Different Types Of Diabetic Neuropathy: Symptoms And Treatment

Diabetes mellitus can develop many forms of neuropathy; these are classified into asymmetrical and symmetrical forms.

The asymmetrical forms include III or IV cranial mono-neuropathy, mono-neuritis multiplex, trunk radiculopathy, non-neuropathy e.g. diabetic femoral neuropathy and lumbo-sacral plexopathy.

Diabetic Femoral Neuropathy

  • It presents with pain in the anterior thighs followed by quadriceps wasting, marked weakness, with inability to get up from sitting position and history of falls.
  • Sensory loss is present in the anterior side of thigh and medial side of leg up to medial malleolus.
  • Sometimes sensory loss may be minimal. The condition tends to occur during periods of change in diabetic status.
    It is seen when diabetes is out of control or just after treatment is started.

Diabetic Amyotrophy

  • The clinical picture is same like diabetic femoral neuropathy, but the extensor plantars and increased cerebrospinal fluid (CSF) proteins.
  • The lesion is suspected to be at the cord and anterior horn cell level.
  • Increased CSF protein is not much useful because in diabetes many patients have increased proteins in CSF without neuropathy.
  • Recovery occurs gradually and good diabetic control is helpful for better recovery.

Diabetic Cranial Neuropathy

  • Diabetes can cause isolated III or IV cranial neuropathy. Both may start with pain and then nerve weakness.
  • In third nerve palsy a characteristic feature is sparing of the pupil. The palsy is due to infarction of the nerve and papillary fibers being peripheral are spared. Diabetic cranial neuropathy recovers gradually with time.

Symmetrical Neuropathies In Diabetes

  • Early diabetic sensory neuropathy (reversible) is usually seen when diabetes is detected and clears rapidly with start of therapy.
  • Diabetic pure motor neuropathy is seen in older people. There is marked muscle wasting.
  • Chronic sensorimotor neuropathy is the commonest neuropathy seen in diabetics. This neuropathy is characterized by pain and parasthesic (abnormal sensation). Vibration is lost first, and then ankle jerk; later touch and pain are lost.
  • Diabetic autonomic neuropathy is the commonest manifestation in impotence. Other features seen are postural hypotension, nocturnal (night) diarrhea and urinary difficulty. Diabetic autonomic dysfunction is the explanation why diabetics frequently have a painless myocardial infarction.

Treatment Of Diabetic Neuropathy

  • Control of diabetes with appropriate anti-diabetic drugs is to be done first.
  • Medicines prescribed by physician for symptomatic relief of paraesthesia and pain are given.
  • Local use of ointment of capsicum can be used.