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284 Cardio Diabetes Medicine 2017

• Patients with Diabetic Neuropathy are 15 times • Painless or silent myocardial infarction
more likely to have Lower limb amputation
Mononeuropathy
• Foot problems are the commonest reason for
in-patient admission In diabetic patients, nerve entrapment is commoner
than nerve infarction. The entrapment neuropathies
Diabetic Sensory Motor Neuropathy have insidious onset, have characteristic electrodi-
agnostic features such as conduction block or seg-
• Most common Diabetic Neuropathy ,three- fourth mental nerve conduction slowing in the entrapped
of all Diabetic Neuropathy.
segment of the nerve. Carpal tunnel syndrome is
• Sensory predominant, autonomic correlate with three times more common in diabetic patients than
severity the normal population. The other entrapment neu-
ropathies in diabetic patients are ulnar, radial, lateral
• Minor involvement of distal muscles of lower ex-
tremities. femoral cutaneous nerve of thigh, peroneal and me-
dial and lateral planter nerves.
• Sensorystocking-glove distribution

• Length-dependent pattern. Cranial neuropathy
Cranial neuropathy in diabetic patients, most com-
• Advanced- sensation impaired over chest & abdo- monly involve the oculomotor nerve followed by
men - wedge-shaped area
trochlear and facial nerve in order of frequency. Third
nerve palsy with pupillary sparing is the hallmark of
Large-fiber neuropathy diabetic oculomotor palsy and is attributed to nerve
• Often asymptomatic, sensory deficit on examina- infarction. The pupillary fibres are peripherally locat-
tion ed; therefore escape in diabetic oculomotor palsy.
• Painless paresthesias beginning at the toes and
feet, Multiple neuropathies
Multiple neuropathies refer to the involvement of two
• Impaired vibration & Joint position sense.
or more nerves. As in mononeuropathy the onset is
• Diminished reflexes. abrupt in one nerve and occurs earlier than the other
• Ataxia secondary to sensory deafferentation. nerves, which are involved sequentially or irregularly.
Nerve infarctions occur because of occlusion of vasa
Small-fiber neuropathy nervosum and should be differentiated from system-
ic vasculitis.
• Deep, burning, stinging, aching pain ;allodynia to
light touch. Diabetic Amyotrophy
• Pain & temperature impaired, relative preservation Unilateral severe pain in the lower back, hip, and an-
of vibration, Joint Position sense and Deep tendon terior thigh heralds onset
reflex.
Within days to weeks, weakness of proximal and,
• Often accompanied by autonomic neuropathy to a lesser extent, distal lower-extremity muscles

• May even develop soon after onset of Impaired (iliopsoas, gluteus, thigh adductor, quadriceps, ham-
Glucose tolerance. string, and anterior tibialis).
Opposite leg affected after days to months.
Autonomic Neuropathy
Reduced or absent knee and ankle jerks.
• Correlates with severity of somatic neuropathy
Subclinical impairment Cardiovascular system , The role of Nerve Conduction studies in
Gastrointestinal system , Genitourinary system Diabetes mellitus
dysfunction
The American Academy of Neurology recommends
• Orthostatic hypotension, resting tachycardia, di- that Diabetic Neuropathy is diagnosed in presence of
minished heart-rate response to respiration somatic or autonomic neuropathy when other causes

• Vagal denervation of heart- high resting pulse & of neuropathy have been excluded.About 10% of dia-
loss of sinus arrhythmia. betic patients may have other causes of neuropathy.
Diabetic Neuropathy cannot be diagnosed without

GCDC 2017