin Chem 27: 94–99
Kendall MG, Stuart MA (1961) The advanced theory of statistics II, Griffin, London, pp 503–506
Nie NH, Hull CH, Jenkins JG, Steinbrenner K, Bent DH (1979) Statistical package for the social sciences update manual, McGraw-Hill, New York, pp 45–65
Marin Neto JA, Gallo L, Manco JC, Rassi A, Amorim DS (1980) Mechanisms of tachycardia on standing: studies in normal individuals and in chronic Chagas heart patients. Cardiovasc Res 14: 541–550
Levy MN, Martin PJ (1979) Neural control of the heart. In: Berne RM, Sperelakis N, Geiger SR (eds) Handbook of physiology, section 2. American Physiological Society, Bethesda, pp 586–587
Borst C, Karemaker JM, Dunning AJ (1982) Prolongation of atrioventricular conduction time by electrical stimulation of the carotid sinus nerve in man. Circulation 65: 432–434
Hilsted (1979) Decreased sympathetic vasomotor tone in diabetic orthostatic hypotension. Diabetes 28: 970–973
Lilavivathana U, Campbell RG (1980) The influence of sodium restriction on orthostatic sympathetic nervous activity. Arch Intern Med 140: 1485–1489
Rosen SG, Cryer PE (1982) Postural tachycardia syndrome. Reversal of sympathetic hyperresponsiveness and clinical improvement during sodium loading. Am J Med 72: 847–850
Robertson D, Johnson GA, Robertson RM, Nies SA, Shand DG, Oates JA (1979) Comparative assessment of stimuli that release neuronal and adrenomedullary catecholamines in man. Circulation 59: 637–643
Hilsted J, Madsbad S, Krarup T, Sestoft L, Christensen NJ, Tronier B, Galbo H (1981) Hormonal, metabolic, and cardiovascular responses to hypoglycemia in diabetic autonomic neuropathy. Diabetes 30: 626–633
Mackay JD, Hayakawa H, Watkins PJ (1978) Cardiovascular effects of insulin: plasma volume changes in diabetics. Diabetologia 15: 453–457
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Wieling, W., Borst, C., van Dongen Torman, M.A. et al. Relationship between impaired parasympathetic and sympathetic cardiovascular control in diabetes mellitus. Diabetologia 24, 422–427 (1983). https://doi.org/10.1007/BF00257340
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DOI: https://doi.org/10.1007/BF00257340