Diabetic Neuropathy Questions & Answers

Updated: Jan 08, 2019
  • Author: Dianna Quan, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Questions & Answers

Overview

What is diabetic neuropathy?

What are the signs and symptoms of diabetic neuropathy?

What should the physical exam of diabetic neuropathy include?

What is the modified Thomas classification system for diabetic neuropathy?

How is distal symmetrical sensorimotor polyneuropathy defined?

How common is pure autonomic diabetic neuropathy?

What are asymmetrical diabetic neuropathies?

How is diabetic polyneuropathy staged?

Which lab tests may be helpful in the diagnosis of diabetic neuropathy?

Which imaging modalities may be considered for the diagnosis of diabetic neuropathy?

What are the key components of diabetic neuropathy management?

Which autonomic dysfunctions must be managed in patients with diabetic neuropathy?

What are the surgical options for diabetic neuropathy?

How is diabetic neuropathy defined?

What is the frequency of diabetic neuropathy?

What are secondary complications of diabetic neuropathy?

What are the manifestations of diabetic neuropathy?

What is the role of electrophysiologic testing in the evaluation of diabetic neuropathy?

How is diabetic neuropathy managed?

What are the treatment options for diabetic neuropathy?

How are peripheral neurons categorized in diabetic neuropathy?

What is the anatomy of motor neurons in diabetic neuropathy?

What is the anatomy of sensory neurons in diabetic neuropathy?

What is the anatomy of autonomic neurons in diabetic neuropathy?

What are the subdivision of sensory neurons in diabetic neuropathy?

What are the risk factors for the development of diabetic neuropathy?

What is the role of hyperglycemia in the pathophysiology of diabetic neuropathy?

What is the role of advanced glycation end products (AGEs) in the pathophysiology of diabetic neuropathy?

What is the role of oxidative stress in the pathophysiology of diabetic neuropathy?

What are contributing factors to the development of focal or asymmetrical diabetic neuropathy syndromes?

What are the risk factors associated with severe symptoms of diabetic neuropathy?

How do symptoms of diabetic neuropathy develop?

What is the most common etiologic mechanism of diabetic neuropathy?

What is the association between impaired glucose tolerance and diabetic peripheral neuropathy?

What are the roles of poor glycemic control, nerve conduction loss, and lipid metabolism changes in the etiology of diabetic peripheral neuropathy?

What is the association between variability in fasting plasma glucose and diabetic peripheral neuropathy?

What is the role of obstructive sleep apnea (OSA) in the etiology of diabetic neuropathy?

What is the odds ratio for peripheral neuropathy in patients with type 2 diabetes versus those with type 1?

What is the prevalence of diabetic neuropathy in the US?

Why is there variability in US prevalence data for diabetic neuropathy?

What is the global prevalence of diabetic neuropathy?

What are the racial predilections for diabetic neuropathy?

How does the prevalence of diabetic neuropathy vary by sex?

How does the prevalence of diabetic neuropathy vary by age?

What is the prognosis of untreated diabetic neuropathy?

What are the limitations of diabetic neuropathy treatments?

What is the mortality rate for diabetic neuropathy?

How does tertiary care affect the outcomes of diabetic neuropathy?

What is the role of diet and nutrition in the management of diabetic neuropathy?

What activity modifications are needed for patients with diabetic neuropathy?

What information about diabetic neuropathy should patients be given?

What foot protection and care instructions should patients with diabetic neuropathy receive?

What are the ophthalmologic and renal conditions associated with diabetic neuropathy?

Where should patient education for diabetic neuropathy be given?

What is diabetic neuropathy?

How does diabetic neuropathy occur?

What are the symptoms of diabetic neuropathy?

How is the pain of diabetic neuropathy characterized?

How is diabetic neuropathy prevented?

How is diabetic neuropathy treated?

What are the self-care measures for diabetic neuropathy?

What is the duration of diabetic neuropathy symptoms?

Presentation

What should be the focus of history for diabetic neuropathy?

What are the sensory symptoms of diabetic neuropathy?

What are the motor symptoms of diabetic neuropathy?

What is the most common presentation of diabetic neuropathy?

What are the autonomic symptoms of diabetic neuropathy?

What are the GI symptoms of diabetic neuropathy?

What are the cardiovascular symptoms of diabetic neuropathy?

What are the symptoms of bladder neuropathy in patients with diabetes?

What are the sudomotor symptoms of diabetic neuropathy?

What is included in the physical exam of patients with diabetic neuropathy?

What is the role of pinprick testing in the assessment of diabetic neuropathy?

How is vibratory sense in the feet assessed in diabetic neuropathy?

How are deep tendon reflexes assessed in diabetic neuropathy?

What is the focus of skin exam in diabetic neuropathy?

What does a finding of paresthesias suggest in the assessment of diabetic neuropathy?

How is cranial nerve testing performed in patients with diabetic neuropathy?

What should be included in an annual screening for diabetic neuropathy?

When is specialized autonomic testing indicated in the assessment of diabetic neuropathy?

How is blood pressure measured in the assessment of diabetic neuropathy?

What are the classification systems for diabetic neuropathy?

What is the Thomas system for classification of diabetic neuropathy?

What are the broad classifications used for diabetic neuropathy?

What are the criteria used to define distal symmetrical sensorimotor diabetic polyneuropathy?

What is chronic symmetrical diabetic neuropathy?

What is the progression of symptoms for chronic symmetrical diabetic neuropathy?

What is small-fiber diabetic neuropathy?

What are some manifestations of autonomic diabetic neuropathy?

What is diabetic neuropathic cachexia?

What are the subtypes of asymmetrical diabetic neuropathy?

How are asymmetrical diabetic differentiated from distal diabetic neuropathy?

What is cranial diabetic mononeuropathy?

What are manifestations of facial diabetic neuropathy?

What are manifestations of anterior ischemic optic diabetic neuropathy?

What are somatic diabetic mononeuropathies?

What are the signs and symptoms of diabetic thoracic radiculoneuropathy?

Where in the body does diabetic radiculoplexus neuropathy occur?

What are the symptoms of diabetic radiculoplexus neuropathy?

How is the severity of diabetic neuropathy assessed?

How is diabetic neuropathy staged?

DDX

What is required to establish the diagnosis of diabetic neuropathy?

What are the differential diagnoses for cranial diabetic mononeuropathy?

What are the differential diagnoses for thoracoabdominal diabetic neuropathy?

What are the differential diagnoses for diabetic lumbosacral radiculoplexopathy?

What are the differential diagnoses for peripheral diabetic neuropathy?

What are the differential diagnoses for cardiovascular autonomic neuropathy?

What are the differential diagnoses for GI diabetic neuropathy?

What are the differential diagnoses for bladder dysfunction in diabetic neuropathy?

What are the differential diagnoses for diabetic mononeuropathy?

What are the differential diagnoses for Diabetic Neuropathy?

Workup

Which lab tests are used to screen for diabetic neuropathy?

What is the role of imaging studies in the diagnosis of diabetic neuropathy?

What is the role of electrophysiologic testing in the diagnosis of diabetic neuropathy?

What is the accuracy of screening tools used for diabetic neuropathy?

What is the role of hemoglobin A1c measurement and fasting plasma glucose testing in the diagnosis of diabetic neuropathy?

Which tests are used to exclude common causes of neuropathy other than diabetes?

What is the role of nerve conduction studies (NCS) and electromyography (EMG) in the diagnosis of diabetic neuropathy?

What is the role of nerve conduction velocity (NCV) studies in the diagnosis of diabetic neuropathy?

What is the role of needle electromyography (EMG) in the diagnosis of diabetic neuropathy?

Which nerve conduction study findings are characteristic of diabetic neuropathy?

Which findings on electromyographic samplings are characteristic of diabetic neuropathy?

How are electrophysiologic studies used for the diagnosis of diabetic neuropathy?

What is the role of MRI and CT scanning in the diagnosis of diabetic neuropathy?

What is the role of nuclear imaging in the diagnosis of diabetic neuropathy?

What is the role of Doppler imaging in the diagnosis of diabetic neuropathy?

What is the role of microdialysis in the diagnosis of diabetic neuropathy?

What is the role of electrocardiography in the diagnosis of diabetic neuropathy?

What is the role of nerve biopsy in the diagnosis of diabetic neuropathy?

What is the role of skin biopsy in the diagnosis of diabetic neuropathy?

Why are biopsies rarely recommended for the diagnosis of diabetic neuropathy?

Which diagnostic approaches for diabetic neuropathy are investigational?

Treatment

When should the management of diabetic neuropathy begin?

What complications are at increased risk with diabetic peripheral neuropathy?

What is included in the follow-up of patients with peripheral diabetic neuropathy?

What is the role of a primary care physicians in the treatment of diabetic neuropathy?

What is the role of glycemic control in the treatment of diabetic neuropathy?

Which medications are used in the treatment of diabetic neuropathic pain?

What is the role of gabapentin in the treatment of diabetic neuropathy?

What are the AAN/AANEM/AAPMR treatment guidelines for painful diabetic neuropathy (PDN)?

What are the AAN/AANEM/AAPMR guidelines for topical treatment used for painful diabetic neuropathy (PDN)?

What are the advantages and disadvantages of administering off-label medications to treat diabetic neuropathic?

What is the role of duloxetine in the treatment of diabetic neuropathy?

What are the differences in efficacy between gabapentin and tricyclic antidepressants for the treatment of diabetic neuropathic pain?

Which medications are used to control diabetic neuropathic pain during pregnancy?

Which medications are used to treat gastroparesis in diabetic neuropathy?

What is the role of dietary supplements in the treatment of diabetic neuropathy?

What is the role of aldose reductase inhibitors in the treatment of diabetic neuropathy?

What is the role of alpha-lipoic acid in the treatment of diabetic neuropathy?

What is the role of actovegin in the treatment of diabetic neuropathy?

What is the role of spinal cord stimulator implants in the treatment of diabetic neuropathy?

How is erectile dysfunction due to diabetic neuropathy treated?

How is symptomatic orthostatic hypotension due to diabetic neuropathy treated?

How is gustatory sweating in diabetic neuropathy treated?

When is surgery indicated in the treatment of diabetic neuropathy?

What is the role of jejunostomy in the treatment of diabetic neuropathy?

When is penile prosthesis indicated in the treatment of diabetic neuropathy?

How are feet complications of diabetic neuropathy treated?

What are the benefits of pancreatic transplantation for treatment of diabetic neuropathy?

What is the role of physical therapy in the treatment of diabetic neuropathy?

What is the role of transcutaneous electrical nerve stimulation (TENS) in the treatment of diabetic neuropathy?

When is physical therapy indicated in the treatment of foot ulcers due to diabetic neuropathy?

What are some therapies used to improve balance in patients with diabetic neuropathy?

When is occupational therapy indicated in the treatment of diabetic neuropathy?

When is speech therapy indicated in the treatment of diabetic neuropathy?

What is the role of recreational therapy in the treatment of diabetic neuropathy?

What are possible complications of peripheral diabetic neuropathy?

What are possible complications of autonomic diabetic neuropathy?

What is the role of an endocrinologist in the management of diabetic neuropathy?

When is a neurology consultation indicated in the management of diabetic neuropathy?

What are the benefits of physical medicine and rehabilitation in the management of diabetic neuropathy?

When are specialist consultations needed in the management of diabetic neuropathy?

What is included in the long-term monitoring of diabetic neuropathy?

Medications

Which medications are used in the treatment of diabetic neuropathy?

Which medications in the drug class Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) are used in the treatment of Diabetic Neuropathy?

Which medications in the drug class Analgesic, Topical are used in the treatment of Diabetic Neuropathy?

Which medications in the drug class Anticonvulsant are used in the treatment of Diabetic Neuropathy?

Which medications in the drug class Antidepressant, Tricyclic are used in the treatment of Diabetic Neuropathy?

Which medications in the drug class Antidepressant, Selective Serotonin/norepinephrine Reuptake Inhibitor (ssnri) are used in the treatment of Diabetic Neuropathy?

Which medications in the drug class Antidepressant, Serotonin Reuptake Inhibitor are used in the treatment of Diabetic Neuropathy?

Which medications in the drug class Antiarrhythmic Agent, Class I-b are used in the treatment of Diabetic Neuropathy?

Which medications in the drug class Prokinetic Agents are used in the treatment of Diabetic Neuropathy?

Which medications in the drug class Antidepressant, Tetracyclic are used in the treatment of Diabetic Neuropathy?

Which medications in the drug class Synthetic Adrenocortical Steroids are used in the treatment of Diabetic Neuropathy?

Which medications in the drug class Cholinergic Agent are used in the treatment of Diabetic Neuropathy?

Which medications in the drug class Laxative, Bowel Evacuant are used in the treatment of Diabetic Neuropathy?