What is Neuropathy

 What is Neuropathy 

Diabetic neuropathy is the most common complication of diabetes mellitus (DM), affecting as many as 50% of patients with type 1 and type 2 DM. 

Diabetic peripheral neuropathy involves the presence of symptoms or signs of peripheral nerve dysfunction in people with diabetes after other possible causes have been excluded.

Or simply put is disease of the nerves in a diabetic patients 

Signs and symptoms

In type 1 DM, distal polyneuropathy typically becomes symptomatic after many years of chronic prolonged hyperglycemia.

Whereas in type 2, it may be apparent after only a few years of known poor glycemic control or even at diagnosis.

Symptoms include the following:

Sensory – Negative or positive, diffuse or focal; usually insidious in onset and showing a stocking-and-glove distribution in the distal extremities

Motor – Distal, proximal, or more focal weakness, sometimes occurring along with sensory neuropathy (sensorimotor neuropathy)

Autonomic – Neuropathy that may involve the cardiovascular, gastrointestinal, and genitourinary systems and the sweat glands.

Diagnosis

The essence of laboratory tests is to exclude other causes of neuropathy in the patients.

Laboratory tests that may be helpful include the following:

Fasting plasma glucose

Hemoglobin A1c

Complete blood count

Complete metabolic panel (electrolytes and liver function panel)

Vitamin B-12 and folate levels

Thyroid function tests

Erythrocyte sedimentation rate

C-reactive protein

Serum protein electrophoresis with immunofixation electrophoresis

Antinuclear antibody

Anti-SSA and SSB antibodies

Rheumatoid factor

Paraneoplastic antibodies

Rapid plasma reagin

Genetic screens

Hematology screen (for anemia)

Management of Diabetic Patient with neuropathy

Key components of the management of diabetic neuropathy include the following:

Foot care, including regular follow-up, patient education, and referral as appropriate

Tight, stable glycemic control (most important for slowing progression of neuropathy)

Pain management (eg, with pregabalin, gabapentin, sodium valproate, dextromethorphan, morphine sulfate, tramadol, oxycodone, duloxetine, topical capsaicin, transdermal lidocaine)

Treatment of diabetic gastroparesis (eg, with erythromycin, cisapride [not available in the United States], metoclopramide, polyethylene glycol 3350, tegaserod [currently available only on an emergency basis])

Treatment of autonomic dysfunction must address the following at this level

Erectile dysfunction

Orthostatic hypotension

Gustatory sweating

I will leave those listed neuropathy complications to our able physician to handle to prevent severe and threaten conditions.

Thanks for reading