|
| |
| Diabetic neuropathy |
| Prevalence |
 | Most common cause of neuropathy |
| About 20% of diabetic has signs & symptoms of neuropathy |
| Most common over 50 years old |
|
| Types |
| Symmetric chronic polyneuropathy
 | most common |
| paresthesia in feet |
| Ankle jerk absent, foot ulcer, Neuropathic joints |
|
| Ophthalmoplegia
| III nerve palsy with pupil sparing |
| May affect VI & VII nerve |
| Usually spontaneous recovery in 6 - 12 weeks |
|
| Mononeuropathy & Mononeuropathy multiplex
| may affect Femoral, Sciatic, Median, Ulnar nerves |
| Compression neuropathy also common |
| Acute onset, painful, ischemic in nature |
|
| Diabetic amytrophy
| painful, asymmetrical |
| unilateral or bilateral |
| affect Lumbosacral plexus |
| Improve in 6 to 18 months |
|
| Diabetic polyradiculopathy
| thoracoabdominal pain and dysesthesia |
| T8-T12 most commonly involved |
| Good prognosis of recovery |
| Increased CSF protein |
|
| Autonomic neuropathy
| often superimposed on polyneuropathy |
| Postural hypotension |
| Pupil & lacrimal dysfunction |
| atonicity of GI & GU tracts |
| impotence |
|
|
| General treatment |
| Tight control of diabetes |
| Meticulous foot care |
| Avoid trauma |
| Symptomatic pain control |
|
| Postural hypotension |
| increase salt intake |
| elastic stocking |
| Fludrocortisone 0.1 mg qd, with gradual increase |
| Indomethacin 25 to 50 mg tid |
| Caffeine 200 mg in am |
|
| Further Reading |
Symposium on complications
of Diabetes - Postgrad Med Feb 99 : nephropathy, Joint mobility, Coronary artery disease |
|
