Diabetic neuropathy

Question 1

What is diabetic neuropathy?

Answer 1

a group of nerve disorders caused by diabetes

Question 2

What are the 4 major diabetes-related pathologies?

Answer 2

cardiovascular compromise
renal compromise
retinopathy
neuropathy

Question 3

What are the 3 types of diabetic neuropathy?

Answer 3

peripheral - feet, lower limbs, hands
autonomic - heart, BP, bladder, sexual response
focal - any nerves in the body including eyes and brain

Question 4

What can diabetic neuropathy lead to?

Answer 4

1. death - compromised control of heart rate, BP, hyperglycaemia
2. lower limb amputation - loss of sensation or ulceration to feet/toes
3. chronic pain - causing sexual dysfunction
4. depression - loss of function, lifestyle change
5. vision and eye problems

Question 5

How can diabetic neuropathy affect the eyes?

Answer 5

1. ocular motility and strabismus
2. corneal sensory nerves
3. corneal sensitivity
4. retinal nerve structure
5. visual field sensitivity
6. pupil reactions
7. colour perception
8. light and dark adaptation

Question 6

What are the indications to diabetic peripheral neuropathy (DPN)?

Answer 6

1. loss of sensation
2. loss of balance
3. ulceration of feet
4. lower limb amputation risk
5. motility and independence loss
6. personal distress and hardship

Question 7

How do you clinically test for DPN?

Answer 7

1. skin biopsy - gold standard
2. neuropathy disability score
3. quantitative sensory testing
4. nerve conduction studies

Question 8

What are the implications for reduced corneal sensitivity due to DPN?

Answer 8

cl wear
foreign bodies
dry eye

Question 9

Which cranial nerves are affected in ocular motility due to DPN?

Answer 9

3rd and 6th cranial nerves. Likely ischaemic in nature - lead to non-concomitant strabismus

Question 10

What are other conditions of the eye due to DPN?

Answer 10

1. colour vision loss - often blur/yellow loss
2. pupil responses compromised - small, hard to dilate, sluggish response