Skip to main content
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1987 Oct;50(10):1337–1341. doi: 10.1136/jnnp.50.10.1337

Peripheral nerve function in patients with painful diabetic neuropathy treated with continuous subcutaneous insulin infusion.

F W Bertelsmann 1, J J Heimans 1, J C Van Rooy 1, H F Dankmeijer 1, S L Visser 1, E A Van der Veen 1
PMCID: PMC1032461  PMID: 3681313

Abstract

In order to study the effects of improved metabolic control on painful diabetic polyneuropathy, 15 patients were treated with continuous subcutaneous insulin infusion over a 12 month period. Polyneuropathy was assessed by pain score, neurological examinations, nerve conduction studies and determination of sensory thresholds and cardiovascular reflexes. Improved metabolic control was confirmed by significantly improved levels of glycosylated haemoglobin (11.7 +/- 0.3% at entry to the study, to 8.7 +/- 0.3% after 12 months; mean +/- SEM). Symptomatic relief was confirmed by significantly improved pain scores. Thresholds for thermal cutaneous sensation improved significantly from 6.0 +/- 0.8 degrees C at entry to the study to 2.7 +/- 0.7 degrees C after 12 months (mean +/- SEM). These findings suggest a selective improvement of peripheral small nerve fibre function after continuous subcutaneous insulin infusion. The importance of quantitating thermal cutaneous sensation in longitudinal studies of patients with diabetic neuropathy was confirmed.

Full text

PDF
1337

Selected References

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

  1. Bertelsmann F. W., Heimans J. J., Weber E. J., van der Veen E. A., Schouten J. A. Thermal discrimination thresholds in normal subjects and in patients with diabetic neuropathy. J Neurol Neurosurg Psychiatry. 1985 Jul;48(7):686–690. doi: 10.1136/jnnp.48.7.686. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bertelsmann F. W., Heimans J. J., van Rooy J. C., Heine R. J., van der Veen E. A. Reproducibility of vibratory perception thresholds in patients with diabetic neuropathy. Diabetes Res. 1986 Nov;3(9):463–466. [PubMed] [Google Scholar]
  3. Bertelsmann F. W., Heimans J. J., van Rooy J. C., Visser S. L. Comparison of Hoffmann reflex with quantitative assessment of cutaneous sensation in diabetic neuropathy. Acta Neurol Scand. 1986 Aug;74(2):121–127. doi: 10.1111/j.1600-0404.1986.tb04637.x. [DOI] [PubMed] [Google Scholar]
  4. Boulton A. J., Drury J., Clarke B., Ward J. D. Continuous subcutaneous insulin infusion in the management of painful diabetic neuropathy. Diabetes Care. 1982 Jul-Aug;5(4):386–390. doi: 10.2337/diacare.5.4.386. [DOI] [PubMed] [Google Scholar]
  5. Brown M. J., Asbury A. K. Diabetic neuropathy. Ann Neurol. 1984 Jan;15(1):2–12. doi: 10.1002/ana.410150103. [DOI] [PubMed] [Google Scholar]
  6. Dahl-Jørgensen K., Brinchmann-Hansen O., Hanssen K. F., Ganes T., Kierulf P., Smeland E., Sandvik L., Aagenaes O. Effect of near normoglycaemia for two years on progression of early diabetic retinopathy, nephropathy, and neuropathy: the Oslo study. Br Med J (Clin Res Ed) 1986 Nov 8;293(6556):1195–1199. doi: 10.1136/bmj.293.6556.1195. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Ehle A. L., Raskin P. Increased nerve conduction in diabetics after a year of improved glucoregulation. J Neurol Sci. 1986 Jul;74(2-3):191–197. doi: 10.1016/0022-510x(86)90104-8. [DOI] [PubMed] [Google Scholar]
  8. Ewing D. J., Campbell I. W., Clarke B. F. The natural history of diabetic autonomic neuropathy. Q J Med. 1980 Winter;49(193):95–108. [PubMed] [Google Scholar]
  9. Fedele D., Bellavere F., Cardone C., Ferri M., Crepaldi G. Improvement of cardiovascular autonomic reflexes after amelioration of metabolic control in insulin-dependent diabetic subjects with severe autonomic neuropathy. Horm Metab Res. 1985 Aug;17(8):410–413. doi: 10.1055/s-2007-1013560. [DOI] [PubMed] [Google Scholar]
  10. Greene D. A., Lattimer S., Ulbrecht J., Carroll P. Glucose-induced alterations in nerve metabolism: current perspective on the pathogenesis of diabetic neuropathy and future directions for research and therapy. Diabetes Care. 1985 May-Jun;8(3):290–299. doi: 10.2337/diacare.8.3.290. [DOI] [PubMed] [Google Scholar]
  11. Heimans J. J., Bertelsmann F. W., Van Rooy J. C. Large and small nerve fiber function in painful diabetic neuropathy. J Neurol Sci. 1986 Jun;74(1):1–9. doi: 10.1016/0022-510x(86)90186-3. [DOI] [PubMed] [Google Scholar]
  12. Holman R. R., Dornan T. L., Mayon-White V., Howard-Williams J., Orde-Peckar C., Jenkins L., Steemson J., Rolfe R., Smith B., Barbour D. Prevention of deterioration of renal and sensory-nerve function by more intensive management of insulin-dependent diabetic patients. A two-year randomised prospective study. Lancet. 1983 Jan 29;1(8318):204–208. doi: 10.1016/s0140-6736(83)92586-2. [DOI] [PubMed] [Google Scholar]
  13. Pickup J. C., Keen H., Viberti G. C., White M. C., Kohner E. M., Parsons J. A., Alberti K. G. Continuous subcutaneous insulin infusion in the treatment of diabetes mellitus. Diabetes Care. 1980 Mar-Apr;3(2):290–300. doi: 10.2337/diacare.3.2.290. [DOI] [PubMed] [Google Scholar]
  14. Pietri A., Ehle A. L., Raskin P. Changes in nerve conduction velocity after six weeks of glucoregulation with portable insulin infusion pumps. Diabetes. 1980 Aug;29(8):668–671. doi: 10.2337/diab.29.8.668. [DOI] [PubMed] [Google Scholar]
  15. Schiffrin A., Belmonte M. M. Comparison between continuous subcutaneous insulin infusion and multiple injections of insulin. A one-year prospective study. Diabetes. 1982 Mar;31(3):255–264. doi: 10.2337/diab.31.3.255. [DOI] [PubMed] [Google Scholar]
  16. Scott J., Huskisson E. C. Graphic representation of pain. Pain. 1976 Jun;2(2):175–184. [PubMed] [Google Scholar]
  17. Service F. J., Daube J. R., O'Brien P. C., Zimmerman B. R., Swanson C. J., Brennan M. D., Dyck P. J. Effect of blood glucose control on peripheral nerve function in diabetic patients. Mayo Clin Proc. 1983 May;58(5):283–289. [PubMed] [Google Scholar]
  18. Service F. J., Rizza R. A., Daube J. R., O'Brien P. C., Dyck P. J. Near normoglycaemia improved nerve conduction and vibration sensation in diabetic neuropathy. Diabetologia. 1985 Oct;28(10):722–727. doi: 10.1007/BF00265018. [DOI] [PubMed] [Google Scholar]
  19. Sherwin R. S., Tamborlane W. V., Genel M., Felig P. Treatment of juvenile-onset diabetes by subcutaneous infusion of insulin with a portable pump. Diabetes Care. 1980 Mar-Apr;3(2):301–308. doi: 10.2337/diacare.3.2.301. [DOI] [PubMed] [Google Scholar]
  20. Strian F., Severin F., Müller J., Montag N. Diagnose der diabetischen "painful small fibre neuropathy" mit Hilfe der Temperaturempfindlichkeitsschwellen. Nervenarzt. 1984 Feb;55(2):103–107. [PubMed] [Google Scholar]
  21. Tolaymat A., Roque J. L., Russo L. S., Jr Improvement of diabetic peripheral neuropathy with the portable insulin infusion pump. South Med J. 1982 Feb;75(2):185–189. doi: 10.1097/00007611-198202000-00017. [DOI] [PubMed] [Google Scholar]
  22. Troni W., Carta Q., Cantello R., Caselle M. T., Rainero I. Peripheral nerve function and metabolic control in diabetes mellitus. Ann Neurol. 1984 Aug;16(2):178–183. doi: 10.1002/ana.410160204. [DOI] [PubMed] [Google Scholar]
  23. Wieling W., van Brederode J. F., de Rijk L. G., Borst C., Dunning A. J. Reflex control of heart rate in normal subjects in relation to age: a data base for cardiac vagal neuropathy. Diabetologia. 1982 Mar;22(3):163–166. doi: 10.1007/BF00283745. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES