Diabetic Neuropathy

This develops due to a combination of ischaemia, axonal degeneration, and demyelination in diabetic patients.

  • Typically worse at night

Types of Neuropathy in Diabetes
  • There are several different types of peripheral neuropathy in diabetes
    • Typically there is a mixture
  1. Symmetrical generalised peripheral neuropathy
    • Like other causes, diabetic peripheral neuropathy  has a  glove/stocking distribution is the main presentation
    • Features mainly present in the feetsee diabetic foot:
      • Numbness
        • Results in repetitive trauma injury leading Charcot arthropathy) and neuropathic foot ulceration
      • Paraesthesia
      • Pain can occur especially in the night
      • Absent ankle Jerks
    • Management: mainly  vigilance
      • Analgesics can also help with neuropathic pain, especially adjuvant analgesics (Amitriptyline, SSRIs, Gabapentin)
  1. Autonomic neuropathy
    • Autonomic nerves can also be affects as well as somatic nerves
    • Features depend on the organs affected:
      • Erectile dysfunction
      • Postural hypotension
      • Gastroparesis
      • Constipation
      • Urinary urge incontinence (neurogenic bladder)
    • Treatment is symptomatic
  1. Diabetic Mononeuropathy
    1. Carpal tunnel syndrome causing compression of median nerve the most  commonly seen
    2. CNIII and CNVI palsies are also fairly common
  1. Diabetic Amyotrophy
    • Painful wasting of the pelvifemoral muscles can occur – e.g. the lateral quadriceps are often affected
    • IVIg can help treat