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 B12 malabsorption, 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].
