Makindo Medical Notes"One small step for man, one large step for Makindo" |
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Diabetic neuropathy is nerve damage caused by chronic hyperglycaemia and metabolic dysfunction. It affects up to 50% of long-standing diabetics and is a diagnosis of exclusion. π Always rule out other causes (B12 deficiency, alcohol, thyroid disease, uraemia, drugs) as they may be treatable.
Type | Clinical Features | Notes / Management |
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π¦Ά Distal Symmetric Polyneuropathy (DSPN) | Burning, tingling, numbness, worse at night; βglove & stockingβ distribution; loss of vibration/temp sense; foot ulcers. | π Amitriptyline β Duloxetine / Gabapentin / Pregabalin. π Daily foot checks & footwear advice. β οΈ Opiates last resort. |
π§ Autonomic Neuropathy | Postural hypotension, resting tachycardia, gastroparesis, diarrhoea, erectile dysfunction, gustatory sweating, urinary retention. | π« Fludrocortisone, Midodrine for OH. π½οΈ Metoclopramide/domperidone for gastroparesis. π PDE-5 inhibitors for ED. π© Codeine phosphate for diarrhoea. |
𦡠Proximal Neuropathy (Diabetic Amyotrophy) | Severe thigh/hip pain, progressive quadriceps wasting, unilateral weakness, difficulty rising from chair. | Likely immune-mediated microvasculitis. Tx = analgesia, physio, glucose optimisation. Improves spontaneously over months. |
π― Focal Neuropathy | Sudden cranial nerve palsy (CN III, IV, VI β diplopia, ptosis), facial nerve palsy, focal limb weakness. Often painful. | Usually self-limiting (weeksβmonths). Supportive care & exclude compressive lesions. |
π Mononeuritis Multiplex | Patchy motor/sensory deficits, can involve cranial nerves. | Self-limiting; rarely steroids/IVIG used in severe cases. |