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    Neurologic Complications in Diabetes Mellitus: Done By-Fatema Burhan Ravat Dtmu 4Th Year January 2020

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    Fatema Ravat
    This document discusses neurologic complications in diabetes mellitus. It notes that 50% of type 2 diabetes patients are affected, most commonly experiencing peripheral and autonomic neuropathy. While the cause is unknown, it may relate to ischemia or metabolic complications affecting nerves. Risk factors include poor glycemic control, obesity, older age, smoking, and family history. Common types of neuropathy include distal symmetric polyneuropathy and isolated peripheral neuropathy. Symptoms and treatments vary depending on the specific nerves affected. Intensive glycemic control and managing modifiable risk factors can help prevent neurologic complications.

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    Neurologic Complications in Diabetes Mellitus: Done By-Fatema Burhan Ravat Dtmu 4Th Year January 2020

    Uploaded by

    Fatema Ravat
    60 views27 pages
    This document discusses neurologic complications in diabetes mellitus. It notes that 50% of type 2 diabetes patients are affected, most commonly experiencing peripheral and autonomic neuropathy. While the cause is unknown, it may relate to ischemia or metabolic complications affecting nerves. Risk factors include poor glycemic control, obesity, older age, smoking, and family history. Common types of neuropathy include distal symmetric polyneuropathy and isolated peripheral neuropathy. Symptoms and treatments vary depending on the specific nerves affected. Intensive glycemic control and managing modifiable risk factors can help prevent neurologic complications.

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    This document discusses neurologic complications in diabetes mellitus. It notes that 50% of type 2 diabetes patients are affected, most commonly experiencing peripheral and autonomic neuropathy. While the cause is unknown, it may relate to ischemia or metabolic complications affecting nerves. Risk factors include poor glycemic control, obesity, older age, smoking, and family history. Common types of neuropathy include distal symmetric polyneuropathy and isolated peripheral neuropathy. Symptoms and treatments vary depending on the specific nerves affected. Intensive glycemic control and managing modifiable risk factors can help prevent neurologic complications.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    60 views27 pages

    Neurologic Complications in Diabetes Mellitus: Done By-Fatema Burhan Ravat Dtmu 4Th Year January 2020

    Uploaded by

    Fatema Ravat
    This document discusses neurologic complications in diabetes mellitus. It notes that 50% of type 2 diabetes patients are affected, most commonly experiencing peripheral and autonomic neuropathy. While the cause is unknown, it may relate to ischemia or metabolic complications affecting nerves. Risk factors include poor glycemic control, obesity, older age, smoking, and family history. Common types of neuropathy include distal symmetric polyneuropathy and isolated peripheral neuropathy. Symptoms and treatments vary depending on the specific nerves affected. Intensive glycemic control and managing modifiable risk factors can help prevent neurologic complications.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 27

    NEUROLOGIC

    COMPLICATIONS IN
    DIABETES MELLITUS
    Done by- FATEMA BURHAN RAVAT
    DTMU 4TH YEAR
    January 2020
    Introduction

    ● 50% of type 2 DM patients affected


    ● Most common- peripheral and autonomic
    ● Cause- unknown;
    ○ may be due to ischemic infarction of
    involved nerve (cranial nerve palsy &
    diabetic amyotrophy)
    ○ Metabolic complications (symmetric
    sensory & motor peripheral) ANA MORALES
    ● No effective treatment
    Risk Factors

    Modifiable Non-modifiable

    ● Poor glycemic control ● Obesity


    ● Alcohol ● Older age
    ● Hypertension ● Male sex
    ● Cigarette smoking ● Height
    ● Hyperlipidemia ● Family hx
    ● APOE genotype
    ● Long duration of diabetes
    Types of neuropathies
    Mechanism
    Common Symptoms
    Physical Examination
    Diagnostic tests
    SUDOSCAN
    Distal Symmetric Polyneuropathy

    ● Most common type


    ● Glove-stocking pattern due to axonal neuropathic
    process
    ● Longer nerves vulnerable- foot affected
    ● Motor and sensory affected, reflexes may be absent
    ● Sensory occurs first- bilateral, symmetric, dull
    vibration and temperature

    Dx- examined with a 5.07 Semmes-Weinstein filament


    Symptoms & Signs

    1. Pain- may be absent (sensory deficit), mild discomfort or incapacitating


    2. Numbness, tingling, sharpness or burning- spreads proximally
    3. Clawing of toes
    4. Displacement of submetatarsal fat pad
    5. Callus and ulceration in high pressure areas eg. Metatarsal heads
    6. Charcot foot and charcot arthropathy-> rocker bottom deformity
    7. Osteoclastic destruction-> deranged joints particularly midfoot
    Management

    ● Improve glycemic control


    ● Mechanical unloading
    ● Antibiotics for infections
    ● Healing time - 8-10 weeks
    ● PDGF (becaplermin) - side effect-> cancer
    ● Therapeutic footwear after ulcer heals
    ● Education, inspection, seek care from podiatrist

    ANA MORALES
    Isolated Peripheral Neuropathy

    ● Mononeuropathy or mononeuropathy multiplex


    ● Sudden onset -> recovery of all function
    ● Due to vascular ischemia or traumatic damage
    ● Most common- Cranial and Femoral nerves
    ● Recovery within 6-12 weeks
    Symptoms & signs

    1. Cranial nerve involvement- III, IV, VI -> diplopia, pupil spared


    2. Diabetic Amyotrophy -> severe pain in thigh
    3. After onset of pain, weakness & wasting in quadriceps
    Management

    ● Improved glycemic control


    ● Analgesia
    ● Improves by 6-18 months

    Wojtek Bąbski
    Diabetic Polyradiculopathy

    ● characterized by severe disabling pain in the


    distribution of one or more nerve roots
    ● May be accompanied by motor weakness
    ● Intercostal or truncal radiculopathy -> pain over the
    thorax or abdomen
    ● Lumbar plexus or femoral nerve -> severe pain in the
    thigh or hip, muscle weakness in the hip flexors or
    extensors (diabetic amyotrophy)
    ● self-limited and resolve over 6–12 months
    Painful Diabetic Neuropathy

    ● Due to hypersensitivity to light touch


    ● Characterized by severe burning pain, typically at night
    ● DOC- Amitryptiline 25-75 mg at bedtime
    ○ Side effect- mild drowsiness
    ○ Discontinued if no improvement within 5 days
    ● Others- Nortriptyline, Desipramine (25-150 mg/d), Gabapentin (900-1800
    mg/d), Pregabalin, Duloxetin
    ● Capsaicin- as a cream used 2-4 times daily
    ○ Gloves used to avoid hand contamination -> discomfort in eyes and sensitive areas
    ● 5% lidocaine patch over painful area
    Diabetic Neuropathic Cachexia

    ● Symmetric peripheral neuropathy


    ● Profound weight loss (upto 60%) and depression
    ● Painful dysesthesias affecting proximal lower limbs, hands or lower trunk
    ● Treatment- Insulin & analgesics
    ● Resolves within 1 year
    Autonomic Neuropathy

    ● Late complication of long


    standing diabetes
    ● Affect cholinergic, adrenergic
    or peptidergic nerves
    (substance P, etc)
    ● Can affect any organ - heart,
    blood pressure, GIT and GU
    Cardiovascular system
    ● Tachycardia
    ● Orthostatic hypotension
    ○ Jobst fitted stockings, tilting the head of the bed, and arising slowly from the supine
    position
    ○ Fludrocortisone acetate 0.1-0.2 mg BID or Midodrine
    ● Abnormal exercise-induced performance
    ● Silent MI
    ● Ventricular arrhythmias
    ● Decreased heart variability or fixed rhythm

    Dx- measure BP and HR changes following Valsalva maneuver, standing,


    handgrip, deep breathing
    Gastrointestinal system

    ● Nausea, vomiting, postprandial fullness (gastric atony), reflux dysphagia


    (esophagus), constipation and diarrhea, fecal incontinence
    ● Gastroparesis
    ○ Type 1 DM with variability in glucose levels after food
    ○ Dx- radiographic studies
    ○ Tx- Metoclopramide 10 mg Orally TID/QID, 30 mins before meals & at bedtime
    ■ Side effects- drowsiness, fatigue, restlessness, tardive dyskinesia, EPS
    ○ Erythromycin - bind to motilin receptors 250 mg TID
    ○ Botulinum toxin into pylorus- decrease sphincter resistance
    ○ Gastric electrical stimulation
    Cont.

    ● Diarrhea- responds to broad spectrum antibiotics


    ● Refractory diabetic diarrhea due to impaired sphincter control & fecal
    incontinence
    ○ Tx- loperamide 4-8 mg/d
    ○ Diphenoxylate with atropine, 2 tablets QID
    ○ If severe- tincture of paregoric or codeine - 60 mg tablets
    ○ Clonidine- side effect- orthostatic hypotension
    ● Constipation relieved by laxatives - senna
    ● Other treatment choice- metamucil (debulking agent)
    Genitourinary System
    ● Bladder dysfunction & Urinary incontinence
    ○ Bethanechol 10-50 mg TID
    ○ Catheter decompression
    ● Erectile dysfunction - can be neuropathic or psychogenic
    ○ To distinguish- administer papaverine in corpus cavernosum - if blood supply is competent -
    erection
    ○ Tx- Sildenafil, 50-mg tablet taken approximately 1 hour before sexual activity (max 100 mg)
    ○ Vardenafil & Tadalafil 10 mg
    ○ Side effects -transient mild headache, flushing, dyspepsia, altered color vision, priapism
    ○ CI- nitrates
    ○ Others- intracorporeal injection of papaverine alone, papaverine with phentolamine, and
    alprostadil (prostaglandin E1)
    ○ External vacuum therapy
    ● Retrograde ejaculation
    Other

    ● Anhidrosis in lower extremities -> drying of skin -> crackling and ulceration
    ○ Emolients, skin lubricants
    ● Reduction of counterregulatory hormone release - hypoglycemic
    unawareness
    ○ Eat frequent meals
    ○ Self monitor blood glucose
    ● Pupillary dysfunction
    Prevention
    ● Intensive glycemic control
    ● Improve modifiable cardiovascular risk factors
    ○ Obesity
    ○ Hyperlipidemia
    ○ Hypertension
    ● Improve lifestyle
    Thank You
    for your attention
    References

    ● Greenspan’s Basic and Clinical Endocrinology


    ● Harrison’s Principles of Medicine
    ● Cardiovascular Autonomic Dysfunction: diagnosis and prognosis
    ● Diabetic Peripheral Neuropathy: an overview

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