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Abnormal sensations in Diabetes Mellitus

The presentation of diabetic neuropathy can be classified as:

  1. Positive symptoms: tingling, pain or abnormal painful sensation which is more apparent at night.
  2. Negative symptoms: mainly in sensory deterioration (pain and sense of heat).
Diabetic neuropathy can be further classified into:
  1. Bilateral multiple neuropathy: the most common type. Sensory abnormality distributions are described as “wearing gloves and pants”. The discomfort in these patients results in poor sleep quality and quality of life, or where they are unable to sense their own injury. In severe cases, falls can result from unsteady gait due to weakness.
  2. Autonomic neuropathy: this is another common presentation that can affect the following:
    1. Heart: postural hypotension can increase the likelihood of dizziness as well as increase in mortality rate due to affected heart rate.
    2. Digestive tract: constipation or diarrhea.
    3. Urogenital: sexual dysfunction and urinary difficulty.
    4. Others: reduction in sweating.
  3. Cranial nerve neuropathy: usually affects the oculomotor nerve. The presentations are pain around the eyes, diplopia, drooping of eyelids. However, the pupils function normally.
  4. Radiculopathy or nerve-plexus neuropathy: commonly found in unilateral thoracic or lumbar spinal nerve, causing pain in the areas which they innervate (abnormal sensation or severe pain). In more severe cases, symptoms can combine muscle weakness.
  5. Single neuropathy of the limbs and its common effects:
    1. Median nerve: causing finger and palm numbness or weakness.
    2. Peroneal nerve: causing drooping foot (sole of the foot drooping downwards and unable to rise up).
       The key in the course of diabetic neuropathy treatment is maintaining good glucose control, as well as hands and foot protection. The pain and discomfort that is caused by neuropathy can be improved by anticonvulsive drugs or antidepressants.