Diabetic Neuropathy Flashcards
What is diabetic neuropathy?
Diabetic neuropathy is a type of nerve damage that can occur if you have diabetes. Diabetic neuropathy is a common complication of both type 1 diabetes and type 2 diabetes.
It is characterised by the signs and symptoms of peripheral or autonomic nerve dysfunction. Motor, sensory, and autonomic nerves may all be affected by diabetic neuropathy.
When does diabetic neuropathy tend to occur in the duration of diabetes?
It tends to occur relatively early on in the progression of the disease, although many patients will be symptomless.
What is the first sign of diabetic neuropathy?
delayed nerve signal transit time
Why does delayed nerve signal transit time get effected?
This is a direct result of demyelination, as a result of damage to schwann cells. At this stage, the axon itself is still intact, and thus the potential for repair is still present. At a later stage, the axons become damaged, and here irreversible damage has occurred.
Give 3 symptoms associated with diabetic neuropathy:
1) burning
2) numbness
3) paraesthesia
Give 3 GI autonomic symptoms of diabetic neuropathy:
1) nausea
2) constipation
3) incontinence
What is the epidemiology of diabetic neuropathy?
Can affect around 70% of people with diabetes
Diabetes is the most common cause of peripheral neuropathy globally
What are the risk factors of diabetic neuropathy?
Poorly-controlled hyperglycaemia
Prolonged hyperglycaemia
Increasing age
Hypertension
Dyslipidaemia
Coexisting cardiovascular disease or risk factors
Obesity
Smoking
What are the 5 types of Diabetic neuropathies?
- Symmetric sensory neuropathy
- Mononeuritis multiplex
- Amyotrophy
- Autonomic
- small-fibre predominant neuropathy
what is the most common form of diabetic peripheral neuropathy?
distal symmetrical sensory neuropathy
what is distal symmetrical sensory neuropathy?
how does it present?
a diabetic peripheral neuropathy due to loss of large sensory fibres
- a glove and stocking distribution
- affects touch, vibration and proprioception
what is small-fibre predominant neuropathy?
how does it present?
a diabetic peripheral neuropathy due to loss of small sensory fibres
- a glove and stocking distribution
- affects pain and temperature with episodes of burning
what is diabetic amyotrophy?
a diabetic peripheral neuropathy
- causes severe pain around the thigh and hips with asymmetric proximal weakness due to inflammation of the lumbosacral plexus or cervical plexus
what is mononeuritis multiplex?
a diabetic peripheral neuropathy involving >2 distinct peripheral nerves
- painful
what is autonomic neuropathy?
how does it present?
a diabetic peripheral neuropathy due to damage of the vagus nerve
- postural hypotension
- gastroparesis
- constipation
- urinary retention
- arrhythmias
- erectile dysfunction
what are the differential diagnosis for diabetic peripheral neuropathy?
- vitamine B12 deficiency
- alcohol-induced peripheral neuropathy
- chronic inflammatory demyelinating polyneuropathy
- hypothyroidism
what are the investigations of diabetic peripheral neuropathy?
- neurological examination (assess sensory and motor deficits)
- nerve conduction studies
- blood tests (identify causes or differentials eg glucose, HbA1c, B12, TFTs and LFTs)
what are the complications of diabetic peripheral neuropathy?
- foot ulcers due to loss of sensation
- cardiac, GI and genitourinary disturbances due to autonomic dysfunction
what is the management for diabetic peripheral neuropathy?
- controlling blood glucose levels to prevent progression of diabetes
- symptoms control eg pain relief with gabapentin or pregabalin
- treat complications accordingly
what is Charcot arthopathy?
a chronic, progressive condition characterised by destruction of bones/joints in patients with neuropathy > loss of sensation
- most commonly caused by diabetic peripheral neuropathy
what are the clinical features of Charcot arthropathy?
6D’s
- Destruction of bone and joint
- Deformity
- Degeneration
- Dense bones
- Debris of bone fragments
- Dislocation
where does Charcot arthropathy most commonly affect?
tarsometatarsal joints
- can affect any joint that has lost sensation due to neuropathy
what is the differential diagnosis for Charcot arthropathy?
OSTEOMYELITITIS!!!
what are the investigations of Charcot arthropathy?
- clinical diagnosis
- X-ray
- MRI
- bone scans if other tests are inconclusive
