The Neurologist: Clinical & Therapeutics Journal
Open Access

Diabetes is one of the most prevalent causes of neuropathy, and it has a high rate of morbidity and mortality, resulting in more hospitalizations for diabetics than any other illness [1]. A variety of neuropathy patterns can be recognised. These are divided into three categories: symmetric, asymmetric, and focal. A distal symmetric sensorimotor neuropathy affects at least half of people with long-term diabetes. Even in the pre-diabetic state, PN can occur early in the course of diabetes. Up to 56 percent of individuals with idiopathic PN have impaired glucose tolerance, which is three times the incidence of matched controls with normal glucose tolerance. The degree and duration of hyperglycaemia are important risk factors for the development of PN. Hypertension, high triglycerides, cigarette use, obesity, micro vascular illness, and cardiovascular disease are all risk factors. The onset is usually gradual, beginning in the toes and forefeet and advancing proximally over time. The majority of patients have both large and small nerve fibre involvement, while large fibre involvement frequently predominates [2]. Both motor and sensory nerves are affected by large fibre involvement. Pain is limited, but when it does occur, it is described as a dull, cramping discomfort. Before symptoms appear, a physical examination may identify abnormalities. Loss of vibratory sensation and position sensation, as well as reduced Achilles reflexes, is some of the first symptoms. Even when monofilament testing is normal, using a tuning fork to detect vibratory loss can reveal neuropathy [3]. Electro diagnostic investigations provide findings that are consistent with axon loss and demyelination. Sensory abnormalities are the first to appear, with sensory investigations revealing the earliest changes on the skin. Because of their more distal placement, medial plantar nerve conduction investigations are more sensitive in patients younger than 60. Motor nerve conduction problems develop later in the disease’s progression. A symmetrical pattern of neuropathic abnormalities will be visible on an EMG needle test, with a distal to proximal gradient. Although quantifiable strength testing often reveals decreasing strength, this often occurs before there is any clinical impairment. Small unmyelinated C fibre involvement causes considerable discomfort and hyperalgesia, and it can happen early in diabetes. There is a loss of temperature awareness as well as autonomic abnormalities such as loss of sweating, dry feet, and vasomotor alterations as the disease advances [4]. Foot ulcers and infections are more likely a result of this. The discomfort may decrease as the neuropathy advances, but this is an indication of disease progression rather than regression. There is no difference between small fibre illness and large fibre disease when small fibre disease develops without large fibre involvement. When small fibre illness develops without large fibre involvement, physical examination findings can be limited despite considerable symptoms. Furthermore, electro diagnostic investigations for tiny fibre nerves are less sensitive and can be normal. Galvanic skin responses can be aberrant, but they’re not always accurate [5]. Skin biopsy is not done on a regular basis; however it can be used to determine the quantity of tiny fibres present. It is critical to emphasise the importance of blood sugar control in preventing diabetic PN. Glycemic management has been reported to reduce the prevalence of PN by over 70% and autonomic dysfunction by more than 50%. Because tight glycaemic control has been found to reverse PN38, it’s critical to educate newly diagnosed type 2 diabetes patients about the necessity of starting strong glycemic control as soon as possible to prevent the risk of PN [6].

Types of diabetic neuropathy include the following

Supplemental neuropathy: Supplemental neuropathy is whimwhams damage that generally affects the bases and legs and occasionally affects the hands and arms.

Autonomic neuropathy: Autonomic neuropathy is damage to jitters that control your internal organs. Autonomic neuropathy can lead to problems with your heart rate and blood pressure, digestive system, bladder, coitus organs, sweat glands, eyes, and capability to smell hypoglycemia.

Focal neuropathies: Focal neuropathies are conditions in which you generally have damage to single jitters, most frequently in your hand, head, torso, and leg.

Proximal neuropathy: Proximal neuropathy is a rare and disabling type of whim-whams damage in your hipsterism, buttock, or ham. This type of whim-whams damage generally affects one side of your body and may infrequently spread to the other side. Proximal neuropathy frequently causes severe pain and may lead to significant weight loss [7-10].

I would like to thank my Professor for his support and encouragement.

The authors declare that they are no conflict of interest.

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