Peripheral Neuropathy (Sensory) |
- Burning, tingling, or numbness in the feet and hands (glove-and-stocking distribution).
- Loss of sensation (vibration, temperature, pain).
- Muscle weakness and balance problems in advanced cases.
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- Monofilament Test: Assess light touch sensation on the soles of the feet.
- Tuning Fork Test: Assess vibration sense with a 128-Hz tuning fork.
- Pinprick Test: Evaluate pain sensation using a sharp object.
- Nerve Conduction Studies (NCS): To assess nerve damage and function.
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- Glycemic Control: Maintain tight control of blood glucose (HbA1c < 7%).
- Pain Management:
- First-line: Pregabalin, gabapentin, or duloxetine.
- Alternative: Tricyclic antidepressants (amitriptyline), topical lidocaine, or capsaicin.
- Foot Care: Regular foot inspections, appropriate footwear, and care for ulcers or injuries.
- Lifestyle Modifications: Smoking cessation, weight management, and exercise.
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Autonomic Neuropathy |
- Orthostatic hypotension (dizziness upon standing).
- Gastroparesis (nausea, vomiting, bloating).
- Urinary retention or incontinence.
- Sexual dysfunction (erectile dysfunction in men).
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- Postural Blood Pressure Measurement: Assess for orthostatic hypotension (drop in BP on standing).
- Gastric Emptying Study: For diagnosis of gastroparesis.
- Bladder Scan: Assess residual urine volume in cases of urinary retention.
- Cardiac Autonomic Reflex Tests: Evaluate heart rate response to deep breathing and standing.
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- Orthostatic Hypotension: Increase salt intake, use compression stockings, and consider fludrocortisone or midodrine.
- Gastroparesis: Dietary modifications (small, frequent meals), prokinetic agents (metoclopramide), and antiemetics.
- Bladder Dysfunction: Bladder training, catheterization if needed, and anticholinergic medications.
- Erectile Dysfunction: Phosphodiesterase inhibitors (e.g., sildenafil).
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Proximal Neuropathy (Diabetic Amyotrophy) |
- Severe pain in the hips, thighs, or buttocks.
- Muscle weakness and wasting, often unilateral.
- Difficulty rising from a seated position or climbing stairs.
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- Physical Examination: Assess muscle strength and reflexes in the lower limbs.
- Nerve Conduction Studies (NCS): To evaluate nerve function.
- Electromyography (EMG): To assess muscle electrical activity and detect neuropathy.
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- Pain Management: Pregabalin, gabapentin, or NSAIDs.
- Physical Therapy: To strengthen affected muscles and improve mobility.
- Glycemic Control: Maintain tight glucose control to prevent progression.
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Focal Neuropathy |
- Sudden onset of pain, weakness, or paralysis in specific nerves.
- Commonly affects cranial nerves (e.g., III, IV, VI) causing double vision or facial palsy.
- Can also affect the thoracic and lumbar nerves, causing localized pain.
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- Physical Examination: Assess for cranial nerve palsies, motor deficits, or localized pain.
- Imaging: MRI or CT if structural lesions are suspected.
- Nerve Conduction Studies (NCS): To assess specific nerve function.
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- Pain Management: Pregabalin, gabapentin, or tricyclic antidepressants.
- Physical Therapy: To maintain muscle strength and prevent contractures.
- Supportive Care: Often resolves spontaneously within weeks to months.
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