Diabetic neuropathy

Question 1

Is diabetic neuropathy common?

Answer 1

• most common chronic complication of diabetes
• diagnosed after exclusion of other causes
• 50% of people with diabetes will develop DN during their lifetime

Question 2

What are RF for diabetic neuropathy?

Answer 2

1. poorly controlled hyperglycaemia
2. older age (e.g., >70 years)
3. prolonged duration of diabetes (e.g., >10 years)
4. tall stature
5. In T2DM: cardiovascular too

Question 3

What are symptoms and signs of diabetic neuropathy?

Answer 3

1. Some asymptomatic
2. Pain (peripheral)
3. Loss of sensation (peripheral) - stocking distribution
4. Dysaesthesia (peripheral)
5. Painless injuries (peripheral)
6. Reduced or absent ankle reflexes
7. Erectile dysfunction

Question 4

What are possible DDx of diabetic neuropathy ?

Answer 4

1. Uraemia
2. Hypothyroidism
3. Chronic high alcohol intake
4. Drug-induced neuropathy
5. Heavy metal poisoning
6. Guillain Barre syndrome
7. Myasthenia gravis
8. Sarcoidosis
   Etc

Question 5

What investigations do you carry out for diabetic neuropathy?

Answer 5

1. Clinical diagnosis
2. Fasting blood glucose + HbA1c
3. Serum TSH
4. Serum Vit B12
5. Electrolytes ,urea, creatinine
6. LFTs
7. FBC and erythrocyte sedimentation rate

Question 6

What is the management plan for diabetic neuropathy?

Answer 6

• 1st line Glycaemic control

- w/pain 1st line: Pregabalin or gabapentin and/or duloxetine (neuropathic pain agent)

Question 7

What are possible complications of diabetic neuropathy?

Answer 7

1. Foot wound/ulcers
2. Wound infection
3. Amputation
4. Silent MI
5. Death
6. Depression
7. Charcot foot

Question 8

What are types of neuropathy?

Answer 8

-peipheral
-mono
-autonomic
see nephropathy flashcards