Skip to main content
NCBI home page
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 1994 Jan;70(1):22–26. doi: 10.1136/adc.70.1.22

Posturally induced vasoconstriction in diabetes mellitus.

A C Shore 1, K J Price 1, D D Sandeman 1, J H Tripp 1, J E Tooke 1
PMCID: PMC1029676  PMID: 8110002

Abstract

In healthy subjects, standing elicits a reduction in blood flow to the skin of the foot. In adults with insulin dependent diabetes this posturally induced response is deficient, resulting in capillary hypertension when the foot is in the dependent position (that is, below heart level). Such functional abnormalities of the microcirculation in diabetes may precede any evidence of clinically detectable microangiopathy. This study investigates the posturally induced change in blood flow to the skin of the foot in prepubertal and postpubertal patients with insulin dependent diabetes. Laser Doppler fluximetry was used to assess the postural change in blood flow at the pulp of the great toe. Postural vasoconstriction (dependent flux value/supine flux value x 100) was greater after puberty in normal subjects (median (range) 60.4 (7.0-164.9)% prepubertal v 20.5 (5.9-101.0)% postpubertal). Prepubertal children with diabetes did not differ from their healthy peers (69.8 (7.2-192.7)% with diabetes v 60.4 (7.0-164.9)% controls); however postpubertal children with diabetes had a significantly impaired postural vasoconstriction (40.6 (7.9-140.2)% with diabetes v 20.5 (5.9-101.7)% controls). Abnormalities in the normal reduction of blood flow on standing occurred in young postpubertal children with diabetes, most of whom were free of complications.

Full text

PDF
22

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Altura B. M. Sex and estrogens and responsiveness of terminal arterioles to neurohypophyseal hormones and catecholamines. J Pharmacol Exp Ther. 1975 May;193(2):403–412. [PubMed] [Google Scholar]
  2. Aronin N., Leeman S. E., Clements R. S., Jr Diminished flare response in neuropathic diabetic patients. Comparison of effects of substance P, histamine, and capsaicin. Diabetes. 1987 Oct;36(10):1139–1143. doi: 10.2337/diab.36.10.1139. [DOI] [PubMed] [Google Scholar]
  3. Boolell M., Tooke J. E. The skin hyperaemic response to local injection of substance P and capsaicin in diabetes mellitus. Diabet Med. 1990 Dec;7(10):898–901. doi: 10.1111/j.1464-5491.1990.tb01325.x. [DOI] [PubMed] [Google Scholar]
  4. Calver A., Collier J., Vallance P. Inhibition and stimulation of nitric oxide synthesis in the human forearm arterial bed of patients with insulin-dependent diabetes. J Clin Invest. 1992 Dec;90(6):2548–2554. doi: 10.1172/JCI116149. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Christlieb A. R., Janka H. U., Kraus B., Gleason R. E., Icasas-Cabral E. A., Aiello L. M., Cabral B. V., Solano A. Vascular reactivity to angiotensin II and to norepinephrine in diabetic subjects. Diabetes. 1976 Apr;25(4):268–274. doi: 10.2337/diab.25.4.268. [DOI] [PubMed] [Google Scholar]
  6. Dahlquist G., Rudberg S. The prevalence of microalbuminuria in diabetic children and adolescents and its relation to puberty. Acta Paediatr Scand. 1987 Sep;76(5):795–800. doi: 10.1111/j.1651-2227.1987.tb10567.x. [DOI] [PubMed] [Google Scholar]
  7. Dhall U., Cowen T., Haven A. J., Burnstock G. Effect of oestrogen and progesterone on noradrenergic nerves and on nerves showing serotonin-like immunoreactivity in the basilar artery of the rabbit. Brain Res. 1988 Mar 1;442(2):335–339. doi: 10.1016/0006-8993(88)91520-x. [DOI] [PubMed] [Google Scholar]
  8. Durante W., Sen A. K., Sunahara F. A. Impairment of endothelium-dependent relaxation in aortae from spontaneously diabetic rats. Br J Pharmacol. 1988 Jun;94(2):463–468. doi: 10.1111/j.1476-5381.1988.tb11548.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Eng G. D., Hung W., August G. P., Smokvina M. D. Nerve conduction velocity determinations in juvenile diabetes: continuing study of 190 patients. Arch Phys Med Rehabil. 1976 Jan;57(1):1–5. [PubMed] [Google Scholar]
  10. Flynn M. D., Hassan A. A., Tooke J. E. Effect of postural change and thermoregulatory stress on the capillary microcirculation of the human toe. Clin Sci (Lond) 1989 Mar;76(3):231–236. doi: 10.1042/cs0760231. [DOI] [PubMed] [Google Scholar]
  11. Hassan A. A., Carter G., Tooke J. E. Postural vasoconstriction in women during the normal menstrual cycle. Clin Sci (Lond) 1990 Jan;78(1):39–47. doi: 10.1042/cs0780039. [DOI] [PubMed] [Google Scholar]
  12. Hassan A. A., Rayman G., Tooke J. E. Effect of indirect heating on the postural control of skin blood flow in the human foot. Clin Sci (Lond) 1986 Jun;70(6):577–582. doi: 10.1042/cs0700577. [DOI] [PubMed] [Google Scholar]
  13. Hassan A. A., Tooke J. E. Mechanism of the postural vasoconstrictor response in the human foot. Clin Sci (Lond) 1988 Oct;75(4):379–387. doi: 10.1042/cs0750379. [DOI] [PubMed] [Google Scholar]
  14. Henriksen L., Sejrsen P. Local reflex in microcirculation in human cutaneous tissue. Acta Physiol Scand. 1976 Oct;98(2):227–231. doi: 10.1111/j.1748-1716.1976.tb10299.x. [DOI] [PubMed] [Google Scholar]
  15. Henriksen O. Local nervous mechanism in regulation of blood flow in human subcutaneous tissue. Acta Physiol Scand. 1976 Jul;97(3):385–391. doi: 10.1111/j.1748-1716.1976.tb10278.x. [DOI] [PubMed] [Google Scholar]
  16. Hill M. A., Meininger G. A., Granger H. J. Altered skeletal muscle microvascular hemodynamics after one week of streptozotocin-induced diabetes. Microcirc Endothelium Lymphatics. 1985;2(6):687–704. [PubMed] [Google Scholar]
  17. ILIFF A., LEE V. A. Pulse rate, respiratory rate, and body temperature of children between two months and eighteen years of age. Child Dev. 1952 Dec;23(4):237–245. [PubMed] [Google Scholar]
  18. Kamata K., Miyata N., Kasuya Y. Impairment of endothelium-dependent relaxation and changes in levels of cyclic GMP in aorta from streptozotocin-induced diabetic rats. Br J Pharmacol. 1989 Jun;97(2):614–618. doi: 10.1111/j.1476-5381.1989.tb11993.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Kastrup J., Nørgaard T., Parving H. H., Lassen N. A. Arteriolar hyalinosis does not interfere with the local veno-arteriolar reflex regulation of subcutaneous blood flow in insulin-dependent diabetic patients. Scand J Clin Lab Invest. 1987 Sep;47(5):483–489. [PubMed] [Google Scholar]
  20. Klein R., Klein B. E., Moss S. E., Davis M. D., DeMets D. L. Retinopathy in young-onset diabetic patients. Diabetes Care. 1985 Jul-Aug;8(4):311–315. doi: 10.2337/diacare.8.4.311. [DOI] [PubMed] [Google Scholar]
  21. Koltai M. Z., Rösen P., Ballagi-Pordány G., Hadházy P., Pogátsa G. Increased vasoconstrictor response to noradrenaline in femoral vascular bed of diabetic dogs. Is thromboxane A2 involved? Cardiovasc Res. 1990 Sep;24(9):707–710. doi: 10.1093/cvr/24.9.707. [DOI] [PubMed] [Google Scholar]
  22. Levick J. R., Michel C. C. The effects of position and skin temperature on the capillary pressures in the fingers and toes. J Physiol. 1978 Jan;274:97–109. doi: 10.1113/jphysiol.1978.sp012136. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. MacLeod K. M., McNeill J. H. The influence of chronic experimental diabetes on contractile responses of rat isolated blood vessels. Can J Physiol Pharmacol. 1985 Jan;63(1):52–57. doi: 10.1139/y85-009. [DOI] [PubMed] [Google Scholar]
  24. Morff R. J. Microvascular reactivity to norepinephrine at different arteriolar levels and durations of streptozocin-induced diabetes. Diabetes. 1990 Mar;39(3):354–360. doi: 10.2337/diab.39.3.354. [DOI] [PubMed] [Google Scholar]
  25. Müller M. J., von zur Mühlen A., Lautz H. U., Schmidt F. W., Daiber M., Hürter P. Energy expenditure in children with type I diabetes: evidence for increased thermogenesis. BMJ. 1989 Aug 19;299(6697):487–491. doi: 10.1136/bmj.299.6697.487. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Nair K. S., Halliday D., Garrow J. S. Increased energy expenditure in poorly controlled Type 1 (insulin-dependent) diabetic patients. Diabetologia. 1984 Jul;27(1):13–16. doi: 10.1007/BF00253494. [DOI] [PubMed] [Google Scholar]
  27. Parkhouse N., Le Quesne P. M. Impaired neurogenic vascular response in patients with diabetes and neuropathic foot lesions. N Engl J Med. 1988 May 19;318(20):1306–1309. doi: 10.1056/NEJM198805193182005. [DOI] [PubMed] [Google Scholar]
  28. Rayman G., Hassan A., Tooke J. E. Blood flow in the skin of the foot related to posture in diabetes mellitus. Br Med J (Clin Res Ed) 1986 Jan 11;292(6513):87–90. doi: 10.1136/bmj.292.6513.87. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Rogers D. G., White N. H., Santiago J. V., Miller J. P., Weldon V. V., Kilo C., Williamson J. R. Glycemic control and bone age are independently associated with muscle capillary basement membrane width in diabetic children after puberty. Diabetes Care. 1986 Sep-Oct;9(5):453–459. doi: 10.2337/diacare.9.5.453. [DOI] [PubMed] [Google Scholar]
  30. Rogers D. G., White N. H., Shalwitz R. A., Palmberg P., Smith M. E., Santiago J. V. The effect of puberty on the development of early diabetic microvascular disease in insulin-dependent diabetes. Diabetes Res Clin Pract. 1987 Jan-Feb;3(1):39–44. doi: 10.1016/s0168-8227(87)80006-2. [DOI] [PubMed] [Google Scholar]
  31. Shore A. C., Price K. J., Sandeman D. D., Green E. M., Tripp J. H., Tooke J. E. Impaired microvascular hyperaemic response in children with diabetes mellitus. Diabet Med. 1991 Aug-Sep;8(7):619–623. doi: 10.1111/j.1464-5491.1991.tb01667.x. [DOI] [PubMed] [Google Scholar]
  32. Tooke J. E. Microvascular haemodynamics in diabetes mellitus. Clin Sci (Lond) 1986 Feb;70(2):119–125. doi: 10.1042/cs0700119. [DOI] [PubMed] [Google Scholar]
  33. Viberti G. C., Hill R. D., Jarrett R. J., Argyropoulos A., Mahmud U., Keen H. Microalbuminuria as a predictor of clinical nephropathy in insulin-dependent diabetes mellitus. Lancet. 1982 Jun 26;1(8287):1430–1432. doi: 10.1016/s0140-6736(82)92450-3. [DOI] [PubMed] [Google Scholar]
  34. Vracko R. Skeletal muscle capillaries in diabetics. A quantitative analysis. Circulation. 1970 Feb;41(2):271–283. doi: 10.1161/01.cir.41.2.271. [DOI] [PubMed] [Google Scholar]
  35. Westerman R. A., Widdop R. E., Hogan C., Zimmet P. Non-invasive tests of neurovascular function: reduced responses in diabetes mellitus. Neurosci Lett. 1987 Oct 16;81(1-2):177–182. doi: 10.1016/0304-3940(87)90361-2. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES