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One of the complications of diabetes is neuropathy, or disease of the nervous system. Autonomic neuropathy is a common form of diabetic neuropathy, and can lead to symptoms of impotence, sweating, diarrhea, and gastroparesis, in which the motility of the stomach is impaired. Other symptoms of autonomic neuropathy are postural hypotension, which is a drop in blood pressure upon standing up, and bladder dysfunction. Fortunately, all of these symptoms are fairly rare and when they do occur, they are usually not so severe as to be devastating. Persons who have symptoms report that they come and go over a period of years, often without becoming worse. It is surprising that when diabetic individuals are tested for autonomic dysfunction, abnormalities are very common, and yet only a small proportion of patients actually experience symptoms. Researchers have investigated whether improving glycemic control (maintaining blood sugar as close to normal as possible) can arrest or even reverse the deterioration of the autonomic nervous system. The most effective means of normalizing blood sugars over the long term is a pancreatic transplant. A study by Kennedy et al. in the April 12, 1990 issue of The New England Journal of Medicine found that there was no significant return of autonomic function even after three years in 61 patients who underwent pancreatic transplantation. There was, however, a trend towards stability of autonomic function in the transplant patients, while control subjects experienced deterioration. In conclusion, good glycemic control may reduce the chances of developing autonomic neuropathy, but once signs of neuropathy occur they can only be treated symptomatically. (Consumer Summary produced by Reliance Medical Information, Inc.)

Aims To determine the prevalence of albuminuria [raised albumin-creatinine ratio (ACR)] in an out-patient population of Afro-Caribbeans with Type 2 diabetes mellitus (DM) and to determine if the possession of the sickle cell trait (SCT) is a risk factor. Patients and methods The ACR in a morning urine sample was determined in each of 181 Afro-Caribbeans with Type 2 DM attending the out-patient clinic at King's Diabetes Centre of King's College Hospital, London. The subjects were genotyped for the SCT, Haemoglobin AS (HbAS). Results Although a raised ACR was demonstrated more frequently in those with the SCT than in those without, with an odds ratio of 1.19, this was not statistically significant (P = 0.68). Conclusions In this study the possession of the SCT does not appear to play a significant role in the development of albuminuria. However, a larger study is needed to clarify its role as a risk factor for development of albuminuria in Afro-Caribbeans with Type 2 DM. [ABSTRACT FROM AUTHOR]

Presents letters on medical related issues presented by the editors of the 'British Medical Journal.' Influence of diet on the incidence of heart disease; Prescription drugs for normal-weight diabetics; Side effects of prolonged antimalaria prophylaxis.

Comments on various issues related to medicine in Great Britain. Possibility of using penicillamine in the management of Wilson's disease; dangers in multigravid labor; Use of polygeline solution to prevent insulin absorption to plastic or glass.

Investigates the evolution of renal disease in insulin dependent diabetics selected for intermittent clinical proteinuria in Great Britain. Effect of glycemic control on renal function of diabetics; Glomerular filtration rates for each patient with intermittent clinical proteinuria; Albumin excretion rates for insulin diabetics.

Examines the renal transplantation in diabetic nephropathy. Rate of survival in the transplantation; Susceptibility of older patients with coronary and peripheral vascular disease to higher postoperative morbidity and mortality; Absence of the influence of advanced retinopathy on the outcome.

Studies the defective innervation of heart in diabetic autonomic neuropathy. Consequences of cardiac denervation; Factors influencing cardiovascular reflexes; Features of autonomic neuropathy.

Focuses on the creation of methods for treatment of diabetes due to complications of insulin infusion systems complications. Application of self-measurement of blood glucose technique; Measurement of glycosylated hemoglobin concentration; Effectiveness of the techniques in avoiding hypoglycemia.

Focuses on the therapeutic value of insulin. Methods of administering the drug; Purpose of insulin treatment; Factors to consider in choosing individual insulin preparations.

Examines the incidence of medial arterial calcification in diabetic neuropathy. Etiology of medial arterial calcification; Detection of calcification by lateral view of the feet and ankles; Mean linear extent of calcification per foot in each patients.

Studies the pathologic changes in the autonomic nervous system in five post-mortem cases of insulin-dependent diabetes of early onset. Clinical evidence of peripheral sensorimotor neuropathy and developed disturbances of autonomic function; Severe loss of myelinated fibers in the vagus nerve and sympathetic nerve trunks; Inflammatory changes in the autonomic ganglia.

Studies the cardiovascular effects of insulin in patients with diabetes. Analysis on the cases of seven diabetics; Increase in heart rates of diabetics with normal cardiovascular reflexes upon insulin intake; Animosity of the mechanism.

Describes the occurrence of iritis in patients with diabetic autonomic neuropathy. Symptoms of autonomic neuropathy; Description of iritis; Measurement of heart rate variability.

Investigates the role of vagal pathways in bronchial response to cold air in diabetic patients with autonomic neuropathy. Pharmacological agents used to test airway reactivity; Result of autonomic function test on patients; Symptoms of autonomic neuropathy.