Diabetic neuropathy

Question 1

what is diabetic neuropathy caused by

Answer 1

blockage of vasa nervorum

Question 1

What is peripheral neuropathy

Answer 1

glove and stocking distribution- lower limbs affected first

loss of sensation in feet

may not sense injury - important to inspect feet

Charcots joint- loss of ankle jerk/vibration sense/fractures

Question 2

What is mononeuropathy

Answer 2

sudden motor loss
- wrist drop, foot drop, 3rd nerve palsy

Question 3

What is autonomic neuropathy

Answer 3

GI tract- gastroparesis, dysphagia, bladder dysfunction

postural hypotension

cardiac autonomic suplly

Question 4

What is the management

Answer 4

• glycaemic control
  -neuropathic pain agents
  -pain management clinic

Question 5

What are some neuropathic agents used

Answer 5

Duloxetine ,
amitriptyline
pregabalin
gabapentin

Question 6

What is used as rescue therapy for exarcebations

Answer 6

Tramadol

Question 7

What can be used for localised neuropathic pain

Answer 7

Topical capsaican

Question 8

What is the stepwise management of diabetic foot disease

Answer 8

daily foot inspection
treat infection - long term antibiotics
manage neuropathy
asses vascular status

Question 9

What 2 screening tests should be done annually for diabetic foot disease

Answer 9

screening for ischaemia-
palpate the dorsalis pedis pulse and posterior tibial artery pulse

screening for neuropathy-
10g monofilament is used on various parts of sole of foot