Diabetic neuropathy
Prevalence	Most common cause of neuropathy About 20% of diabetic has signs & symptoms of neuropathy Most common over 50 years old
Types	Symmetric chronic polyneuropathy most common paresthesia in feet Ankle jerk absent, foot ulcer, Neuropathic joints Ophthalmoplegia III nerve palsy with pupil sparing May affect VI & VII nerve Usually spontaneous recovery in 6 - 12 weeks Mononeuropathy & Mononeuropathy multiplex may affect Femoral, Sciatic, Median, Ulnar nerves Compression neuropathy also common Acute onset, painful, ischemic in nature Diabetic amytrophy painful, asymmetrical unilateral or bilateral affect Lumbosacral plexus Improve in 6 to 18 months Diabetic polyradiculopathy thoracoabdominal pain and dysesthesia T8-T12 most commonly involved Good prognosis of recovery Increased CSF protein Autonomic neuropathy often superimposed on polyneuropathy Postural hypotension Pupil & lacrimal dysfunction atonicity of GI & GU tracts impotence
General treatment	Tight control of diabetes Meticulous foot care Avoid trauma Symptomatic pain control
Postural hypotension	increase salt intake elastic stocking Fludrocortisone 0.1 mg qd, with gradual increase Indomethacin 25 to 50 mg tid Caffeine 200 mg in am
Further Reading	Symposium on complications of Diabetes - Postgrad Med Feb 99 : nephropathy, Joint mobility, Coronary artery disease