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Diabetic Neuropathy

Diabetic Neuropathy

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Diabetic Neuropathy
  • Diabetic microvascular disease (ischemia) + hyperglycemia (metabolic changes) can result in different types of diabetic neuropathy.
  • Thus, treatment involves glycemic control and pain management.
    • Diabetic foot screening to monitor changes in foot sensation.
    • Prevent progression to infection, gangrene, amputation.
  • Symmetric polyneuropathy
    • Most common.
    • Distal feet and hands (stocking-glove distribution).
    • Loss of sense of touch, temperature, proprioception
    • Note that dysfunction in the feet can lead to foot trauma and ulceration with infections, fractures, dislocations.
    • May involve small or large fibers.
Small fiber: pain, numbness, loss of temperature sensation but patients still perceive vibration and can sense position. Large fiber: More prone to foot ulceration and joint degenerations, more likely to have autonomic neuropathy. Patients experience muscle weakness and cannot perceive vibration or position, and lose deep tendon reflexes. Foot drop can occur with intrinsic foot muscle atrophy.
  • Autonomic neuropathy
    • Affects ANS, so can cause GI issues (nausea, vomiting, constipation, diarrhea), Urogenital issues (incontinence or retention, erectile dysfunction, reduced vaginal lubrication), Cardiovascular issues (exercise intolerance, tachycardia, orthostatic hypotension).
  • Radiculopathy caused by nerve root dysfunction
    • L2-L4 nerve roots: pain and weakness of the lower extremities
    • T4-T12: abdominal pain
  • Cranial neuropathy
    • CN3: ptosis, anisocoria, diplopia
    • CN 4/CN6: motor palsies
  • Mononeuropathy
    • Median nerve: finger weakness/numbness
    • Peroneal nerve: foot drop
    • Compression disorders (carpal tunnel syndrome)

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