Regional variation in skin blood flow response to hypoglycaemia in Type 1 (insulin-dependent) diabetic patients without complications

Wiles, Philip; Grant, P. J.; Stickland, M. H.; Dean, H. G.; Wales, J. K.; Davies, J. A.

doi:10.1007/bf00395555

Cited by 13 publications

(12 citation statements)

References 19 publications

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“…However, during recovery, Ts decreased on the fingertips, but only in the aware group. Our results are in accordance with a study from Wiles et al [25] demonstrating that finger blood flow remains high during hypoglycaemia in patients with type 1 diabetes despite a decrease in interdigital skin blood flow. It was only in the recovery period that the finger blood flow fell.…”

Section: Discussionsupporting

confidence: 94%

Infrared thermographic assessment of changes in skin temperature during hypoglycaemia in patients with type 1 diabetes

et al. 2015

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Aims/hypothesis Hypoglycaemia is associated with reduced skin temperature (Ts). We studied whether infrared thermography can detect Ts changes during hypoglycaemia in patients with type 1 diabetes and how the Ts response differs between patients with normal hypoglycaemia awareness and hypoglycaemia unawareness. Methods Twenty-four patients with type 1 diabetes (ten aware, 14 unaware) were studied during normoglycaemia (5.0-6.0 mmol/l), hypoglycaemia (2.0-2.5 mmol/l) and during recovery from hypoglycaemia (5.0-6.0 mmol/l) using hyperinsulinaemic glucose clamping. During each 1 h phase, Ts was measured twice by infrared thermography imaging in pre-defined areas (nose, glabella and the five left fingertips), symptoms of hypoglycaemia were scored and blood was sampled.Results Ts decreased during hypoglycaemia on the nose and glabella. The highest decrements were recorded on the nose (aware: −2.6°C, unaware: −1.1°C). In aware patients, the differences in temperature were statistically significant on both nose and glabella, whereas there was only a trend in the unaware group. There was a significant difference in hypoglycaemia-induced temperature changes between the groups. Patients in the aware group had higher hypoglycaemia symptom scores and higher adrenaline (epinephrine) levels during hypoglycaemia. Conclusions/interpretation The hypoglycaemia-associated decrement in Ts can be assessed by infrared thermography Diabetologia (2015) 58:1898-1906 DOI 10.1007 Electronic supplementary material The online version of this article (doi:10.1007/s00125-015-3616-6) contains peer-reviewed but unedited supplementary material, which is available to authorised users. and is larger in patients with normal hypoglycaemia awareness compared with unaware patients.

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Section: Discussionsupporting

confidence: 94%

Infrared thermographic assessment of changes in skin temperature during hypoglycaemia in patients with type 1 diabetes

et al. 2015

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“…They found a decrease in LDF dur ing hypoglycemia, while we did not record any change in LDF at all. Furthermore, Wiles et al [21] postulate that they have measured 'capillary blood How' with the laser Doppler technique, which is not the case as has been dem onstrated in several previous studies [15,16]. When used on the skin the laser Doppler technique measures the blood cell movements in all microvascular compartments, and the signal is predominantly generated by blood flow in the subpapillary vascular bed [16].…”

Section: Discussionmentioning

confidence: 99%

“…However, different protocols and skin areas have been used in these studies. Wiles et al [21] used the finger skin web in diabetic patients and did not investigate any con trol group. Consequently, it is not possible to compare their and our results.…”

Section: Discussionmentioning

confidence: 99%

Patients with Type 1 Diabetes Lack Vasoconstrictor Response in Skin Microcirculation during Insulin-Induced Hypoglycemia

et al. 1994

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Disturbed hemodynamic reactions to insulin-induced hypoglycemia have been documented in diabetic patients and considered related to hyperinsulinemia and impairment of autonomic nervous functions. In the present study we investigated the effect on skin microcirculation of insulin-induced hypoglycemia obtained during moderate hyperinsulinemia, in 7 men with type 1 diabetes and in 8 healthy age- and sex-matched controls. The patients had all normal cardiovascular reflexes as assessed by respiratory sinus arrhythmia and Valsalva ratio. The skin microcirculation of the left fourth finger nailfold was investigated by laser Doppler fluxmetry, and the skin temperature within the same area was measured by a thermistor. Hypoglycemia was induced by a constant insulin infusion of Actrapid Human®, 0.034 U kg^-1 h^-1 during 120 min. Plasma adrenaline, noradrenaline and pancreatic polypeptide increased significantly in both groups during hypoglycemia and the insulin levels never exceeded 50 mU1^-1. A close to identical arterial hypoglycemia was obtained in the two groups 60 min after onset of insulin infusion. During hypoglycemia the control subjects revealed a significant decrease in laser Doppler flux (p < 0.025), while it was unchanged in the diabetic patients. Simultaneously, the skin temperature decreased (p < 0.05) in the controls, but was unchanged in the diabetic patients. The present study indicates that type 1 diabetic patients with normal cardiovascular reflexes have an abolished vasoconstrictor response in skin microcirculation of fingers during insulin-induced hypoglycemia, despite the fact that neurogenic and neuroglucopenic symptoms developed in these patients during hypoglycemia.

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“…There are several potential areas where responses in diabetic patients may differ from those of normal subjects: the sympathoadrenal response to hypoglycaemia is attenuated in diabetes of long duration [4], diabetic patients have abnormal vascular responses to a number of different stresses [5], more specifically, there is evidence that skin vascular responses to hypoglycaemia may be abnormal [6] and abnormal sweating is well documented [7]. We have therefore examined the thermoregulatory responses to sustained hyperinsulinaemic hypoglycaemia and euglycaemia in IDDM of short and long duration in a single blind, experimental protocol.…”

Section: : 689~596]mentioning

confidence: 99%

“…This is highlighted by the observation that the early vasodilator response to hypoglycaemia in the skin of the forehead and forearm of healthy control subjects was absent in diabetic patients [24]. A differential effect of hypoglycaemia on skin blood flow in diabetic patients was reported by Wiles et al [6] who noted a fall in capillary blood flow but sustained flow in arteriovenous anastomoses. This was interpreted as a thermoregulatory response to dissipate heat in the arteriovenous anastomoses, overriding the effect of high circulating adrenaline.…”

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confidence: 92%

Thermoregulatory responses to hyperinsulinaemic hypoglycaemia and euglycaemia in IDDM

1994

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SummaryIn healthy subjects hypoglycaemia causes a fall in body temperature through increased sweating and limb blood flow, and despite increased metabolic heat production. We studied thermoregulatory responses to hyperinsulinaemic (100mU.m-2-min -1) (a) hypoglycaemia (2.5mmol/1) and (b) euglycaemia (4.5 mmol/1) in insulin-dependent diabetic men of short (< 5 years) and long (> 15 years) diabetes duration. Plasma noradrenaline (p < 0.0001), metabolic rate (p < 0.005), heart rate (p < 0.0001) and skin blood flow (p < 0.05) increased during hypoglycaemia and euglycaemia with a greater rise in noradrenaline during the former (p < 0.05). Plasma adrenaline (p < 0.005), forearm blood flow (p < 0.05) and systolic blood pressure (p < 0.02) increased and diastolic blood pressure decreased (p < 0.005) during hypoglycaemia, with greater changes in adrenaline (p < 0.05) and diastolic blood pressure in patients of short diabetes duration. Only two patients (diabetes duration < 2 years) sweated appropriately, while body temperature changed minimally in the two groups of patients. In summary, thermoregulatory responses to hypoglycaemia are impaired in IDDM due to attenuated sweating and adrenomedullary responses. [Diabetologia (1994) 37: 689~596]Key words Blood glucose, body temperature, diabetes mellitus insulin.In healthy subjects hypoglycaemia causes a disturbance of thermoregulation: heat is dissipated and core temperature falls despite an increase in heat production [1]. Heat dissipation occurs primarily through sympathetically mediated sweat production and subsequent evaporative heat loss but also by increased peripheral blood flow. The rise in heat production is caused by increased sympathoadrenal activity and limb muscle blood flow increases through the effects of increased plasma adrenaline. It is thought that skin blood flow increases through withdrawal of vasoconstrictor tone [2] which is at odds with the often reported skin pallor noted in hypoglycaemic subjects.Hypothermia is known to accompany hypoglycaemia in diabetic patients [3] but there is little detailed information of the associated thermoregulatory changes. There are several potential areas where responses in diabetic patients may differ from those of normal subjects: the sympathoadrenal response to hypoglycaemia is attenuated in diabetes of long duration [4], diabetic patients have abnormal vascular responses to a number of different stresses [5], more specifically, there is evidence that skin vascular responses to hypoglycaemia may be abnormal [6] and abnormal sweating is well documented [7]. We have therefore examined the thermoregulatory responses to sustained hyperinsulinaemic hypoglycaemia and euglycaemia in IDDM of short and long duration in a single blind, experimental protocol.

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Regional variation in skin blood flow response to hypoglycaemia in Type 1 (insulin-dependent) diabetic patients without complications

Cited by 13 publications

References 19 publications

Infrared thermographic assessment of changes in skin temperature during hypoglycaemia in patients with type 1 diabetes

Infrared thermographic assessment of changes in skin temperature during hypoglycaemia in patients with type 1 diabetes

Patients with Type 1 Diabetes Lack Vasoconstrictor Response in Skin Microcirculation during Insulin-Induced Hypoglycemia

Thermoregulatory responses to hyperinsulinaemic hypoglycaemia and euglycaemia in IDDM

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