What's New in Diabetic Neuropathy?

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ADA Definition, Recommendations • Symmetrical, length-dependent sensorimotor polyneuropathy attributable to metabolic and microvessel alterations as a result of chronic hyperglycemia exposure and cardiovascular risk covariates. -Diabetes Care 33: 2285-2293, 2010 • Screen at diagnosis and yearly for DPN using simple tests. EP studies are rarely necessary. • Screen for autonomic neuropathy. • Medications improve quality of life. - Diabetes Care 34 (supplement 1): S8, 2011. Presented by IHS Division of Diabetes 8
Diabetic Neuropathies Focal/Multifocal Polyneuropathy • Mononeuropathy • Median • Ulnar >>> Radial • Multiple lesions “mononeuritis multiplex” RARE • Amyotrophy, proximal motor neuropathy • Deep, burning thigh pain • Progressive, asymmetric proximal weakness • Marked quadriceps wasting & absent knee jerk(s) Presented by IHS Division of Diabetes • Diabetic peripheral neuropathy, polyneuropathy, sensorimotor neuropathy • Acute sensory neuropathy • Very poor control or DKA, rapid glycemic control, or weight loss • Small fiber, normal exam • Resolves in a year • Autonomic neuropathy • Orthostatic hypotension • Gastroparesis, constipation, nocturnal diarrhea • Bladder hypomotility • Sexual dysfunction • Sudomotor and pupil abnormalities 9
Page 1 and 2: What’s New in Diabetic Neuropathy
Page 3 and 4: * Presented by IHS Division of Diab
Page 5 and 6: Case Presentation • PMH: HTN, hyp
Page 7: Thinking • Classic presentation f
Page 11 and 12: Classic Symptoms • Pain worsens a
Page 13 and 14: Patient Education • A condition t
Page 15 and 16: Michigan Neuropathy Screening Instr
Page 17 and 18: MNSI - Physical TEN POINTS MAX 0 PO
Page 19 and 20: Charcot Presented by IHS Division o
Page 21 and 22: Skin Abnormalities Presented by IHS
Page 23 and 24: Tuning Fork for Your Entire Sensory
Page 25 and 26: MNSI - Monofilament • Foot suppor
Page 27 and 28: Treatment • Glycemic control and
Page 29 and 30: Education 2 • Wear clean, dry, so
Page 31 and 32: IHS Guidelines 2010 • First Line
Page 33 and 34: AAN Recommendations Recommended, in
Page 35 and 36: Stepwise Management (IHS, JAMA) •
Page 37 and 38: Effect on Co-morbidities DULOX- ETI
Page 39 and 40: Amitriptyline • Check standing BP
Page 41 and 42: Pregabalin (Lyrica©) • Relative
Page 43 and 44: Topiramate (Topamax©) • AAN: ins
Page 45 and 46: Venlafaxine (Effexor ©) • 75-225
Page 47 and 48: Opioids • Dextromethorphan 400 mg
Page 49 and 50: Capsaicin, Isosorbide, Lidoderm©
Page 51 and 52: Autonomic Neuropathy • Orthostati

What's New in Diabetic Neuropathy?

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