Diabetic Neuropathy

Definition

Diabetic neuropathy is a type of nerve damage that can occur in people with diabetes. It is caused by high blood sugar levels injuring nerves throughout the body, most commonly in the legs and feet.

Aetiology

Diabetic neuropathy can be caused by various factors, including:

• Prolonged exposure to high blood glucose levels
• Metabolic factors such as high cholesterol and triglycerides
• Neurovascular factors leading to damage in the blood vessels supplying oxygen and nutrients to nerves
• Autoimmune factors causing inflammation in nerves
• Genetic factors
• Lifestyle factors such as smoking and alcohol consumption

Pathophysiology

Diabetic neuropathy involves damage to the nerves due to chronic high blood glucose levels. This leads to oxidative stress, inflammation, and microvascular changes, which in turn cause nerve fibre damage and loss of nerve function.

Risk Factors

• Poorly controlled blood sugar levels
• Duration of diabetes
• Kidney disease
• Overweight and obesity
• Smoking
• High blood pressure and cholesterol levels

Signs and Symptoms

• Numbness or reduced ability to feel pain or temperature changes
• Tingling or burning sensations
• Sharp pains or cramps
• Increased sensitivity to touch
• Muscle weakness
• Loss of reflexes, especially in the ankle
• Foot problems such as ulcers, infections, and bone and joint pain

Investigations

• Clinical history and physical examination
• Monofilament testing for loss of sensation
• Electromyography (EMG) and nerve conduction studies to evaluate nerve function
• Blood tests to monitor blood glucose levels and metabolic factors
• Assessment of foot health and circulation

Management

Primary Care Management

• Initial assessment and diagnosis based on clinical history and physical examination
• Optimal blood sugar control through lifestyle modifications and medications
• Pain management with medications such as pregabalin, duloxetine, or gabapentin
• Regular foot care and monitoring for complications
• Education on self-care practices and lifestyle modifications
• Referral to a specialist for further evaluation and treatment if necessary

Specialist Management

• Advanced diagnostic testing (e.g., EMG, nerve conduction studies)
• Multidisciplinary approach involving diabetologists, neurologists, and pain specialists
• Intensive blood sugar management with insulin or advanced medications
• Physical therapy to improve strength and balance
• Occupational therapy to assist with daily activities
• Surgical intervention in severe cases (e.g., decompression surgery)

Example Management for Diabetic Neuropathy

A patient presenting with symptoms of diabetic neuropathy should have a comprehensive assessment including blood glucose monitoring, monofilament testing, and a review of their medication regimen. Initial management should focus on optimizing blood sugar control through lifestyle modifications such as diet and exercise, as well as the use of medications like metformin or insulin. Pain management may include medications such as pregabalin or duloxetine. Regular foot care and education on self-care practices are essential to prevent complications. Referral to a specialist for further evaluation and treatment may be necessary if symptoms persist or worsen.

References

1. NICE. (2024). Type 2 Diabetes in Adults: Management. Retrieved from NICE
2. NHS. (2023). Diabetic Neuropathy. Retrieved from NHS
3. American Diabetes Association. (2023). Standards of Medical Care in Diabetes. Retrieved from ADA
4. Vinik, A. I., & Casellini, C. M. (2013). Diabetic Neuropathy. Endocrinology and Metabolism Clinics of North America.
5. Boulton, A. J. M., et al. (2005). Comprehensive Foot Examination and Risk Assessment. Diabetes Care.