Diabetes

Question 1

Diabetic sensory polyneuropathy

Answer 1

Commonest

Distal, symmetrical polyneuropathy
Glove and stocking
Numbness, pain, tingling (paresthesia)
All forms of sensation can be affected
Minor motor involvement

Irreversible
Leads to foot ulceration
Charcot joint (neuropathic osteoarthropathy) - deformity of joint, commonly tarsometatarsal

Question 2

Acute Painful Diabetic Neuropathy

Answer 2

Uncommon

Acute burning/aching of lower limbs
Widespread contact hyperaesthesia
Slight distal sensory loss
Depression of ankle jerks

Associated with rapid weight loss and institution of tight glycemic control

Question 3

Autonomic neuropathy

Answer 3

Damage to small nerve fibres

⬇️temp and pain sensation
Sweating with eating
Orthostatic hypotension
Diarrhoea
Impotence
Bladder hypotonia
Gastroparesis

Question 4

Focal and multifocal neuropathies

Answer 4

Isolated 3rd nerve lesion - ischaemia

Question 5

Proximal diabetic neuropathy/diabetic amyotrophy

Answer 5

Unilateral/asymmetric bilateral lower limb neuropathy
⬇️muscle bulk
Pain around hip and thigh