Arterio-venous shunting and proliferating new vessels in acute painful neuropathy of rapid glycaemic control (insulin neuritis)

S. Tesfaye, Rayaz Malik, N. Harris, J. J. Jakubowski, C. Mody, I. G. Rennie, J. D. Ward

Research output: Contribution to journalArticle

152 Citations (Scopus)

Abstract

Insulin neuritis, or painful neuropathy following rapid improvement in glycaemic control, is well recognised but its aetiology is unclear. An understanding of the processes involved in the genesis of acute painful neuropathy of rapid glycaemic control may give an insight into the early pathogenetic factors leading to diabetic nerve damage in general. We have identified five subjects with insulin neuritis including one who developed severe autonomic neuropathy following treatment with insulin. Subjects underwent: 1) assessment of neuropathic symptom and deficit scores, 2) quantitative sensory and electrophysiological studies and 3) sural nerve epineurial vessel photography and fluorescein angiography in vivo. The sural nerve photographs were independently graded by an ophthalmologist. All subjects with insulin neuritis presented with severe sensory symptoms but clinical examination and electrophysiological tests were normal except in the subject with he severe autonomic neuropathy in whom all the tests were abnormal. On nerve photography, there vas an abundance of epineurial nutrient vessels although these showed severe abnormalities including arteriolar attenuation, tortuosity and arterio-venous shunting in all subjects. Proliferating neural 'new vessels' which bear striking similarities to those found in the retina and that were more leaky to fluorescein than normal vessels, were observed in three subjects. Venous distension and/or tortuosity was also observed in three subjects and this was most marked in the subject with severe autonomic neuropathy. This study shows that epineurial nutrient vessel anatomy is abnormal in subjects with acute painful neuropathy of rapid glycaemic control, a condition previously thought to be purely metabolic in origin. The presence of epineurial arterio-venous shunting and a fine network of vessels resembling the new vessels of the retina, may lead to a 'steal' effect rendering the endoneurium ischaemic. This process may be important in the genesis of neuropathic pain, and further supports the importance of vascular factors in the pathogenesis of diabetic neuropathy.

Original languageEnglish
Pages (from-to)329-335
Number of pages7
JournalDiabetologia
Volume39
Issue number3
DOIs
Publication statusPublished - 1996
Externally publishedYes

Fingerprint

Neuritis
Insulin
Sural Nerve
Photography
Retina
Food
Symptom Assessment
Diabetic Neuropathies
Fluorescein Angiography
Neuralgia
Fluorescein
Peripheral Nerves
Anatomy
Painful Neuropathy
Therapeutics

Keywords

  • Arterio-venous shunting
  • Diabetic neuropathy
  • Fluorescein angiography
  • Hypoxia
  • Insulin neuritis
  • Nerve
  • Nerve blood flow
  • New vessel formation
  • Sural nerve

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Arterio-venous shunting and proliferating new vessels in acute painful neuropathy of rapid glycaemic control (insulin neuritis). / Tesfaye, S.; Malik, Rayaz; Harris, N.; Jakubowski, J. J.; Mody, C.; Rennie, I. G.; Ward, J. D.

In: Diabetologia, Vol. 39, No. 3, 1996, p. 329-335.

Research output: Contribution to journalArticle

Tesfaye, S. ; Malik, Rayaz ; Harris, N. ; Jakubowski, J. J. ; Mody, C. ; Rennie, I. G. ; Ward, J. D. / Arterio-venous shunting and proliferating new vessels in acute painful neuropathy of rapid glycaemic control (insulin neuritis). In: Diabetologia. 1996 ; Vol. 39, No. 3. pp. 329-335.
@article{1195540ff40e4883aaebd31bbfc807be,
title = "Arterio-venous shunting and proliferating new vessels in acute painful neuropathy of rapid glycaemic control (insulin neuritis)",
abstract = "Insulin neuritis, or painful neuropathy following rapid improvement in glycaemic control, is well recognised but its aetiology is unclear. An understanding of the processes involved in the genesis of acute painful neuropathy of rapid glycaemic control may give an insight into the early pathogenetic factors leading to diabetic nerve damage in general. We have identified five subjects with insulin neuritis including one who developed severe autonomic neuropathy following treatment with insulin. Subjects underwent: 1) assessment of neuropathic symptom and deficit scores, 2) quantitative sensory and electrophysiological studies and 3) sural nerve epineurial vessel photography and fluorescein angiography in vivo. The sural nerve photographs were independently graded by an ophthalmologist. All subjects with insulin neuritis presented with severe sensory symptoms but clinical examination and electrophysiological tests were normal except in the subject with he severe autonomic neuropathy in whom all the tests were abnormal. On nerve photography, there vas an abundance of epineurial nutrient vessels although these showed severe abnormalities including arteriolar attenuation, tortuosity and arterio-venous shunting in all subjects. Proliferating neural 'new vessels' which bear striking similarities to those found in the retina and that were more leaky to fluorescein than normal vessels, were observed in three subjects. Venous distension and/or tortuosity was also observed in three subjects and this was most marked in the subject with severe autonomic neuropathy. This study shows that epineurial nutrient vessel anatomy is abnormal in subjects with acute painful neuropathy of rapid glycaemic control, a condition previously thought to be purely metabolic in origin. The presence of epineurial arterio-venous shunting and a fine network of vessels resembling the new vessels of the retina, may lead to a 'steal' effect rendering the endoneurium ischaemic. This process may be important in the genesis of neuropathic pain, and further supports the importance of vascular factors in the pathogenesis of diabetic neuropathy.",
keywords = "Arterio-venous shunting, Diabetic neuropathy, Fluorescein angiography, Hypoxia, Insulin neuritis, Nerve, Nerve blood flow, New vessel formation, Sural nerve",
author = "S. Tesfaye and Rayaz Malik and N. Harris and Jakubowski, {J. J.} and C. Mody and Rennie, {I. G.} and Ward, {J. D.}",
year = "1996",
doi = "10.1007/s001250050449",
language = "English",
volume = "39",
pages = "329--335",
journal = "Diabetologia",
issn = "0012-186X",
publisher = "Springer Verlag",
number = "3",

}

TY - JOUR

T1 - Arterio-venous shunting and proliferating new vessels in acute painful neuropathy of rapid glycaemic control (insulin neuritis)

AU - Tesfaye, S.

AU - Malik, Rayaz

AU - Harris, N.

AU - Jakubowski, J. J.

AU - Mody, C.

AU - Rennie, I. G.

AU - Ward, J. D.

PY - 1996

Y1 - 1996

N2 - Insulin neuritis, or painful neuropathy following rapid improvement in glycaemic control, is well recognised but its aetiology is unclear. An understanding of the processes involved in the genesis of acute painful neuropathy of rapid glycaemic control may give an insight into the early pathogenetic factors leading to diabetic nerve damage in general. We have identified five subjects with insulin neuritis including one who developed severe autonomic neuropathy following treatment with insulin. Subjects underwent: 1) assessment of neuropathic symptom and deficit scores, 2) quantitative sensory and electrophysiological studies and 3) sural nerve epineurial vessel photography and fluorescein angiography in vivo. The sural nerve photographs were independently graded by an ophthalmologist. All subjects with insulin neuritis presented with severe sensory symptoms but clinical examination and electrophysiological tests were normal except in the subject with he severe autonomic neuropathy in whom all the tests were abnormal. On nerve photography, there vas an abundance of epineurial nutrient vessels although these showed severe abnormalities including arteriolar attenuation, tortuosity and arterio-venous shunting in all subjects. Proliferating neural 'new vessels' which bear striking similarities to those found in the retina and that were more leaky to fluorescein than normal vessels, were observed in three subjects. Venous distension and/or tortuosity was also observed in three subjects and this was most marked in the subject with severe autonomic neuropathy. This study shows that epineurial nutrient vessel anatomy is abnormal in subjects with acute painful neuropathy of rapid glycaemic control, a condition previously thought to be purely metabolic in origin. The presence of epineurial arterio-venous shunting and a fine network of vessels resembling the new vessels of the retina, may lead to a 'steal' effect rendering the endoneurium ischaemic. This process may be important in the genesis of neuropathic pain, and further supports the importance of vascular factors in the pathogenesis of diabetic neuropathy.

AB - Insulin neuritis, or painful neuropathy following rapid improvement in glycaemic control, is well recognised but its aetiology is unclear. An understanding of the processes involved in the genesis of acute painful neuropathy of rapid glycaemic control may give an insight into the early pathogenetic factors leading to diabetic nerve damage in general. We have identified five subjects with insulin neuritis including one who developed severe autonomic neuropathy following treatment with insulin. Subjects underwent: 1) assessment of neuropathic symptom and deficit scores, 2) quantitative sensory and electrophysiological studies and 3) sural nerve epineurial vessel photography and fluorescein angiography in vivo. The sural nerve photographs were independently graded by an ophthalmologist. All subjects with insulin neuritis presented with severe sensory symptoms but clinical examination and electrophysiological tests were normal except in the subject with he severe autonomic neuropathy in whom all the tests were abnormal. On nerve photography, there vas an abundance of epineurial nutrient vessels although these showed severe abnormalities including arteriolar attenuation, tortuosity and arterio-venous shunting in all subjects. Proliferating neural 'new vessels' which bear striking similarities to those found in the retina and that were more leaky to fluorescein than normal vessels, were observed in three subjects. Venous distension and/or tortuosity was also observed in three subjects and this was most marked in the subject with severe autonomic neuropathy. This study shows that epineurial nutrient vessel anatomy is abnormal in subjects with acute painful neuropathy of rapid glycaemic control, a condition previously thought to be purely metabolic in origin. The presence of epineurial arterio-venous shunting and a fine network of vessels resembling the new vessels of the retina, may lead to a 'steal' effect rendering the endoneurium ischaemic. This process may be important in the genesis of neuropathic pain, and further supports the importance of vascular factors in the pathogenesis of diabetic neuropathy.

KW - Arterio-venous shunting

KW - Diabetic neuropathy

KW - Fluorescein angiography

KW - Hypoxia

KW - Insulin neuritis

KW - Nerve

KW - Nerve blood flow

KW - New vessel formation

KW - Sural nerve

UR - http://www.scopus.com/inward/record.url?scp=0030065230&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0030065230&partnerID=8YFLogxK

U2 - 10.1007/s001250050449

DO - 10.1007/s001250050449

M3 - Article

VL - 39

SP - 329

EP - 335

JO - Diabetologia

JF - Diabetologia

SN - 0012-186X

IS - 3

ER -