Diabetic neuropathy

Question 1

What causes diabetic neuropathy?

Answer 1

-Longstanding hyperglycaemia leads to:
1. Enhanced advanced glycosylation end-product formation
2. Oxidative stress
3. Excessive cytokine release etc
-Leads to sparse vascular supply to axons, especially longer ones, causing hypoxic damage

Question 1

What are the common features of diabetic neuropathy?

Answer 1

-Decreased sensation, numbness, tingling in glove and stocking distribution (but can be patchy so important to test all areas)
-Absent ankle jerks
-Charcot joint
-Loss of pain sensation leads to increased mechanical stress and repeated joint injury
-Swelling, instability and deformity

Question 2

How would you treat diabetic neuropathy?

Answer 2

NB v difficult
-DM control to avoid progression
-Avoid weight-bearing
-Pain control - paracetamol, gabapentin, pregabalin (opiates if severe)
-Regular chiropody
-Treat complications eg cellulitis, gangrene, surgical referral if necessary

Question 3

What must be taken into account when treating diabetic foot complications?

Answer 3

Degree of:
-Neuropathy (clinically)
-Ischaemia (clinically, doppler, angiography)
-Bone deformity (clinically, X-ray)
-Infection (swabs, blood culture, X-ray)