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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Nausea, vomiting, chronic abdominal pain, and constipation developed in three children with insulin-dependent diabetes mellitus beginning 1 to 7 years after the onset of diabetes. All three had considerable difficulty in achieving satisfactory glycemic control. All had delayed gastric emptying of solids and postprandial antral hypomotility. Diabetic autonomic neuropathy must be considered in the differential diagnosis of gastrointestinal symptoms even in the young diabetic patient.
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PMID:Diabetic gastroparesis due to postprandial antral hypomotility in childhood. 161 77

Diabetic autonomic neuropathy (DAN) has been shown to confer a high risk of mortality. The association between DAN and cardiovascular risk factors was examined in a well-defined cohort of 25- to 34-year-old insulin-dependent diabetes mellitus subjects (n = 168) with and without DAN as evaluated by heart rate response to deep breathing, standing, and the Valsalva maneuver. The autonomic tests were performed using both an office-based procedure and a method employed by the Diabetes Control and Complications Trial with analyses performed by the Diabetes Research and Analysis Association, Lexington, Ky. Good agreement was found between the procedures for the assessment modalities of heart rate response to deep breathing. Modeling potential correlates in logistic analyses, where heart rate response to deep breathing was the dependent variable, revealed hypertension status, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and gender (female) to be independent determinants of DAN. These results suggest that traditional cardiovascular risk factors are important correlates of DAN and may relate to both its cause and poor prognosis. Since these results are from a cross-sectional study, prospective follow-up of this cohort will be needed for confirmation.
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PMID:Diabetic autonomic neuropathy and cardiovascular risk. Pittsburgh Epidemiology of Diabetes Complications Study III. 235 55

This study examined the effect of autonomic neuropathy on hearing in diabetes mellitus. Twelve diabetics with autonomic neuropathy and eleven healthy controls were examined for hearing loss using standard audiological tests. Several subjects in both groups had some abnormal hearing tests, but the incidence was no greater in the diabetic group. No group trends were apparent. Diabetic autonomic neuropathy is unlikely to be associated with hearing deficits.
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PMID:Does autonomic neuropathy in diabetes cause hearing deficits? 276 91

Diabetic autonomic neuropathy, the most common of all the complications associated with diabetes mellitus, is manifested as cardiovascular or gastrointestinal denervation, counterregulatory hormone dysfunction, and genitourinary tract denervation. Its treatment at this time is largely palliative, although there is some indication that control of hyperglycemia, hypertension, and obesity may prevent or delay its development. Both counseling and pharmaceutical approaches are essential to permit the afflicted diabetic patient a reasonably good quality of life.
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PMID:Coping with autonomic neuropathy. 297 62

Autonomic neuropathy is now well established as a relatively common and significant complication of diabetes mellitus. Its importance has been clarified in recent years during which the extent of autonomic control over all areas of body function has been defined. Using simple cardiovascular reflex tests, autonomic abnormalities can be demonstrated without any corresponding symptoms. The often stated concept of 'patchy' involvement in diabetic autonomic neuropathy should now be rejected as too should the view that autonomic neuropathy is either 'present' or 'absent' based on a single test result. When generalized and predominantly metabolic disturbances, as in diabetes, give rise to impaired nerve function, autonomic as well as somatic components of the nerve are affected. Where damage is severe this leads to the characteristic florid picture of symptomatic autonomic neuropathy with its particularly poor prognosis. For the physician in a busy clinic, much of the theoretical and experimental basis for autonomic neuropathy may not appear of direct relevance. However, he has now to be aware of the clinical implications of autonomic damage in the diabetic. This may have particular relevance in the care of the diabetic foot (see Chapter 10), the recognition of many of the vague symptoms associated with autonomic damage, the treatment of disabling features such as postural dizziness and nocturnal diarrhoea, and an awareness of the poor prognosis associated with symptomatic autonomic neuropathy. He will also need to be alert to the dangers of general anaesthesia in such patients, and the possibility of sudden unexpected deaths. Diabetic autonomic neuropathy causes widespread abnormalities, some of which are clinically apparent, some of which can be detected by sensitive tests, and others which have yet to be discovered. Inclusion of the neuropeptides and other hormones within the compass of autonomic control has opened up a whole new area of investigative interest, with many complex interrelationships which still need to be unravelled. This should lead to better understanding of the pathophysiological processes that cause damage to diabetic nerves. With so much research effort directed towards better glycaemic control and aldose reductase inhibitors (see Chapter 8), it may eventually be possible to reverse or prevent this potentially disabling and lethal complication of diabetes.
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PMID:Autonomic neuropathy: its diagnosis and prognosis. 353 3

Rats with chronic streptozotocin (SZ) diabetes develop dilatation of the alimentary tract, loss of fecal consistency, and autonomic neuropathy involving unmyelinated axons of the extrinsic innervation of the small bowel. Diabetic autonomic neuropathy involving the ileal mesenteric nerves is characterized by modest to marked dilatation of axons by distinctive subcellular organelles identical to those described in experimental and clinical axonal dystrophies. Axonopathy is confined to the alimentary tract; examination of myelinated and unmyelinated axons of the sciatic (midthigh level) and distal somatic nerves of the tail of diabetic animals with prominent ileal axonopathy failed to demonstrate significant numbers of dystrophic axons. The prevention or reversal of diabetic autonomic neuropathy by a variety of experimental manipulations clearly indicates that the lesions we have demonstrated in chronically SZ-induced diabetic animals were produced by diabetes and were not the result of a direct neurotoxic effect of the diabetogenic agent streptozotocin. Animals did not develop axonopathy after simultaneous administration of SZ and nicotinamide, a procedure which prevents pancreatic beta-cell necrosis and induction of diabetes while exposing the nervous system to a possible neurotoxic agent. Selected animals that were given SZ, became diabetic, and subsequently received daily insulin therapy or pancreatic islet transplantation also did not develop axonopathy. Transplantation of pancreatic islets 6 mo after induction of diabetes, a time at which mesenteric axonopathy was well developed, quickly reestablished normoglycemia, and within 3 mo resulted in nearly complete resolution of the neuropathy. Mild chronic diabetes maintained for 5-6 mo failed to produce significant levels of axonopathy.(ABSTRACT TRUNCATED AT 250 WORDS)
Diabetes 1983 Jun
PMID:The effect of pancreatic islet transplantation and insulin therapy on experimental diabetic autonomic neuropathy. 641 60

Diabetic autonomic neuropathy is rarely symptomatic but very frequent at a subclinical stage. Symptoms may be gastrointestinal, urinary, genital or cardiac. Sudoral, vasomotor or pupillary symptoms may also occur. Standardized cardiovascular tests are used to investigate parasympathetic and sympathetic nervous control. Because of their easy feasibility and good reproducibility they might be performed in the largest part of the diabetic population. These tests also strongly suggest that cardiac autonomic neuropathy is of poor prognosis, even when it is subclinical. Most treatments are symptomatic, but optimized diabetes control and administration of aldose reductase inhibitors are rational therapeutic measures, although their long-term effectiveness remains to be demonstrated.
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PMID:[Autonomic diabetic neuropathy]. 849 28

Painful peripheral diabetic neuropathy is a major cause of morbidity in diabetes mellitus. In addition to good glycemic control, therapeutic options include simple analgesics, the occasional use of narcotic analgesics, tricyclic antidepressants, or topically applied capsaicin cream. Other options such as carbamazepine and lidocaine have clinical drawbacks, but some investigational compounds may hold promise in the future. Diabetic autonomic neuropathy is often undiagnosed because of its diffuse organ involvement and gradual onset. Affected organ systems may include the ocular pupil, sweat glands, gastrointestinal tract, bladder, sex organs, cardiovascular system, and adrenal medullary system. Diagnosis requires the exclusion of other causes for the patient's symptoms.
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PMID:Diabetic neuropathy: therapies for peripheral and autonomic symptoms. 911 37

Diabetic autonomic neuropathy is a known complication of long-standing diabetes. The present study was designed to study the prevalence of asymptomatic prolonged gastric emptying (GE) in young patients with IDDM and its correlations with disease duration and autonomic nerve function. The study population included 40 poorly controlled patients, mean age 17.6 +/- 4.6 years, with a disease duration of 1-17.5 years, and 20 age- and sex-matched controls. Autonomic nerve functions were assessed by standard cardiovascular reflexes, and gastrointestinal (GI) symptoms were assessed by a detailed questionnaire. GE was assessed by electrical impedance tomography (EIT), at 2 hours after a standard semisolid meal. Mean half-time gastric emptying was significantly prolonged in diabetic patients, 54.80 +/- 26.63 versus 40.37 +/- 8.62 min (p < 0.05), with a higher prevalence in the first 3 years and after 10 years of disease duration. No differences were found between diabetics and controls regarding cardiovascular tests. No correlations were found between age, GI scores, cardiovascular tests, and GE. Patients with IDDM may suffer from prolonged GE. This is not always accompanied by autonomic impairments. As impaired gastric emptying may involve poor glycemic control and early satiety, patients with difficulties in metabolic control or poor caloric intake should be studied for the possibility of delayed gastric emptying.
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PMID:Gastric emptying in patients with type I diabetes mellitus. 1037 86

Diabetic autonomic neuropathy (DAN) may affect up to 30% of the diabetic population. Sometimes DAN becomes clinically manifest causing specific symptoms and signs; more often, however, DAN is responsible for subtle alterations detectable only by functional tests, as in the case of the respiratory system. At first, abnormalities both in the bronchomotor tone and aspecific airway responsiveness to different stimuli were recognised in diabetic patients with DAN, indicating a defective control of mechanisms which regulate the bronchial calibre in these subjects. Subsequently, peculiar changes in breathing pattern and greater ventilatory requirements have been observed during incremental exercise in diabetics with DAN, suggesting an altered control of breathing in stressful conditions. Alterations in either peripheral or central chemosensitivity have been repeatedly shown in these patients, with marked differences related to the severity of DAN, concerning the neuro-muscular and ventilatory responsiveness to CO2. Following anecdotal reports, respiratory disturbances during sleep have been more carefully investigated in diabetic subjects and greater prevalence of sleep apnea, mainly in the obstructive form, has been found in the presence of DAN. The underlying mechanisms of sleep disordered breathing, however, are poorly understood in DAN and further studies are needed to elucidate them.
Diabetes Nutr Metab 2000 Jun
PMID:Impairment of the respiratory system in diabetic autonomic neuropathy. 1096 93


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