Diabetic Neuropathy Flashcards
What diabetic neuropathy?
Describes a group of nerve disorders caused by diabetes
What are the 4 major diabetes-related pathologies?
- Cardiovascular compromise
- Retinal compromise
- Retinopathy
- Neuropathy
What can diabetic neuropathy be?
Peripheral - feet, lower limbs and hands
Autonomic - heart, BP, bladder and sexual response
Focal - any nerves in the body, including eyes and brain
What can diabetic neuropathy lead to?
- Death via compromised control of heart rate, BP & hypoglycaemia
- Lower limb amputation due to loss of sensation
- Chronic pain
- Depression in response to pain, functional loss or lifestyle change from above factors
- Vision and eye problems
What are the mechanisms of diabetic neuropathy?
Direct insult to nerve conduction response from compromised glycemic control
- Micro-angiopathy leading to neural ischemia & hypoxia
- Biochemical changes leading to increased sorbitol & reactive oxygen molecules within nerve cells
- loss of osmotic control
What are the clinical testing for diabetic peripheral neuropathy?
Skin biopsy - gold standard, painful slow & expensive
the healing is compromised so procedure is risky
Neuropathy disability score (NDS) - temperature, vibration and touch sensitivity
Nerve conduction studies (NCS) - expensive electrophysiological procedure, large motor nerves targeted
What is corneal confocal microscopy?
It is a rapid, non-invasive in vivo clinical examination technique capable of imaging corneal nerve fibres.
What is third nerve palsy?
- Exotropia and mild hypotropia
- medial, superior, inferior recti & inferior oblique affected
- ptosis due to levator palpebrae involvement
- possible fixed dilated pupil
- often diabetes related
What is sixth nerve palsy?
- It is usually acquired
- Can be partial (paresis) and difficult to confirm
- vascular in older px
- esotropia in primary gaze
- limitation of abduction on affected side
- head turn to affected side
