Diabetic neuropathy (DN) is a highly prevalent complication of diabetes (type 1 or type 2) and is characterised by the presence of symptoms and/or signs of peripheral nerve dysfunction and/or autonomic nerve dysfunction.

It is diagnosed after the exclusion of other causes. Frequently, however, people with DN are asymptomatic.

Manifestations

• Symmetrical distal polyneuropathy
  • early on it’s sensory
  • later on patient may complain of sensation of walking on cotton wool
  • impaired proprioception
  • interosseous wasting of feet (hands is uncommon
• Acute painful neuropathy
• Mononeuritis complex
• Diabetic amyotrophy
  • This condition is usually seen in older men with diabetes.
  • Presentation is with painful wasting, usually asymmetrical, of the quadriceps muscles.
• Autonomic neuropathy
  • postural hypotension
  • GI: gastroperesis, dysphagia, diarrhoea
  • Bladder: UTIs, loss of tone, incomplete emptying
  • sexual dysfunction

Risk factors:

• Poorly controlled hyperglycaemia
• Prolonged duration of diabetes
• Older age (>70)
• Tall stature
• HTN
• Dyslipidaemia with elavated triglycerides
• Co-existence of multiple cardiovascular disease risk factors (people with T2)