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Diabetic neuropathy

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Introduction to diabetic neuropathy

Diabetic neuropathy is a complication of long-standing diabetes, which affects the nerves of the body.1 Diabetic neuropathy can affect all the tissues and the organs of the body. Initially, symptoms cannot be observed, but later pain, numbness or loss of feeling in hands, arms, feet and legs can be observed. Treatments are given to subside the symptoms. The key to management of this disorder is adequate control of the blood sugar levels.

Epidemiology (Occurrence of diabetic neuropathy in different groups)

Epidemiological studies suggest that prevalence of neuropathy in diabetic patients is 30% in hospital patients and 20% in patients living in communities.2

Approximately, about 60–70% of the people with diabetes suffer from neuropathy and the onset can be at any time in life. A recent study revealed that about 7% of the patients had neuropathy on diagnosis of diabetes and 50% of the diabetic neuropathy patients were among people who had diabetes for more than 25 years. In other words, the incidence of neuropathy in diabetic patients increases with the period of diabetes and the degree of hyperglycemia.3

It is not possible to predict accurate prevalence rate as the criteria for diagnosis, patients receiving medical care vary and in some cases, the disease remains undiagnosed in a large population.4

Symptoms of diabetic neuropathy

Symptoms of diabetic neuropathy depend on the kind the nerves affected and involve sensory, motor and autonomic nervous system. The pain may be sudden or severe in patients suffering with focal neuropathy.

Some of the symptoms of diabetic neuropathy are as follows:

Types of diabetic neuropathy

Diabetic neuropathies are classified as generalized and multifocal neuropathies. Generalized neuropathies are further classified as:

  • Distal symmetric polyneuropathy
    • Large fiber sensory
    • Small fiber painful sensory
    • Subclinical neuropathy
  • Acute painful diabetic neuropathy
  • Autonomic neuropathy

Multifocal neuropathies are also further classified as:

  • Compressive focal neuropathies
    • Carpal tunnel syndrome,
    • Ulnar neuropathy
    • Peroneal neuropathy
  • Noncompressive focal and multifocal neuropathies
    • Diabetic amyotrophy
    • Mononeuritis multiplex
    • Cranial neuropathies
    • Femoral, sciatic, ulnar, peroneal neuropathies
    • Truncal neuropathies

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Risk factors for diabetic neuropathy

The risk factors of diabetic neuropathy involve the following.5–7

Diagnosis of diabetic neuropathy

Diagnosis is based on the symptoms and physical examination, which includes hypertension, heart rate, muscle strength, touch, vibration, temperature etc. People diagnosed with peripheral neuropathy should get their foot examined frequently.8

Other diagnostic tests include the following:

  • Electromyography or nerve conduction studies
  • Checking variability in heart rate
  • Ultrasound

Treatment of diabetic neuropathy

Treating diabetic neuropathy includes the following.

Preventive Treatment

This is the best option for treating neuropathies. The most important step is maintaining blood glucose levels within normal limits.9 Patients suffering with diabetes should take care of foot, footwears, protect hyposensitive points and pressure points to prevent ulcers and bone infections. Specialized foot clinics are helpful in treating and preventing diabetic foot ulcers.10

Symptom Management

In proximal diabetic neuropathy, truncal neuropathy and focal neuropathy, the disease is self-limited with good recovery rate. The pain is caused is very severe. Medications like carbamazepine, phenytoin, clonazepam, or paracetamol in combination with codeine phosphate are useful. Tricyclic antidepressants are also very effective. Drugs like duloxetine and pregabalin are also very helpful.

Disease Modifying

Proximal diabetic neuropathy is quite painful and is resistant to conventional or conservative methods of treatment. In such cases, prescribing corticosteroids seems helpful, along with controlling the blood glucose levels.11

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1. Vinik AI, Park TS, Stansberry KB, Pittenger GL. Diabetic neuropathies. Diabetologia. 2000; 43(8): 957–973.

2. Shaw JE, Zimmet PZ. The epidemiology of diabetic neuropathy. Diabetes Rev. 1999; 7: 245–252.

3. Thomas PK, Tomlinson DR. Diabetic and hypoglycemic neuropathy. In: Dyck PJ, Thomas PK (eds). Peripheral Neuropathy. Philadelphia: WB Saunders; 1993, pp. 1219–1250

4. Vinik AI, Holland MT, Le Beau JM, Liuzzi FJ, Stansberry KB, Colen LB. Diabetic neuropathies. Diabetes Care. 1992; 15(12): 1926–1975.

5. Shaw JE, Zimmet PZ. The epidemiology of diabetic neuropathy. Diabetes Rev. 1999; 7: 245–252.

6. Adler AI, Boyko EJ, Ahroni JH, Stensel V, Forsberg RC, Smith DG. Risk factors for diabetic peripheral sensory neuropathy. Diabetes Care. 1997; 20: 1162–1167.

7. Perkins BA, Greene DA, Bril VB. Glycemic control is related to the morphological severity of diabetic sensorimotor polyneuropathy. Diabetes Care. 2001; 24: 748–752.

8. Abbott CA, Carrington AL, Ashe H, Bath S, Every LC, Griffiths J, The North-West Diabetes Foot Care Study: Incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort. Diabet Med. 2002; 19: 377–384.

9. Martin CL, Albers J, Herman WH. Neuropathy among the Diabetes Control and Complications Trial Cohort 8 years after trial completion. Diabetes Care. 2006; 29: 340–344.

10. Giurini JM, Rosenblum BI, Lyons TE: Management of the diabetic foot. In The Clinical Management of the Diabetic Foot. Veves A, Ed. Totowa, NJ, Humana Press, 1998, p.303 -318.

11. Said G, Lacroix C, Lozeron P, et al. Inflammatory vasculopathy in multifocal diabetic neuropathy. Brain. 2003; 126: 376–385.

Written by: healthplus24.com team

Date last updated: February 05, 2015