Nerve conduction slowing in acute diabetes in animals has been associated with both a diminished axolemmal transmembrane Na+ potential and a myo-inositol-related defect in nerve Na+-K+-ATPase activity. The interaction between these two potentially related defects, their reversibility, and their possible role in the nerve conduction slowing and axonopathy of diabetes are not well defined. Therefore, the effects of rigorous insulin replacement on peripheral nerve conduction velocity, myoinositol content, and Na+-K+-ATPase activity were studied in the spontaneously diabetic BB-Wistar rat, an animal model that manifests both conduction slowing and a characteristic progressive axonopathy. Twelve weeks of sustained hyperglycemia reduced both motor conduction velocity and Na+-K+-ATPase activity in sciatic nerve. Six weeks of subsequent vigorous insulin replacement normalized the enzymatic defect but only partially corrected diminished nerve conduction velocity. Hence, nerve conduction slowing in diabetic animals may be partly attributable to reduced nerve Na+-K+-ATPase activity, but a less readily reversible component of conduction slowing probably reflects structural alterations that occur in nerve within the first 3 mo of diabetes.