Diabetic neuropathy
From IDWiki
Background
- Diabetic neuropathy represents a wide spectrum of diseases that includes mononeuropathies, nerve entrapment, and polyneuropathies
Classification
- Rapidly reversible
- Hyperglycemic neuropathy
- Generalized symmetric polyneuropathy
- Acute sensory neuropathy
- Chronic sensorimotor neuropathy or distal symmetric polyneuropathy (DPN)
- Small-fiber neuropathy
- Large-fiber neuropathy
- Autonomic neuropathy
- Focal and multifocal neuropathies
- Focal-limb neuropathy
- Cranial neuropathy
- Proximal-motor neuropathy (amyotrophy)
- Truncal radiculoneuropathy
- Coexisting chronic inflammatory demyelinating neuropathy (CIDP)
Clinical Manifestations
| Feature | Mononeuropathy | Entrapment | Polyneuropathy |
|---|---|---|---|
| Onset | Sudden | Gradual | Gradual |
| Pattern | Single nerve (but may be multiple) | Single nerve exposed to trauma | Distal symmetrical polyneuropathy |
| Nerves involved | CN III, VI, VII, ulnar, median, peroneal | Median, ulnar, peroneal, medial plantar, lateral plantar | Mixed, motor, sensory, or autonomic |
| Natural history | Resolves spontaneously | Progressive | Progressive |
| Treatment | Symptomatic | Rest, splints, local steroids, diuretics, surgery | Glycemic control, pregabalin, duloxetine, antioxidants |
| Distribution of sensory loss | Area supplied by the affected nerve(s) | Area supplied beyond the site of entrapment | Distal and symmetrical, "glove and stocking" distribution |
