Thursday, 4 November 2010

MRCP revision battle 42.4: Diabetic neuropathy

Diabetics may suffer from several different types of neuropathy.

1. Diabetic sensory neuropathy

The classic diabetic neuropathy is sensory neuropathy.  This causes a distal numbness ('glove and stocking') with tingling and pain.  

  • 1st line: TCA
  • 2nd line: gabapentin, pregabalin

2. Diabetic amyotrophy

Diabetic amyotrophy is sometimes known as proximal diabetic neuropathy.  This causes painful wasting of the quadriceps.   It is thought to be caused by occlusion of the vasa nervorum of the proximal lumbar plexus.  There is loss of the knee reflexes.

3. Autonomic neuropathy

If you need a recap refer back to revision battle 32.7

4. Mononeuritis multiplex

Particularly of CN III and VI.

Next up... a bit of nystagmus...