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Diabetic Neuropathy

Diabetic neuropathy is a common neuropathic disorder associated with diabetes mellitus.


Presentation

Presentation is dependent on the type of neuropathy being dealt with [6].

Peripheral neuropathy

Autonomic neuropathy

Radiculoplexus neuropathy

Mononeuropathy

  • Difficulty focusing the eyes, double vision or aching behind one eye
  • Paralysis on one side of your face (Bell's palsy)
  • Pain in the shin or foot
  • Pain in the front of the thigh
  • Chest or abdominal pain
Lymphedema
  • However, because lymphedema was also observed at the same site, this lesion could also be diagnosed as elephantiasis nostras verrucosa arising in diabetic neuropathy.[ncbi.nlm.nih.gov]
Chest Discomfort
  • During a head-up tilt test, his heart rate increased from 105 to 155 beats/minute within 3 minutes, and chest discomfort began.[ncbi.nlm.nih.gov]
Nausea
  • Erythromycin, domperidone (Motilium), or metoclopramide (Reglan) may help with nausea and vomiting. Pain medications (analgesics) may work for some patients on a short-term basis, but in most cases they do not provide much benefit.[web.archive.org]
  • Conversely, alteration of the inhibitory neural pathways results in impaired relaxation of the stomach in response to a meal; in this case increased wall tension may produce early satiation, fullness and nausea.[ncbi.nlm.nih.gov]
  • Consider gastric emptying studiesif the individual has persistent nausea/vomiting.[nhshighland.scot.nhs.uk]
  • In blood vessels: Symptoms include: Blacking out when you stand up quickly Faster heartbeat Dizziness Low blood pressure Nausea Vomiting Feeling full sooner than normal If you have it: Avoid standing up too quickly.[webmd.com]
  • Peppermint and ginger can stop the nausea induced by cayenne if it is still a problem. In addition, cayenne is a laxative. Once your body adapts to cayenne, the laxative effect will stop.[earthclinic.com]
Dyspepsia
  • Symptoms such as anorexia, nausea, vomiting, and dyspepsia are nonspecific and resemble many other conditions ( 186 ) and may just be associated with the presence of diabetes ( 181 ).[doi.org]
  • In clinical trials, only a few adverse effects have been reported - transient mild headache, flushing, dyspepsia, and some altered color vision.[health.am]
  • The withdrawal related adverse events for tramadol were dyspepsia and nausea. Common adverse events related to use of tramadol were nausea, constipation, headache, and somnolence.[doi.org]
Abdominal Mass
  • In patients with diabetes who have a painful abdominal mass, the potential presence of a diabetic truncal neuropathy should be considered.[ncbi.nlm.nih.gov]
Left Ventricular Dysfunction
  • ventricular dysfunction, silent or asymptomatic myocardial infarction, and exercise intolerance. [1,13,14,15] There is evidence that the disease process may begin early in the course of diabetes but remain asymptomatic until later stages. [1,13,15] Gastroparesis[medscape.com]
Diplopia
  • The onset of a diabetic third nerve palsy is usually abrupt, beginning with frontal or periorbital pain and then diplopia.[en.wikipedia.org]
  • The patient with cranial nerve involvement usually has diplopia and single third, fourth, or sixth nerve weakness on examination but the pupil is spared. A full recovery of function occurs in 6-12 weeks.[health.am]
  • Cranial nerve III involvement results in ophthalmoplegia, ptosis, and diplopia with sparing of pupillary function. The median, radial, and lateral popliteal nerves are the most common sites of peripheral nerve involvement.[aafp.org]
Retinal Pigmentation
  • Perpendicular CT was measured from the outer edge of the hyperreflective retinal pigment epithelium to the inner sclera at seven locations: the fovea; and 500, 1000, and 1500 μm temporally and nasally to the fovea.[ncbi.nlm.nih.gov]
Vaginal Dryness
  • If you have vaginal dryness, your doctor may suggest a lubricant. If you have erectile dysfunction, they may prescribe medication that can help.[healthline.com]
  • dryness and other sexual difficulties in women Increased or decreased sweating Inability of the body to adjust blood pressure and heart rate, leading to sharp drops in blood pressure following rise from sitting or lying down (orthostatic hypotension)[symptoma.com]
  • dryness or orgasm problems in women.[mountsinai.org]
  • Female sexual dysfunction may manifest as diminished libido as a result of vaginal dryness and pain during intercourse (dyspareunia). [16,17] Neurogenic bladder or cystopathy may also be caused by diabetic autonomic neuropathy and can result in the inability[medscape.com]
Sexual Dysfunction
  • In diabetic autonomic neuropathy, the patients may experience persistent nausea, vomiting, diarrhea, constipation, incontinence, sweating abnormalities or sexual dysfunction.[hopkinsmedicine.org]
  • Female sexual dysfunction may manifest as diminished libido as a result of vaginal dryness and pain during intercourse (dyspareunia). [16,17] Neurogenic bladder or cystopathy may also be caused by diabetic autonomic neuropathy and can result in the inability[medscape.com]
  • Symptoms of autonomic nerve dysfunction include: erectile or sexual dysfunction loss of bladder or bowel control abnormal sweating with inability to tolerate changes in temperature abnormal blood pressure control, causing lightheadedness when standing[healthcentral.com]
Urinary Incontinence
  • Serious foot problems, such as ulcers, infections, deformities, and bone and joint pain Autonomic neuropathy A lack of awareness that blood sugar levels are low (hypoglycemia unawareness) Bladder problems, including frequent urinary tract infections or urinary[symptoma.com]
  • For example, antispasmodic or anticholinergic drugs can help prevent urinary incontinence .[medicinenet.com]
  • For example, antispasmodic or anticholinergic drugs can help prevent urinary incontinence.[medicinenet.com]
  • The urinary tract may also be affected, and at the worst stages this can cause urinary incontinence. Also, neuropathy can decrease sexual response in both men and women.[diabetes.co.uk]

Workup

The condition is diagnosed based on symptoms presented, a physical exam and a medical history [7]. During the exam, the muscle strength and tone is checked, tendon reflexes as well as sensitivity to touch, temperature and vibration are also checked. Other tests that may be conducted include the following:

  • Filament test
  • Nerve conduction studies
  • Electromyography (EMG)
  • Quantitative sensory testing
  • Autonomic testing
HLA-DR3
  • They include the following: Poor glycemic control Advanced age Hypertension Long duration of diabetes mellitus Dyslipidemia Smoking Heavy alcohol intake HLA-DR3/4 phenotype Tall height Development of symptoms is however, dependent on a variety of factors[symptoma.com]

Treatment

Diabetic neuropathy has no known cure [8] [9]. Treatment and management is mostly focused on slowing of the progression of the disease, relieving of pain, management of complications and restoration of functions.

Prognosis

  • Prognosis of diabetic neuropathy is an uphill task as it remains silent for several years after the onset of diabetes.[ncbi.nlm.nih.gov]
  • Expectations (prognosis) Treatment relieves pain and can control some symptoms, but the disease generally continues to get worse.[web.archive.org]
  • Prognosis of Diabetic Neuropathy The prognosis for diabetic neuropathy depends largely on how well the underlying condition of diabetes is handled. Treating diabetes may halt progression and improve symptoms of the neuropathy, but recovery is slow.[sydneynorthneurology.com.au]
  • More than 100 types of peripheral neuropathy have been identified, each with its own symptoms and prognosis, according to the National Institute of Neurological Disorders and Stroke.[practicalpainmanagement.com]

Etiology

There are certain risk factors associated with more severe cases of diabetic neuropathy. They include the following [2]:

Development of symptoms is however, dependent on a variety of factors such as the total hyperglycemic exposure as well as other risk factors like elevated lipds, blood pressure, smoking, increased height as well as excessive exposure to some other neurotoxic agents like ethanol. Genetic factors have also be considered to have a role.

Epidemiology

In the United States, 47% of patients with diabetes show some peripheral neuropathy [3]. Neuropathy is believed to be seen in 7.5% of patients at the time of diagnosis of diabetes with more than half of the cases demonstrating distal symmetric polyneuropathy. Internationally, figures are far lower.

Diabetes mellitus affects men and women with the same frequency. However, male patients with type 2 diabetes may develop polyneuropathy much earlier than their female counterparts. Diabetic neuropathy can be seen at any age but it is most common with increasing age, severity and duration of the diabetes.

Sex distribution
Age distribution

Pathophysiology

The major factors responsible for the development of diabetic neuropathy remains incompletely understood [4]. However, multiple hypotheses have been brought forward. It is generally believed that the condition is a multifactorial process.

Development of symptoms is dependent on several factors such as total hyperglycemic exposure and other risk factors like elevated lipids, blood pressure, smoking, increased height, as well as high exposure to other potentially neurotoxic agents like ethanol. Genetic factors can also play a role.

Important contributing biochemical mechanisms in the development of the more commonly known symmetrical forms of diabetic polyneuropathy may include the following: polyol pathway, advanced glycation end products as well as oxidative stress.

Prevention

  • Prevention Tight control of blood sugar levels may prevent neuropathy in many people with type 1 diabetes, and may reduce the severity of symptoms. In addition, regular foot care can prevent a small infection from getting worse.[web.archive.org]
  • No single treatment exists to prevent or reverse neuropathic changes or to provide total pain relief.[ncbi.nlm.nih.gov]
  • SETTING: This study was part of a longitudinal cohort study of a nurse-led health promotion programme for preventing foot ulceration in Chiayi County, Taiwan.[ncbi.nlm.nih.gov]
  • Hassan Murad, MD, MPH, Department of Medicine, Division of Preventive Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905; e-mail, murad.mohammad@mayo.edu. Current Author Addresses: Drs.[doi.org]
  • PREVENTION Prevention of diabetic neuropathies focuses on glucose control and lifestyle modifications.[doi.org]

Summary

Diabetic neuropathies refer to any of the neuropathic disorders that are commonly associated with diabetes mellitus [1]. These conditions are believed to arise mostly from diabetic microvascular injuries which often involve the small blood vessels responsible for supplying nerves as well as macrovascular conditions that may end up in diabetic neuropathy. There are 4 major types of neuropathy: Peripheral neuropathy, autonomic neuropathy, radiculoplexus neuropathy or diabetic amyotrophy and mononeuropathy.

Patient Information

Diabetic neuropath refers to a type of nerve damage which can occur in people with diabetes. High blood sugar may bring about injury to the nerve fibres around the body but diabetic neuropathy is focused on the legs and feet.

Depending on the affected nerves, symptoms of diabetic neuropathy can range from pain, to numbness in the extremities as well as problems in the urinary tract, digestive tract, blood vessels and the heart. For some people, these symptoms are often mild while for others, diabetic neuropathy can be fatal, painful or disabling.

Diabetic neuropathy is common but serious complication of diabetes that can only be controlled by sticking to prescribed blood sugar controls and living a healthy lifestyle. 

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Last updated: 2019-07-11 21:13