Vibratory perception during ischaemia in uraemic patients and in subjects with mild carbohydrate intolerance.

Diabetic patients retain their vibratory perception during ischaemia longer than non-diabetics. This abnormality is found even in patients with newly diagnosed diabetes and it can be normalized after several days of intensive treatment with insulin (Steiness, 1959, 1961a; Gregersen, 1968a). Further studies in diabetics have demonstrated that the retained ability of nerve conduction during ischaemia also applies to other sensory modalities as well as to efferent nerve conduction (Castaigne, Cathala, Dry, and Mastropaolo, 1966; Gregersen, 1968a; Seneviratne and Peiris, 1968). It seems of considerable interest to try to clarify the basis for this acute reversible disorder in diabetics as well as its possible significance for the later irreversible diabetic neuropathy. The abnormality may be due to either biochemical or morphological alterations in the nerves. Steiness (1961b) was not able to induce a similar phenomenon in non-diabetics in biochemical experiments such as glucose loading, cortisone treatment, or prolonged fasting. Neither has the abnormality so far been demonstrated in any other disorder than diabetes mellitus. The finding of a similar abnormality in other metabolic and neurological diseases might well supply new information on the pathophysiological basis of this phenomenon. We have studied vibratory perception during ischaemia in patients with uraemia and, for purposes of comparison, in two groups of subjects with normal kidney function: one with mild carbohydrate intolerance and one with normal glucose tolerance.