Diabetic Neuropathy(Series "Treatment of Diabetes Mellitus" (4))

Diabetic neuropathy occurs during the early clinical course of diabetes and is the most common diabetic complication. Onsets of diabetic neuropathy can be classified into three types: acute, subacute, and chronic. Differential diagnosis of diabetic polyneuropathy should exclude neuropathy from other causes. Distal, symmetrical, sensory dominant neuropathies are positive signs of diabetic polyneuropathy. Patients with diabetic neuropathy can have pain, numbness, diarrhea, erectile dysfunction, as well as asymptomatic problems such as foot ulcer, gangrene, hypoglycemic unawareness, or painless myocardial infarction. Tight glycaemic control is the most important treatment method for diabetic neuropathy while other therapies are symptom-based. For painful neuropathy, pain relief using mexiletine and anxiety relief using anti-depressants such as amitriptyline and imipramine at night are recommended