Diabetic Neuropathy Part 1

Abstract

Diabetes is the most common cause of neuropathy in US and neuropathies are the most common complication of diabetes mellitus affecting up to 50% of patients with type 1 and type 2 diabetes mellitus. Various types of neuropathies can be associated with diabetes mellitus.1 Symptoms usually include numbness, tingling, pain and weakness. Dizziness with postural changes can be seen with autonomic neuropathy. Metabolic, vascular and immune theories have been proposed for the pathogenesis of diabetic neuropathy. Pathologically axonal damage and segmental demyelination can be seen with diabetic neuropathies. Management of diabetic neuropathy should begin at the initial diagnosis of diabetes and mainly requires tight and stable glycemic control. Many medications are available for the treatment of neuropathic pain.

Ankle-brachial index and diabetic neuropathy: study of 225 patients

“…Vascular pathogens have been postulated and hypoxia and ischemia are also involved in diabetic polyneuropathy. On a macroscopic level, the study of the distribution and fiber loss in diabetic nerves also suggests a vascular disorder 8 .…”

“…The ABI reference scores are: a) > 1.3 = hardened vessels; b) from 0.9-1.3 = normal arterial flow; c) < 0.9 = arterial occlusion. The ABI measurement is recommended for all patients with diabetes over 50 years of age, or those presenting with symptoms of peripheral arterial disease or other cardiovascular risk factors 8,16,17 . Patients' DN4 scores were then subjected to ABI measurement, which was calculated by dividing the highest systolic blood pressure in the lower and upper limbs 17 .…”

An association of large-fibre peripheral nerve dysfunction with non-invasive measures of liver fibrosis secondary to non-alcoholic fatty liver disease in diabetes

“…The histopathology of the Sural nerve in severe liver disease reveals an indolent process with damaged whole Schwann cells resulting in a picture of demyelination and re-myelination, associated with mild axonal degeneration only (Knill-Jones et al, 1972). This is dissimilar to the classic changes seen in diabetic peripheral neuropathy (Pasnoor, Dimachkie, Kluding, & Barohn, 2013;Younger, 2010). While not completely defined, the primary abnormality in DSP due to diabetes is axonopathy, although both primary and secondary segmental demyelinations are often present.…”

Beta-endorphin levels in both painful and painless diabetic peripheral neuropathy and its relations to pain characters and severity

“…Distal symmetric polyneuropathy (DSP) is the commonest type of neuropathy complicating diabetes [1]. Pain is the most agonizing symptom of DPN [2].…”