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2	Diabetic Neuropathy
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4	Definition “The presence of signs and/or symptoms of peripheral nerve dysfunction in diabetic patient after exclusion of other causes.”
5	Peripheral NERVES
6	Peripheral NERVES
7	Epidemiology 50% of patients who have diabetes for >25 yrs (Pirart. Diabetes Care 1978) Late in type 1, may be 1^st presentation of type 2 DM 50% are painful neuropathy
8	Pathogenesis Metabolic
9	Risk factors Duration of diabetes Control of diabetes Hyperlipaedemia Overweight Smoking Alcohol Old age
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12	Clinical presentations Diffuse neuropathy Symmetric sensorimotor polyneuropathy Autonomic neuropathy
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14	Peripheral sensori-motor neuropathy Distal, bilateral,symmetrical, stocking-glove distribution. Symptoms range from numbness (“deadness”) to severe pain. Burning, alteration of temperature sensation, parathesias, shooting, or stabbing pains are common. May worsen at night. Minor motor involvement causing weakness.
15	Peripheral sensori-motor neuropathy (cont.) Decrease or absent reflexes Loss or diminished vibratory sensation (128Hz tuning fork), pin prick, light touch, or pressure perception Muscle atrophy Foot complications, ulcerations, blisters, deformities (Charcot’s joint)
16	Autonomic neuropathy Affects the autonomic nerves controlling internal organs Peripheral Genitourinary Gastrointestinal Cardiovascular Is classified as clinical or subclinical based on the presence or absence of symptoms
17	Peripheral Autonomic Dysfunction Contributes to the following symptoms/signs: Neuropathic arthropathy (Charcot foot) Aching, pulsation, tightness, cramping, dry skin, pruritus, edema, sweating abnormalities Weakening of the bones in the foot leading to fractures
18	Genitourinary Autonomic Neuropathy
19	Gastrointestinal Autonomic Neuropathy Symptoms/Signs Gastroparesis resulting in anorexia, nausea, vomiting, and early satiety Diabetic enteropathy resulting in diarrhea and constipation
20	Cardiovascular Autonomic Neuropathy Symptoms/Signs Exercise intolerance Postural hypotension
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23	Treatment Based on pathogenesis Symptomatic
24	Based on Pathogenesis
25	Symptomatic
26	Symptomatic Analgesics Antidepressants Antiepileptics Antiarrhythmics.
27	Symptomatic treatment Antidepressants
28	Symptomatic treatment Antiepileptics
29	Symptomatic treatment Other agents
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31	Diabetic neuropathy OR Neuropathy in diabetic patient ? Chronic inflammatory demyelinating polyneuropathy B12 deficiency Uremia Hypothyroidism Monoclonal gamopathies 1/3 of diabetics have neuropathy unrelated to diabetes
32	Diabetic neuropathy OR Neuropathy in diabetic patient ? Rapidly progressive Prominent motor Cranial nerves Predominant large fiber
33	Summary Diabetic neuropathy is common [up to 40-50% over a 10-25 year span] Tight control can prevent neuropathy Once a patient develops neuropathy, there are few treatments proven to be effective Foot care is essential in preventing neuropathic complications Neuropathy in diabetic patient may be caused by other etiologies