diabetic neuropathy

Question 1

what is diabetic neuropathy?

Answer 1

peripheral and/or autonomic nerve dysfunction caused by chronic diabetes.

Question 2

what are the risk factors for diabetic neuropathy?

Answer 2

poorly controlled hyperglycaemia
longer duration of diabetes
older age
tall stature

Question 3

what are the types of symptoms of diabetic neuropathy?

Answer 3

frequently asx
can be split into peripheral and autonomic sx.

Question 4

what are the peripheral nerve symptoms of diabetic neuropathy?

Answer 4

pain due to peripheral nerve damage -affects 16-26% of people with diabetes
loss of sensation

Question 5

what are the autonomic symptoms of diabetic neuropathy?

Answer 5

GI -constipation, diarrhoea, gastroparesis, foecal incontinence
sweat -anhydrosis, hyperhydrosis, heat intolerance, dry skin
hypoglycaemia unawareness
postural hypotension
erectile dysfunction and female sexual dysfunction

Question 6

how do you diagnose diabetic neuropathy?

Answer 6

diagnosis of exclusion in someone with diabetes and these symptoms

Question 7

what is the management of diabetic neuropathy?

Answer 7

control the diabetes!
NICE neuropathic pain guidelines
management of other sx -eg erectile dysfunction, constipation accordingly

Question 8

what are the NICE neuropathic pain mx guidelines?

Answer 8

-choice of amitriptyline, duloxetine, gabapentin, or pregabalin -only ever 1 at once. need to check for history of drug use with gabapentin and pregabalin.
-capsaicin 0.075% cream for people with localised neuropathic pain who wish to avoid or can’t tolerate oral treatments
-refer to specialist pain service or relevant specialty if they have severe pain /pain is limiting ADLs
-consider short course of tramadol for people awaiting referral after initial treatments have failed