Diabetic neuropathy

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