Cardiorespiratory reflexes, vibratory and thermal thresholds, sensory and motor conduction in diabetic patients with...

The neuropathic profile was studied in 26 patients with long-standing, insulin-dependent diabetes mellitus and end-stage nephropathy using tests to evaluate large and small nerve fibres and autonomic function. Clinically, 18 patients (69%) has symptoms and signs of peripheral neuropathy, 9 (35%) had symptoms of autonomic involvement. Vibratory sensation was impaired in 20 patients (77%) in the lower limbs and in 6 (22%) in the upper limbs; cold and warm sensation was equally often impaired in the feet and in the hands with no significant difference between patients with and without neuropathy. Heart rate variation was abnormal in 23 patients at rest (88%), in 24 (92%) during deep breathing and during the orthostatic test. Conduction studies revealed abnormalities in two or more nerves in all patients regardless of whether or not they had overt neuropathy clinically. Thus, the applied multimodal tests revealed evidence of impaired function in large or small nerve fibres or both in all patients independent of clinical findings.