Diabetic Neuropathy

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)

Diabetic Neuropathy

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