Presentation
Abstract Diabetic polyneuropathy (DPN) has several forms of clinical presentation. It may be asymptomatic, or present with prominent sensory symptoms, including neuropathic pain. [ncbi.nlm.nih.gov]
Entire Body System
- Burning Pain
An 80-year-old man with a history of diabetes mellitus complained of low back pain along with burning pains in the lower extremities and poor balance. [ncbi.nlm.nih.gov]
The primary outcome measure was the change from baseline of the Total Symptom Score (TSS), including stabbing pain, burning pain, paresthesia, and asleep numbness of the feet. [drperlmutter.com]
Symptoms typically include numbness, tingling, and/or burning pain in the extremities. Autonomic nerve dysfunction may occur and cause constipation, erectile dysfunction, dizziness, and urinary incontinence. [visualdx.com]
pain) or numbness present symmetrically in both feet, determined to be on a peripheral nerve basis Total Neuropathy score of ≥ 2 based on symptoms, signs, and nerve conduction study abnormality Average pain on Likert scale (range 0 - 10) ≥5 Good diabetic [clinicaltrials.gov]
Diabetic neuropathy commonly causes painful tingling or burning sensations in the hands and feet—a condition called distal polyneuropathy. Pain is often worse at night and may be aggravated by touch or by a change in temperature. [merckmanuals.com]
- Burning Feet
The first signs and symptom are hypoalgesia, burning feet particularly during the night increasing with touch, and paraesthesia of the feet. Paroxysmal shooting pains also occur. [pijn.com]
For sensory neuropathy: Numbness or tingling in the feet Pain or discomfort in the feet or legs, including prickly, sharp pain or burning feet For motor neuropathy: Muscle weakness and loss of muscle tone in the feet and lower legs Loss of balance Changes [foothealthfacts.org]
One individual, who reported burning feet at night, slept with her feet uncovered and a fan blowing cool air on them. [nfb.org]
Besides that, patients with burning feet due to small fiber neuropathy are not expected to have abnormalities in nerve conduction studies. [scielo.br]
- Progressive Polyneuropathy
Ms Q is a 52-year-old woman who has had progressive polyneuropathy in the setting of diabetes for the past 8 years. [ncbi.nlm.nih.gov]
Cardiovascular
- Tachycardia
It may present with: Cardiac autonomic neuropathy, which has been linked to [ 5 ] : Resting tachycardia, postural hypotension, orthostatic bradycardia and orthostatic tachycardia. Exercise intolerance. Decreased hypoxia-induced respiratory drive. [patient.info]
Subclinical impairment CVS, GI, GU dysfunction Orthostatic hypotension, resting tachycardia, diminished heart-rate response to respiration Vagal denervation of heart- high resting pulse & loss of sinus arrhythmia. Painless or silent myocardial infarction [slideshare.net]
Clinical findings may include exercise intolerance, persistent sinus tachycardia, no variation in heart rate during activities, and bradycardia. Baroreceptor disease contributes to supine hypertension. [aafp.org]
Skin
- Foot Ulcer
It can also lead to foot ulcers and amputation. [cochrane.org]
Exclusion criteria were: physical problems leading to instability, BMI>35 kg/m2, ankle fractures in history, amputations proximal to the tarsometatarsal joints, active foot ulcer(s), severe occlusive peripheral vascular diseases. [ncbi.nlm.nih.gov]
- Skin Fissure
Patients should be instructed to inspect their feet daily for dry or cracking skin, fissures, plantar callus formation, and signs of infection between the toes and around the toenails. 22, 23 Application of topical ointments to intertriginous areas should [aafp.org]
Musculoskeletal
- Numbness of the Feet
There may be loss of muscle in the feet, legs, hands, and hips along with difficulties with walking, balance, and coordination. With numbness of the feet, pressure points from shoes may not be felt, leading to ulcers and infections. [jamanetwork.com]
The primary outcome measure was the change from baseline of the Total Symptom Score (TSS), including stabbing pain, burning pain, paresthesia, and asleep numbness of the feet. [drperlmutter.com]
Symptoms can range from pain and numbness in your feet to problems with the functions of your internal organs, such as your heart and bladder. What Is Diabetic Neuropathy? Diabetic neuropathy is nerve damage that is caused by diabetes. [niddk.nih.gov]
Peripheral neuropathy most commonly causes : pain, burning, tingling, and numbness of the feet and lower legs. [medicinenet.com]
Neurologic
- Paresthesia
Its symptoms are paresthesia, dysesthesia and pain. The signs of damage to the peripheral neurons are hypoesthesia, hypoalgesia, hyperesthesia and hyperalgesia, decreased tendon reflexes, and, possibly, weakness and muscle atrophy. [ncbi.nlm.nih.gov]
Numbness and paresthesia may accompany or precede loss of motor function, which varies from mild to severe. Laboratory findings include elevated protein levels in the cerebrospinal fluid. [medical-dictionary.thefreedictionary.com]
Treatment Treatment of diabetic neuropathies depends on optimum diabetic control, exercise and weight loss to reduce insulin resistance, and symptomatic control when paresthesias are painful. [hopkinsmedicine.org]
- Radiculopathy
We evaluated sensitivity in 100 diabetic patients with suspected polyneuropathy, and specificity in 200 non-diabetic patients with suspected lumbosacral radiculopathy. All results were expressed in number of standard deviations (SD). [ncbi.nlm.nih.gov]
Skip to main content General Medicine Samir Malkani, MD, MRCP—UK Reviewed 06/2018 Peripheral nerve dysfunction seen in diabetes; several patterns described ( 1 ): Symmetric polyneuropathy Distal sensory or sensorimotor Mononeuropathy, radiculopathy, and [5minuteconsult.com]
Radiculopathy occurs when the root of a nerve is pinched. [pharmacytimes.com]
This could actually be an advantage, since healthy subjects are not referred for neurophysiological evaluation, and lumbosacral radiculopathy is an important differential diagnosis. [scielo.br]
- Ataxia
In order to qualify under this listing, you must be diagnosed with neuropathy that is characterized by tremor, ataxia, paralysis, or involuntary movement in two of your arms or legs, causing you the inability to perform gross motor and fine movements, [disability-benefits-help.org]
Home, Search, Index, Links, Pathology, Molecules, Syndromes, Muscle, NMJ, Nerve, Spinal, Ataxia, Antibody & Biopsy, Patient Info DIABETES: NEUROPATHIES & NEUROMUSCULAR DISORDERS CLASSIFICATION OF DIABETES MELLITUS OVERVIEW: DIABETES & NEUROPATHY Prevalence [neuromuscular.wustl.edu]
Weakness and ataxia, likelihood of falling 15 times unaffected. 7. 25% had symptoms, 50% had neuropathy after ankle reflex or vibration test. 90% positive on sophisticated tests of autonomic function or peripheral sensation. Major morbidity is [slideshare.net]
Motor examinations did not show any atrophy, fasciculations and ataxia. He was able to ambulate well, including a good toe and heel walking. Deep tendon reflexes were symmetric and graded +2 in all extremities. [openaccessjournals.com]
- Dysesthesia
Abstract Patients with diabetes occasionally develop diabetic polyneuropathy (DPN), which is characterized by both positive symptoms such as pain and negative symptoms such as numbness/dysesthesia. [ncbi.nlm.nih.gov]
[…] standing up a faster heart rate than normal excessive sweating, even in cool temperatures or while at rest bladder problems, for example, difficulty emptying the bladder completely when urinating, leading to incontinence sexual dysfunction in men and women dysesthesia [medicalnewstoday.com]
- Seizure
Neuropathic pain due to diabetic neuropathy can be treated with anti-seizure medications, antidepressants, or analgesics, including opiate drugs. [hopkinsmedicine.org]
Anti- seizure drugs such as gabapentin ( Neurontin ), carbamazepine ( Tegretol ), and pregabalin ( Lyrica ) are drugs that can also work to relieve pain in people with diabetic neuropathy. In severe cases, opioid analgesic medications may be needed. [medicinenet.com]
These medicines may be tried to reduce your pain even though you do not have depression or seizures. Complementary therapies such as acupuncture and biofeedback Physiotherapy such as exercises, stretching, and massage. [healthlinkbc.ca]
Workup
The workup is completed by the performance of an electromyogram with nerve conduction studies to quantitate the extent of involvement of the peripheral nervous system. Diabetic neuropathy, unfortunately, has no effective treatment at this point. [bcm.edu]
(See Workup.) Management of diabetic neuropathy should begin at the initial diagnosis of diabetes. [emedicine.medscape.com]
Treatment
Preoperative clinical sensory testing did not differentiate between treatment responders from non-responders. CONCLUSIONS: SCS seems to be an efficacious and feasible treatment for intractable PDP. [ncbi.nlm.nih.gov]
Prognosis
AIMS/HYPOTHESIS: Early diagnosis of diabetic polyneuropathy (DPN) is critical for a good prognosis. [ncbi.nlm.nih.gov]
The prognosis for diabetic neuropathy is based on the type of neuropathy. As discussed in an earlier question, there are several type of diabetic neuropathy and listed below is the prognosis of each. [sharecare.com]
Prognosis for Diabetics with Neuropathy The prognosis for diabetic neuropathy depends largely on how well the underlying condition of diabetes is handled. [agingcare.com]
When the velocity of the fastest conducting fibers is maintained, the prognosis is favorable. Neurological impairment is less likely in this instance. [dynamicchiropractic.com]
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]
Etiology
Treatment should be directed to improve etiologic factors besides reducing symptoms; several approaches have been evaluated to reduce neuropathic impairments and improve nerve conduction, such as oral antidiabetics, statins, and antioxidants (alpha-lipoic [ncbi.nlm.nih.gov]
Antioxidants are considered to be the only etiologic management for diabetic polyneuropathy, and statins such as rosuvastatin increase nitric oxide bioavailability and reduce lipid peroxidation. [dovepress.com]
Additionally, patients can be referred if the diagnosis is unclear or if a different etiology is suspected. [pharmacytimes.com]
Proposed vascular etiologies include nerve dysfunction secondary to disease of vasa nervorum, the microvasculature to the nerves. [practicalpainmanagement.com]
You can also refer if the diagnosis is unclear or different etiology is suspected. [labblog.uofmhealth.org]
Epidemiology
Abstract This chapter outlines: (1) the reasons why epidemiologic surveys and randomized controlled clinical trials (RCTs) of diabetic polyneuropathy (DPN) are difficult and expensive, and often poorly done, (2) primary and secondary neuropathy end points [ncbi.nlm.nih.gov]
Epidemiological correlates of diabetic neuropathy. Report from Pittsburgh Epidemiology of Diabetes Complications Study. Diabetes 1989;38:1456–1461. PubMed CrossRef Google Scholar 5. Ziegler D. [link.springer.com]
The epidemiology of diabetic neuro-pathy depends on the case definitions used. [practicalpainmanagement.com]
Pathophysiology
Its pathophysiological mechanism is not completely clarified and major occurrences boil down to the change in neural phenotype and vasa nervorum. [ncbi.nlm.nih.gov]
Prevention
We concentrate on the prevention of the long-term deficits of neuropathy. [ncbi.nlm.nih.gov]