Diabetic neuropathy

Question 1

What is the pathophysiology of diabetic neuropathy?

Answer 1

Chronic hyperglycaemia leads to peripheral nerve damage through inflammatory pathways, oxidative stress and advanced glycation end products

Question 2

What are the types of diabetic neuropathy?

Answer 2

Distal symmetrical sensory neuropathy
Small-fibre predominant neuropathy
Diabetic amyotrophy
Mononeuritis multiplex
Autonomic neuropathy

Question 3

What is distal symmetrical sensory neuropathy and how does it present?

Answer 3

The most common form of DPN - results from loss of large sensory fibres
- It presents with sensory loss in a glove and stocking distribution
- Affects touch, vibration and proprioception

Question 4

What is small fibre predominant neuropathy and how does it present?

Answer 4

Diabetic neuropathy due to the loss of small sensory fibres
- Loss of pain and temperature sensation in a glove and stocking distribution

Question 5

What is diabetic amyotrophy and how does it present?

Answer 5

Diabetic neuropathy originating from inflammation of the lumbosacral plexus or cervical plexus
- Presents with severe pain around the thighs and hips, with proximal weakness

Question 6

What is mononeuritis multiplex?

Answer 6

Mononeuritis multiplex is a neuropathy involving two or more distinct peripheral nerves

Question 7

What is autonomic neuropathy and how does it present?

Answer 7

Occurs when the nerves that control autonomic body function are damaged
- Presents with postural hypotension, gastroparesis, constipation, urinary retention, arrhythmias and erectile dysfunction

Question 8

What are the differentials of diabetic neuropathy?

Answer 8

Vitamin B12 deficiency
Alcohol induced peripheral neuropathy
CIDP
Hypothyroidism

Question 9

What investigations are indicated in suspected diabetic neuropathy?

Answer 9

Neurological examination
Nerve conduction studies
Blood tests:
- Glucose levels
- HbA1c
- B12 levels
- TFTs
- LFTs

Question 10

What is the management of diabetic neuropathy?

Answer 10

First line - amitriptyline, duloxetine, gabapentin or pregabalin

Pain management clinic
Tramadol - rescue therapy for exacerbations

Question 11

What are the complications of autonomic neuropathy?

Answer 11

Gastroparesis
- Presents with erratic blood glucose control, bloating and vomiting
- Management with metoclopramide, domperidone or erythromycin (prokinetics)