DM complications - Neuropathy

Question 1

Types of diabetic neuropathy

Answer 1

• Distal symmetric polyneuropathy (DSPN)
• Autonomic neuropathy
• Mononeuropathy and/or radiculopathy/polyradiculopathy

Question 2

Diabetic neuropathy, which occurs in ____ % of individuals with longstanding type 1 and type 2 DM, manifests as ____

Answer 2

• ~50
• Diffuse neuropathy (distal symmetrical polyneuropathy and/or autonomic neuropathy), a mononeuropathy, and/or a radiculopathy/polyradiculopathy

Question 3

Risk factors in developing neuropathy

Answer 3

• Duration of diabetes
• Glycemic control
• BMI (the greater the BMI, the greater the risk
• Smoking
• Presence of CVD
• Elevated triglycerides
• Hypertension

Question 4

Type(s) of nerve fibers lost in diabetic neuropathy

Answer 4

Myelinated and unmyelinated nerve fibers

Question 5

The most common form of diabetic neuropathy

Answer 5

Distal symmetric polyneuropathy (DSPN)

Question 6

Distal symmetric polyneuropathy (DSPN) most frequently presents with ____

Answer 6

• Distal sensory loss and pain
  
  • Typically involves the lower extremities
  • Usually present at rest, and worsens at night
• Note:*
• Up to 50% of patients do not have symptoms of neuropathy

Question 7

DSPN screening

Answer 7

Annual screening for DSPN should begin 5 years after diagnosis of type 1 DM and at the time of diagnosis of type 2 DM and is aimed at detecting loss of protective sensation (LOPS)

Question 8

Systems affected in autonomic neuropathy and manifestations

Answer 8

• Multiple systems, including the cardiovascular, GI, GU, sudomotor, and metabolic systems
• Cardiovascular autonomic neuropathy
  
  • Decreased heart rate variability
  • Resting tachycardia
  • Orthostatic hypotension
• Gastrointestinal
  
  • Gastroparesis
• Genitourinary
  
  • Bladder-emptying abnormalities
• Sympathetic nervous system dysfunction
  
  • Hyperhidrosis of the upper extremities and anhidrosis of the lower extremities

Question 9

What is hypoglycemia unawareness? What causes it?

Answer 9

• Definition
  
  • Inability to sense hypoglycemia appropriately (hypoglycemia unawareness
• Mechanism
  
  • Autonomic neuropathy may reduce counterregulatory hormone release (especially catecholamines), leading to hypoglycemia unawareness thereby subjecting the patient to the risk of severe hypoglycemia and complicating efforts to improve glycemic control