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
- Symmetrical generalised peripheral neuropathy
- Like other causes, diabetic peripheral neuropathy has a glove/stocking distribution is the main presentation
- Features mainly present in the feet– see 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
- Numbness
- Management: mainly vigilance
- Analgesics can also help with neuropathic pain, especially adjuvant analgesics (Amitriptyline, SSRIs, Gabapentin)
- 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
- Diabetic Mononeuropathy
- Carpal tunnel syndrome causing compression of median nerve the most commonly seen
- CNIII and CNVI palsies are also fairly common
- Diabetic Amyotrophy
- Painful wasting of the pelvifemoral muscles can occur – e.g. the lateral quadriceps are often affected
- IVIg can help treat