Diabetic Neuropathy

Question 1

Inspection

Answer 1

Evidence of finger pricks from BM monitoring Peripheral vascular disease Charcot joints

Question 2

Motor

Answer 2

Bilateral loss of ankle jerks 2O to sensory neuropathy Mononeuritis multiplex Foot drop

Question 3

Sensory

Answer 3

Distal sensory loss in stocking distribution

Question 4

Completing the examinations

Answer 4

Examine the fundi Examine the upper limbs and cranial nerves Sensory neuropathy Mononeuritis multiplex CN3 CN6 Ulnar nerve Urine dip: glucose, proteinuria

Question 5

History

Answer 5

Pain: esp. @ night Glycaemic control Complications of insulin Other micro- and macro-vascular complications

Question 6

Pathophysiology?

Answer 6

Metabolic: glycosylation, ROS, sorbitol accumulation Ischaemia: loss of vasa nervorum

Question 7

Investigations

Answer 7

Urine: glucose, ACR Blood Glucose HbA1c U+E

Question 8

Treatment

Answer 8

MDT: GP, endocrinologist, neurologist, DNS Good glycaemic control Amitriptyline, Gabapentin, duloxetine Capsaicin cream

Question 9

Common neuropathies and entrapments

Answer 9