Chapter 1
Diabetic Neuropathy
What is diabetic neuropathy?
Diabetic neuropathy is a medical disorder that causes nerve damage in people who have diabetes.
This nerve damage makes it hard for the nerve to transmit messages to the brain and other parts of the body.
What causes diabetic neuropathy?
Causes
Diabetes causes the level of sugar in the blood to be higher than normal.
Over time, high blood sugar levels damage the blood vessels and nerves.
That is why patients who do not control (or cannot control) their blood sugar very well tend to have diabetic neuropathy.
Men are more likely to have diabetic neuropathy than women.
High cholesterol levels and smoking also increase the risk.
What are the symptoms of diabetic neuropathy?
Symptoms
In type 1 DM, distal polyneuropathy normally becomes symptomatic after many years of chronic prolonged hyperglycemia
In type 2, it may appear after only a few years of known poor glycemic control or even at diagnosis.
Diabetic neuropathy can produce the following symptoms:
1. Sensory – Negative or positive, diffuse or focal; usually insidious in onset and showing a stocking and glove appearance in the distal extremities
a. Numbness (loss of feeling)
b. Painful tingling and burning in parts of the body, especially the fingers, toes, hands or feet
2. Motor – Distal, proximal, or more focal weakness, sometimes appearing as sensory neuropathy (sensorimotor neuropathy)
a. Muscle weakness and difficulty walking
3. Autonomic – Neuropathy that may affect the cardiovascular, gastrointestinal, and genitourinary systems and the sweat glands
a. Bladder problems such as urinary tract infections and urinary incontinence (the loss of bladder control)
b. Digestive problems e.g., bloating, constipation, nausea, vomiting, abdominal pain, and diarrhea
c. Erectile dysfunction in men and vaginal dryness in women
4. Cuts, sores or blisters on the feet that do not hurt as much as the patient would expect, and that also heal very slowly
Physical examination should include the following evaluation:
1. Peripheral neuropathy testing:
a. Gross light touch and pinprick sensation;
b. Vibratory sense;
c. Deep tendon reflexes;
d. Strength testing and muscle atrophy;
e. Dorsal pedal and posterior tibial pulses;
f. Skin assessment;
g. Tinel testing; cranial nerve testing
2. Autonomic neuropathy testing
Objective evaluation of cardiovagal, adrenergic, and sudomotor function in a specialized autonomic laboratory;
It may be preceded by bedside screening to assess heart rate and supine and upright blood pressure with evaluation of sinus arrhythmia ratio
Two classification systems for diabetic neuropathy are the Thomas system and the symmetrical vs. asymmetrical system.
The Thomas system (modified) is as follows:
1. Hyperglycemic neuropathy
2. Generalized symmetrical polyneuropathies
3. Sensory neuropathy
4. Sensorimotor neuropathy
5. Autonomic neuropathy
6. Focal and multi-focal neuropathies
7. Superimposed chronic inflammatory demyelinating polyneuropathy
Distal symmetrical sensorimotor polyneuropathy is frequently defined according to the following 3 key criteria:
1. The patient suffer from diabetes mellitus consistent with a widely accepted definition
2. Severity of polyneuropathy should be commensurate with duration and severity of diabetes
3. Other causes of sensorimotor polyneuropathy must be excluded
Pure autonomic diabetic neuropathy is rare.
Asymmetrical neuropathies are:
1. Median neuropathy of the wrist (carpal tunnel syndrome)
2. Other single or multiple limb mononeuropathies
3. Thoracic radiculoneuropathy
4. Lumbosacral radiculoplexus neuropathy
5. Cervical radiculoplexus neuropathy
TABLE OF CONTENT
Introduction
Chapter 1 Diabetes Neuropathy
Chapter 2 Causes
Chapter 3 Symptoms
Chapter 4 Diagnosis
Chapter 5 Treatment
Chapter 6 Prognosis
Chapter 7 Peripheral Neu
Diabetic Neuropathy
What is diabetic neuropathy?
Diabetic neuropathy is a medical disorder that causes nerve damage in people who have diabetes.
This nerve damage makes it hard for the nerve to transmit messages to the brain and other parts of the body.
What causes diabetic neuropathy?
Causes
Diabetes causes the level of sugar in the blood to be higher than normal.
Over time, high blood sugar levels damage the blood vessels and nerves.
That is why patients who do not control (or cannot control) their blood sugar very well tend to have diabetic neuropathy.
Men are more likely to have diabetic neuropathy than women.
High cholesterol levels and smoking also increase the risk.
What are the symptoms of diabetic neuropathy?
Symptoms
In type 1 DM, distal polyneuropathy normally becomes symptomatic after many years of chronic prolonged hyperglycemia
In type 2, it may appear after only a few years of known poor glycemic control or even at diagnosis.
Diabetic neuropathy can produce the following symptoms:
1. Sensory – Negative or positive, diffuse or focal; usually insidious in onset and showing a stocking and glove appearance in the distal extremities
a. Numbness (loss of feeling)
b. Painful tingling and burning in parts of the body, especially the fingers, toes, hands or feet
2. Motor – Distal, proximal, or more focal weakness, sometimes appearing as sensory neuropathy (sensorimotor neuropathy)
a. Muscle weakness and difficulty walking
3. Autonomic – Neuropathy that may affect the cardiovascular, gastrointestinal, and genitourinary systems and the sweat glands
a. Bladder problems such as urinary tract infections and urinary incontinence (the loss of bladder control)
b. Digestive problems e.g., bloating, constipation, nausea, vomiting, abdominal pain, and diarrhea
c. Erectile dysfunction in men and vaginal dryness in women
4. Cuts, sores or blisters on the feet that do not hurt as much as the patient would expect, and that also heal very slowly
Physical examination should include the following evaluation:
1. Peripheral neuropathy testing:
a. Gross light touch and pinprick sensation;
b. Vibratory sense;
c. Deep tendon reflexes;
d. Strength testing and muscle atrophy;
e. Dorsal pedal and posterior tibial pulses;
f. Skin assessment;
g. Tinel testing; cranial nerve testing
2. Autonomic neuropathy testing
Objective evaluation of cardiovagal, adrenergic, and sudomotor function in a specialized autonomic laboratory;
It may be preceded by bedside screening to assess heart rate and supine and upright blood pressure with evaluation of sinus arrhythmia ratio
Two classification systems for diabetic neuropathy are the Thomas system and the symmetrical vs. asymmetrical system.
The Thomas system (modified) is as follows:
1. Hyperglycemic neuropathy
2. Generalized symmetrical polyneuropathies
3. Sensory neuropathy
4. Sensorimotor neuropathy
5. Autonomic neuropathy
6. Focal and multi-focal neuropathies
7. Superimposed chronic inflammatory demyelinating polyneuropathy
Distal symmetrical sensorimotor polyneuropathy is frequently defined according to the following 3 key criteria:
1. The patient suffer from diabetes mellitus consistent with a widely accepted definition
2. Severity of polyneuropathy should be commensurate with duration and severity of diabetes
3. Other causes of sensorimotor polyneuropathy must be excluded
Pure autonomic diabetic neuropathy is rare.
Asymmetrical neuropathies are:
1. Median neuropathy of the wrist (carpal tunnel syndrome)
2. Other single or multiple limb mononeuropathies
3. Thoracic radiculoneuropathy
4. Lumbosacral radiculoplexus neuropathy
5. Cervical radiculoplexus neuropathy
TABLE OF CONTENT
Introduction
Chapter 1 Diabetes Neuropathy
Chapter 2 Causes
Chapter 3 Symptoms
Chapter 4 Diagnosis
Chapter 5 Treatment
Chapter 6 Prognosis
Chapter 7 Peripheral Neu
