The sympathetic nervous system in diabetic neuropathy. A clinical and pathological study

Tests of autonomic function were performed on 16 subjects with diabetic neuropathy. Abnormal sweating occurred in 10/10 (100 per cent), postural hypotension in 7/16 (44 per cent), an abnormal Valsalva ratio in 7/11 (64 per cent), and denervation hypersensitivity to phenylephrine in 2/8 (25 per cent) of patients tested. A quantitative assessment of baroreceptor function was made. In diabetics, there was a reduced resting heart period, heart period range and mean gain. Quantitative histological studies were performed on the greater splanchnic nerves removed at autopsy from 9 control subjects and from 8 subjects with diabetic neuropathy. The fibre density was significantly reduced in the greater splanchnic nerve of diabetics. The predominant pathology on teased fibre preparations was that of demyelination. Disordered blood pressure control in diabetes correlated with the pathological abnormalities in the sympathetic nervous system. Light and electronmicroscopic studies were performed on the sural nerves of 2 diabetic subjects with autonomic dysfunction. The predominant change was active axonal degeneration affecting mainly unmyelinated and small myelinated fibres.