Diabetic Neuropathy

Question 1

How does diabetes cause nerve damage

Answer 1

Hyperglycaemia and dyslipidemia damage the vasa nervorum supplying the nerves

Question 2

Describe the neuropathy seen in diabetes

Answer 2

Bilateral symmetrical glove and stocking neuropathy - starts in the legs and then the hands. Typically causes loss of sensation however some patients may get a burning or tingling sensation

Question 3

What features of autonomic neuropathy may we see in diabetes

Answer 3

• GI: gastroparesis with erratic glucose control, diarrhoea, GORD
• Erectile dysfunction
• Orthostatic hypotension
• Impaired heart variability
• Hypoglycaemic unawareness

Question 4

What is a neuropathic ulcer

Answer 4

• Commonly over plantar surface of metatarsal head and plantar surface of hallux
• The plantar neuropathic ulcer is the condition that most commonly leads to amputation - Due to pressure
• Management includes cushioned shoes to reduce callous formation

Question 5

What is Charcot foot

Answer 5

Destruction of foot architecture due to tissue necrosis from an ulcer

Question 6

How do we manage diabetic neuropathy

Answer 6

Same as neuropathic pain:
- 1st line = Amitriptyline, gabapentin, duloxetine or pregabalin
- 2nd line = Try one of the other drugs
- Rescue therapy for exacerbations = tramadol
- Resistant problems = pain clinic referral