DIABETIC NEUROPATHY

SUMMARY

1. Axonal neuropathy, mainly sensory changes, propriocpetion loss.

2. Diabetes can affect CN III (pupil sparing), IV, VI, VII, ulnar n. or peroneal n. Note - if there is CN III palsy with pupillary dilatation, think of a PCOM aneurysm.

3. Diabetic lumbosacral plexopathy (amyotrophy) presents with leg pain (82%) followed by proximal weakness of the leg. The condition develops over months and so does partial or complete recovery.

4. Effective treatments for pain include the FDA-approved duloxetine and pregabalin; others - tricyclic antidepressants, carbamazepine, gabapentin, lamotrigine, tramadol, and venlafaxine.

5. Metformin can lead to Vit B₁₂malabsorption, leading to peripheral neuropathy.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].