Diabetic neuropathy

Introduction

Diabetic neuropathy occurs in approximately 50% of individuals with long-standing type 1 and type 2 DM. There are two types of neuropathies; Microvascular and macrovascular

1. Microvascular
I. Hyperglycemic neuropathy
II. Acute painful sensory neuropathy
III. Sensory motor polyneuropathy
IV. Mononeuropathy
V. Diabetic truncal neuropathy
VI. Proximal diabetic neuropathy
VII. Autonomic neuropathy

2. Macrovascular
I. TIA & Strokes


Hyperglycemic neuropathy

This is common among newly diagnosed or poorly controlled diabetic patients. This is a very uncomfortable dysasthesiae affecting feet and lower legs. This condition is rapidly resolved with the establishment of euglycemia.

Acute painful sensory neuropathy

This condition is common among diabetic male whose glycemic control is poor. The patient will experience burning and aching pain. There is a widespread Cutaneous contact hyperesthesia. This is associated with depression and impotence. Proper control of blood sugar is the treatment.

Mononeuropathy

This is a dysfunction of isolated cranial or peripheral Nerves and it is less common than polyneuropathy in DM and presents with pain and motor weakness in the distribution of a single nerve. A vascular etiology has been suggested, but the pathogenesis is unknown. Involvement of the third cranial nerve is most common and is heralded by diplopia.


Diabetic truncal neuropathy

This occurs in thoracic nerve roots and it could be unilateral. Patient may have symptoms of chest pain or abdominal pain. This is commonly associated with Sensory motor and autonomic neuropathy

Proximal diabetic neuropathy/ proximal amyotrophy

• Involvement of lumbo - sacral nerves
• Metabolic in origin
• Middle aged or elderly
• Symptoms unilaterally or bilaterally
• Clinical features
• Prognosis - Good

Autonomic neuropathy

• Prevalence increases with poor control of DM and longer duration
• Poor prognostic indicator
• Symptoms
– Gustatory sweating
– Postural hypotension
– Diarrhoea alternating constipation
– Anhidrosis of limbs
– Small pupil
– Dysphagia and vomiting due to gastroparesis
– Impotence

TIA & Strokes

• Commonest brain disorder responsible for deaths and disability of adults.
• What are the risk factors?
• What are the clinical features?
• Characteristic feature is sudden onset of symptoms with maximum disability in the acute stage

Treatment

• Near normal glycaemic control
– DCCT -Reduced clinical neuropathy by 60% in Type I
– UKPDS - Reduced micro vascular complications by 25% in Type II
• Prevention of foot damage
– Screening
• Drugs
– Amitriptyline - Side effects
– Imipramine
– Carbemazepine
– Phenytoin
– GLA