Diabetic neuropathy Flashcards
Diabetic neuropathy
Peripheral neuropathy Sensory loss typically results in ?
‘glove and stocking’ distribution, with the lower legs affected first due to the length of the sensory neurons supplying this area
vibration is the first sensory modality affected in DM neuropathy
numbness, tingling, or pain
Vibration loss
loss of ability to feel changes in temperature
What is Amyotrophy
diabetic lumbosacral plexus neuropathy and Bruns-Garland syndrome.
asymmetric, b/l or unilateral
painful muscle wasting
weakness affecting the lower limbs
loss of reflexes
and objective weakness on examination.
x
x
Diabetic neuropathy is now managed in the same way as other forms of NEUROPATHIC PAIN , what is the first line?
amitriptyline, duloxetine, gabapentin or pregabalin
what do you give in Diabetic neuropathy if first lineTX don’t work ?
try one of the other 3 drugs
NEVER ADD GIVEN AS MONOTHERWPY - so Stop amitryptiline and add duloxentine
what may be used as ‘rescue therapy’ for exacerbations of neuropathic pain
tramadol
what may be used for localised neuropathic pain
topical capsaicin
topical capsaicin can also be used in which condition ?
post-herpetic neuralgia
what are diabetic Gastrointestinal autonomic neuropathy ?
1) Gastroparesis - paralysis of the stomach giving :
erratic blood glucose control, bloating and vomiting
2)Chronic diarrhoea
often occurs at night
3)Gastro-oesophageal reflux disease
caused by decreased lower esophageal sphincter (LES) pressure
management of gastrparesis?
metoclopramide,
domperidone
or erythromycin (prokinetic agents)
amitriptyline is contraindicated in ?
benign prostatic hyperplasia it is better to avoid amitriptyline due to the risk of urinary retention.
