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Diabetic NeuropathyAka: Peripheral Neuropathy in Diabetes Mellitus

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  1. Epidemiology
    1. Occurs in Type I and Type II Diabetes Mellitus
    2. Occurs in 42% of Type II Diabetes Mellitus
      1. Onset within 10 years of disease
      2. Higher risk with higher Glycosylated Hemoglobin
      3. Partanen (1995) N Engl J Med 333:89
  2. Types
    1. Bilateral Peripheral Polyneuropathy in Diabetes
    2. Diabetic Focal Neuropathy
    3. Diabetic Autonomic Neuropathy
  3. Diagnosis
    1. See also Peripheral Neuropathy Testing
  4. Differential Diagnosis
    1. See Autonomic Neuropathy
    2. Peripheral Polyneuropathy
      1. Vitamin B12 Deficiency
      2. Folic Acid deficiency
      3. Hypothyroidism
      4. Uremia
      5. Chemical Toxin exposure (heavy metal toxicity)
      6. Alcohol Abuse
      7. Sarcoidosis
      8. Leprosy
      9. Periarteritis nodosum
      10. Lupus erythematosus
      11. Leukemia
  5. Complications (of distal symmetric Polyneuropathy)
    1. See Charcot Foot
    2. See Foot Wound
    3. See Suspected Osteomyelitis in Diabetes Mellitus
    4. See Peripheral Neuropathy Tremor
  6. Prevention
    1. See Diabetic Foot Care
    2. Optimize Diabetes Mellitus management
      1. Goal Hemoglobin A1C <7.0
  7. Management: Painful Peripheral Neuropathy
    1. Anticonvulsants
      1. May be more effective in sharp lancinating pain
      2. Phenytoin
      3. Gabapentin (Neurontin)
        1. Start at 100 qhs to 100 mg PO tid
        2. Advance to 300 - 1200 mg PO tid
        3. Backonja (1998) JAMA 280:1831
      4. Pregabalin (Lyrica)
        1. Dosing: 50 mg PO tid titrating to 100 mg PO tid
      5. Carbamazepine (Tegretol)
        1. Start at 100 mg PO bid
        2. Advance to 200 mg PO qid as tolerated
        3. Requires Complete Blood Count monitoring
      6. Valproic Acid
        1. Start at 500 mg PO daily
        2. Advance to 500 mg PO bid
        3. Requires hepatic transaminase monitoring (AST, ALT)
        4. Kochar (2004) QJM 97:33
    2. Tricyclic Antidepressants
      1. May be more effective in burning, steady pain
      2. Amitriptyline (Elavil)
      3. Imipramine
      4. Desipramine
      5. References
        1. McQuay (1996) Pain 68:217
    3. SSRIs (Appear less effective than Tricyclics)
      1. Duloxetine (Cymbalta)
      2. Paroxetine (Paxil)
        1. Sindrup (1990) Pain 42:135
    4. Other pain management options
      1. Capsaicin 0.075% cream
      2. TENS Unit
      3. NSAIDS (e.g. Sulindac)
      4. Tramadol (Ultram)
  8. References
    1. Simmons (2000) Clinical Diabetes 18:116-7
    2. Lipnick (1996) Am Fam Physician 54(8):2478
    3. Aring (2005) Am Fam Physician 71:2123

Diabetic Neuropathies (C0011882)

Definition (MSH)Peripheral, autonomic, and cranial nerve disorders that are associated with DIABETES MELLITUS. These conditions usually result from diabetic microvascular injury involving small blood vessels that supply nerves (VASA NERVORUM). Relatively common conditions which may be associated with diabetic neuropathy include third nerve palsy (see OCULOMOTOR NERVE DISEASES); MONONEUROPATHY; mononeuropathy multiplex; diabetic amyotrophy; a painful POLYNEUROPATHY; autonomic neuropathy; and thoracoabdominal neuropathy. (From Adams et al., Principles of Neurology, 6th ed, p1325)
Definition (CSP)common complication of diabetes mellitus in which nerves are damaged as a result of hyperglycemia (high blood sugar levels).
ConceptsDisease or Syndrome (T047)
ICD9250.6
EnglishDiabetes + neuropathy, Diabetes mellitus with neurological manifestation, Diabetes mellitus with neuropathy, Diabetes with neurological manifestations, Diabetic Neuropathies, DIABETIC NEUROPATHY, Neuropathy - diabetic
Spanishdiabetes mellitus con manifestacion neurologica, diabetes mellitus con neuropatia, diabetes sacarina con neuropatia, neuropatia diabetica
Parent ConceptsComplications of Diabetes Mellitus (C0342257), Diabetes Mellitus (C0011849), Peripheral Neuropathy (C0031117), Neuropathy (C0442874), Neuropathy associated with endocrine disorder (C0393828), Ambiguous concept (C1274012), Neurologic disorder associated with diabetes mellitus (C1720078)
SourcesCCS, COSTAR, CSP, DXP, ICD9CM, LCH, MSH, MTH, NCI, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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