DIABETIC

NEUROPATHY

AMITHBABU.C.B
MScd-ENDO
 INTRODUCTION
Diabetic neuropathies are a family of nerve disorders
caused by diabetes. People with diabetes can, over
time, have damage to nerves throughout the body.
Neuropathies lead to numbness and sometimes pain
and weakness in the hands, arms, feet, and legs.
Problems may also occur in every organ system,
including the digestive tract, heart, and sex organs
 INCIDENCE OF
NEUROPATHY
 Commonest complication of diabetes
 Can occur at onset of illness
 Multi systemic symptoms
 Subjective vs. objective reporting
 25% : volunteer symptoms
 50% : clinical features
 75% : abnormality on sophisticated tests
DIABETIC NEUROPATHY
 RISK FACTORS
 Older age
 Having diabetes for 25 years or more
 Having type 2 diabetes
 High blood pressure
 Smoking
 Obesity
 Lack of exercise
 Peripheral vascular disease
 High cholesterol
 Pathogenesis of Diabetic
Neuropathy
 Metabolic factors
 High blood glucose
 Advanced glycation end products
 Sorbitol
 Abnormal blood fat levels
 Ischemia
 Nerve fiber repair mechanisms
 SYMPTOMS
 Numbness in the extremities
 Tingling in the extremities
 Pain in the extremities
 Wasting of the muscles of the feet or hands
 Indigestion
 Nausea or vomiting
 Diarrhoea or constipation
 Dizziness
 SYMPTOMS
 Urination problems
 Impotence or vaginal dryness
 Weakness in arms and or legs
 Foot drop
 Weakness of facial muscles resulting in drooping eyelid,
drooping mouth, facial droop, difficulty swallowing
 Muscle cramps
 A prolonged feeling of fullness after eating and/or
abdominal pain
 Heat intolerance due to a decreased ability to sweat
normally
 Classification of Diabetic
Neuropathy
 A. Diffuse Neuropathy
 1. Distal symmetric sensorimotor neuropathy
 2. Autonomic neuropathy
a. Sudomotor
b. Cardiovascular
c. Gastrointestinal
d. Genitourinary
 3. Symmetrical proximal lower limb motor neuropathy
(amyotrophy)
 B. Focal Neuropathy
1. Cranial neuropathy
2. Radiculopathy and plexopathy
3. Entrapment neuropathy
 Complications of Diabetic
Neuropathy
 Foot ulceration
 Gangrene
 Amputations
 Sexual dysfunction
 Sudden death from cardiac arrhythmias
 Complications of Diabetic
Neuropathy
 Those patients who are symptomatic complain of frequent or
continuous pain, numbness, or other severe discomfort in the
affected extremity or dermatome.

 Despite the prevalence of diabetic neuropathy, many

physicians fail to recognize it, and if they do recognize it,
many fail to evaluate or treat these patients appropriately.

 Medical science stands poised to take a very aggressive

approach to diabetic neuropathy; preventing it, diagnosing it,
controlling its secondary complications and symptoms, and
possibly even reversing it.
COMPLICATIONS
 Diagnostic Tests
 Assess symptoms - muscle weakness, muscle
cramps, prickling, numbness or pain, vomiting,
diarrhoea, poor bladder control and sexual
dysfunction
 Comprehensive foot exam
 Skin sensation and skin integrity
 Quantitative Sensory Testing (QST)
 X-ray
 Nerve conduction studies
 Electromyographic examination (EMG)
 Ultrasound
 EDX Testing for Diabetic
Neuropathy
 Nerve conduction studies can demonstrate both
demyelination and axonal degeneration.
 Demyelination primarily affects the nerve
conduction velocity, which is slowed.
 Among the earliest detectable findings in diabetic
neuropathy are distal slowing of nerve
conduction velocity with axonal degeneration.
 Reduced amplitudes are a later finding
consistent with advanced neuropathy.
 What should be done ?
 Detect neuropathy early
 Correct neuropathy early
 Correct footwear
 Correct vascular status
 Prevent diabetic foot
 Prevent amputations
 TREATMENT
 There is currently no cure for diabetic neuropathy.
 Good control of diabetes over time is the key to
treating neuropathy
 To help control your diabetes, eat food that is
good for you and exercise
 it is important to properly care for your feet when
you have diabetic neuropathy. Diabetic
neuropathy may cause a loss of feeling in your
feet.
 TREATMENT
 Aldose reductase inhibitors
 ACE inhibitors
 Weight control
 Exercise
ALGORITHM FOR
MANAGEMENT
THANK YOU