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Diabetes - Screening and Management of Foot Complications

Diabetic Neuropathy

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Peripheral Neuropathy

See - Foot Complications

Painful Peripheral Neuropathy

This can be a very debilitating condition with severe pain leading to a situation of ‘diabetic cachexia’. It usually resolves over 12-18 month period.

Start treatment with a tricyclic drug then consider duloxetine, gabapentin or pregabalin; opiate analgesia may be necessary if pain persists.

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Mononeuritis Multiplex

Diabetes can cause single nerve palsies both in cranial and peripheral nerves. These resolve typically over a period of weeks or months. Specialist referral is recommended.

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Diabetic Amyotrophy

Diabetes may present with painful weakness and wasting of thighs. This is thought to be due to a radiculopathy and resolves with control of the diabetes. It may last for many months.

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Autonomic Neuropathy

Gastroparesis

Consider the diagnosis of gastroparesis in an adult with erratic blood glucose control or unexplained gastric bloating or vomiting, taking into consideration possible alternative diagnoses.

Consider a trial of metoclopramide, domperidone or erythromycin for an adult with gastroparesis.

If gastroparesis is suspected, consider referral to specialist services if:

the differential diagnosis is in doubt, or persistent or severe vomiting occurs

Diabetic Diarrhoea

Consider the possibility of autonomic neuropathy affecting the gut in an adult with unexplained diarrhoea, particularly at night. This should be a diagnosis of exclusion after other pathologies have been ruled out.

Neurogenic Bladder

Autonomic neuropathy can cause a variety of urinary problems including retention. Intermittent self catheterisation may be necessary in some cases.

Erectile Dysfunction

See - Erectile Dysfunction, Sexual Issues & Contraception

Postural Hypotension

Autonomic neuropathy can cause marked postural hypotension which can be disabling. Treatment is difficult and specialist help may be needed.

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Useful External Links & Resources

 

 
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