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Br Med J. 1978 January 21; 1(6106): 145–147.
PMCID: PMC1602825

Immediate heart-rate response to standing: simple test for autonomic neuropathy in diabetes.


The immediate heart-rate response to standing was measured in 22 normal controls and 25 patients with diabetes, 15 of whom had autonomic neuropathy. The response in the controls and patients without autonomic neuropathy was characteristic and consistent, with tachycardia maximal at around the 15th beat and relative bradycardia maximal at around the 30th beat. The diabetics with autonomic neuropathy, however, showed a flat response. In three controls the response was abolished with intravenous atropine but not with propranolol, showing that it is mediated through the vagus. A simplified test using routine ECGs and measuring the R-R interval at beats 15 and 30 with a ruler is easily performed as an outpatient procedure and may be used as a measure of autonomic function in diabetes.

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Selected References

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  • Ewing DJ, Irving JB, Kerr F, Wildsmith JA, Clarke BF. Cardiovascular responses to sustained handgrip in normal subjects and in patients with diabetes mellitus: a test of autonomic function. Clin Sci Mol Med. 1974 Mar;46(3):295–306. [PubMed]
  • Campbell IW, Ewing DJ, Clarke BF. Therapeutic experience with fludrocortisone in diabetic postural hypotension. Br Med J. 1976 Apr 10;1(6014):872–874. [PMC free article] [PubMed]
  • Page MM, Watkins PJ. Provocation of postural hypotension by insulin in diabetic autonomic neuropathy. Diabetes. 1976 Feb;25(2):90–95. [PubMed]
  • Wheeler T, Watkins PJ. Cardiac denervation in diabetes. Br Med J. 1973 Dec 8;4(5892):584–586. [PMC free article] [PubMed]
  • Murray A, Ewing DJ, Campbell IW, Neilson JM, Clarke BF. RR interval variations in young male diabetics. Br Heart J. 1975 Aug;37(8):882–885. [PMC free article] [PubMed]
  • Hill L. The Influence of the Force of Gravity on the Circulation of the Blood. J Physiol. 1895 May 20;18(1-2):15–53. [PubMed]
  • Page MM, Watkins PJ. The heart in diabetes: autonomic neuropathy and cardiomyopathy. Clin Endocrinol Metab. 1977 Jul;6(2):377–388. [PubMed]

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