Neurologist's view of diabetic neuropathy

Authors:

• Edvard Ehler

Abstract

Diabetic neuropathy is the most frequently occurring neuropathy in the developed countries. It occurs in up to 66% of diabetics type 1 and in 59% of diabetics type 2. From a pathophysiological point of view it is primary axonal lesion with subse-quent lesion of myelin sheet. Both thick fibres and thin fibres, namely motoric, sensory and vegetative, are affected in various extents and various severities. Individual forms of diabetic neuropathy may be classified on the basis of symmetry and localisa-tion of the infliction in symmetric forms (sensory motoric distal polyneuropathy, autonomous neuropathy, acute painful neuro-pathy), asymmetric forms (cranial and limb mononeuropathy, thoracoabdominal polyradiculopathy, diabetic amyotrophy) and mixed forms. From a neurologist's view it is necessary to determine the form of neuropathy, degree of infliction, to exclude other neuropathies (they may occur in diabetic patient, too), to express opinion of treatment possibilities (reversibility of some forms, treatment of neuropathic pain) and to contribute to prognosis determination (occurrence of complications of underlying neuropathy). Origin and dynamics of development and signs of sensory fibres disorders are important in the medical history. During the clinical examination it is necessary to assess sensitivity disorders (including vibration, heat and algesic sensations), muscular pareses and atrophies, vegetative signs (sudomotoric disorders). Among the auxiliary examinations the most important is an electromyography (especially the examination of motoric and sensory nerves conduction).