Diabetic neuropathy

Diabetic polyneuropathy

This condition presents as a distal, symmetrical sensory neuropathy, predominantly affecting the toes and progressing up to knees in a glove-and-stocking distribution. It may be associated with autonomic dysfunction.

Symptoms

• Numbness, tingling, and burning sensations in the feet
• Weakness in small muscles of the feet
• Absence of ankle and/or knee reflexes

Specialist to approach 
Neurologist

Diagnosis

• Nerve conduction studies- reveal mixed axonal and demyelinating changes
• Nerve biopsy is rarely needed

Treatment

• Foot care to prevent diabetic ulcers
• Regular ophthalmologic and renal evaluations
• Tight glycaemic control
• Medications for neuropathic pain (e.g., gabapentin, pregabalin, carbamazepine, amitriptyline, lamotrigine)

Diabetic cachectic neuropathy (Acute painful neuropathy of DM)

This condition is commonly seen in older men with poorly controlled diabetes and significant loss of weight.

Symptoms

• Burning, allodynia, and hypersensitivity
• Spontaneous recovery with improved control over diabetes
• Insulin neuritis- Painful neuropathy onset during insulin therapy that improves with better management of diabetes

Diabetic lumbosacral radiculo-plexus-neuropathy (Bruns–Garland syndrome)
Typically affects men over age 50 with type 2 diabetes.

Symptoms

Sudden, unbearable pain in the hips, back, hips, thighs, followed by progressive proximal muscle weakness and atrophy

Diagnosis

• Nerve conduction tests to assess distal sensory diabetic neuropathy
• Electromyography to detect changes in denervation related to paraspinal, proximal, and distal muscles
• MRI (with contrast) of the lumbosacral spine and plexus for signs of infiltration
• CSF testing for malignancy changes
• Nerve tests can sometimes show microvasculitis

Treatment

• Strict diabetic control
• Steroids and intravenous immunoglobulin treatment is uncertain
• Pain management
• Most patients recover without intervention

Diabetic truncal radiculoneuropathy

This rare complication causes pain and discomfort in the trunk.

Symptoms

• Sudden onset of radicular pain with burning sensation over the thoracic spine, chest, ribs, or abdomen.
• Weakness in respiratory or abdominal muscles

Treatment

Recovery within 2-6 months without intervention

Cranial neuropathies

These involve damage to the third and sixth cranial nerves, which control sensation and facial and eye movements.

Symptoms

• Pain, tingling, numbness
• Altered smell or taste
• Sensitive skin
• Tinnitus or ringing in the ears
• Weakness or paralysis of muscles, leading to issues like drooling, choking, or slurred speech
• Vision changes, including double vision

Diagnosis

Magnetic resonance angiography (MRA) to rule out posterior communicating artery aneurysm

Treatment

• Medication
• Radiosurgery
• Microvascular decompression (MVD)
• Peripheral nerve stimulation (supraorbital and infraorbital)
• Percutaneous Glycerol Rhizotomy
• Recovery typically within 3 months

Mononeuropathies

This type of neuropathy results from damage to a peripheral nerve, often caused by injury.

Symptoms

• Loss of sensation or weakness in the affected area
• Pain or burning sensation
• Tingling or “pins and needles” feeling
• Increased risk of compression injuries like carpal tunnel syndrome, ulnar nerve entrapment, and peroneal nerve damage

Treatment

• Removing pressure from the affected nerve
• Splints to immobilize the area
• Corticosteroid injections
• Treatment of any underlying medical conditions
• Surgery to relieve pressure if other treatments fail