DIABETIC NEUROPATHY AND THE MICROCIRCULATION

There is a close relationship between the abnormal microcirculation in diabetic subjects and diabetic neuropathy. Neurogenic factors play a prominent role in the regulation of the microcirculation. In diabetic neuropathy, damage to these mechanisms results in a profound haemodyna mic disturbance with increased arteriovenous shunting, abnormal postur al regulation of blood flow, and abnormal inflammatory responses to ti ssue injury. Abnormal neurogenic regulation of microvascular haemodyna mics may contribute to the development of microangiopathy manifest as increased basement thickening and both are undoubtedly implicated in t he pathogenesis of diabetic foot ulceration. In turn it is now recogni zed that microvascular abnormalities may contribute to the ischaemic a etiology of diabetic neuropathy.