抄録
Neurological examinations of diabetes mellitus are important either for early diagnosis or for preventive measures of urinary tract infections, intractable renal damage, leg lesions and so on.
Quantitative examinations of vibratory sense (by 128 Hz vibrometer), motor nerve conduction velosity (MCV), pupillary reactions (by cinepupillogram) and residual urine volume (by post voiding film) were studied in 286 diabetics, 51 borderline cases and 137 control subjects, being compared to the history and clinical features of diabetes mellitus. Absent ankle jerks, prolonged MCV and prolonged latency period of the pupillary reaction are correlative to the diabetic control. The incidence of prolonged MCV, spastic miosis and sluggish reaction of the pupils and abnormal residual volume of the urine is remarkably higher in diabetics than borderline cases, and increases with progression of retinopathy and with the duration of diabetes.
Absent ankle jerks and impaired vibratory sense and sluggish reaction of the pupils are the earliest signs for diabetes mellitus. Abnormal pupillary reaction including spastic miosis and abnormal post voiding films are not only found in diabetics with long duration but also common in younger group aged below 29 years old, and visceral neuropathy is often an initial sign of diabetes.
Insulinogenic index was measured in 92 cases with mild glucose intolerance. The cases with 30'ΔI/ΔG of 0.49 or less were not always compulsory to have diabetic neuropathy, but most of the cases who had any single sign of neuropathy showed low 30'ΔI/ΔG.
In general, the impaired vibratory sense, absent ankle jerks and slow contraction of the pupils are found in early stage with relatively higher incidence and spastic miosis, sluggish and shallow reaction of the pupils, abnormal post voiding film and prolonged MCV are closely related to diabetic retinopathy and also to the degree of control. Therefore, the development of diabetic neuropathy is caused by metabolic derangement but its progress appears to be related to morphological disorder such as diabetic microangiopathy.
