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Diabetic neuropathy

Definition:

  • Diabetic neuropathy is a type of nerve damage that can occur in people with diabetes. It is a common complication and can affect different parts of the body.

Types:

  1. Peripheral Neuropathy:
    • Most common type. Affects the feet and legs first, followed by the hands and arms.
    • Symptoms include numbness, tingling, pain, or weakness.
  2. Autonomic Neuropathy:
    • Affects the autonomic nerves controlling internal organs.
    • Can impact digestive system, bladder, sexual organs, and cardiovascular system.
  3. Proximal Neuropathy (Diabetic Amyotrophy):
    • Affects nerves in the thighs, hips, buttocks, or legs.
    • Characterized by pain and weakness in the proximal muscles.
  4. Focal Neuropathy:
    • Affects a single nerve, often in the hand, head, torso, or leg.
    • Causes muscle weakness or pain.

Epidemiology:

  • Common in both Type 1 and Type 2 diabetes.
  • Risk increases with the duration of diabetes and poor glycemic control.

Pathophysiology:

  • Chronic hyperglycemia leads to nerve damage through various pathways, including glycosylation of proteins, increased oxidative stress, and inflammation.

Clinical Features:

  • Symptoms vary depending on the type of neuropathy.
  • Peripheral neuropathy: Loss of sensation, burning or electric pain, increased sensitivity to touch.
  • Autonomic neuropathy: Digestive issues, bladder problems, sexual dysfunction, cardiovascular symptoms.
  • Proximal neuropathy: Sudden, severe pain in hip and thigh or buttock, atrophy of thigh muscles.
  • Focal neuropathy: Sudden weakness or pain in a specific nerve distribution.

Diagnosis:

  • Clinical diagnosis based on patient history and physical examination.
  • Nerve conduction studies and electromyography (EMG) for confirmation.
  • Screening for diabetic neuropathy is recommended for all patients with diabetes.

Management:

  • Optimal control of blood glucose levels to prevent or slow progression.
  • Pain management with medications such as anticonvulsants, antidepressants, or topical agents.
  • Management of autonomic symptoms depending on the affected system.
  • Regular foot care and monitoring to prevent complications such as ulcers and infections.

Prognosis:

  • Progressive condition; early intervention can help manage symptoms and reduce the risk of complications.

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