Diabetic Neuropathy

The diabetic polyneuropathy (DN) is a common disorder with diverse clinical presentations depending on the type and duration of diabetes, number of nerve fibers affected and its glycemic control. They progress in length-dependent pattern causing severe sensory-motor deficit, more common in distal lower limbs than in upper limbs. In addition, small fiber polyneuropathy has been identified in vast majority of patients affecting sensory and autonomic system in distal limbs. Excruciating pain, trophic changes in the feet, abnormal sweating and numbness are the main manifestations of small fiber DN. Occasionally diabetic neuropathy can present with focal and multifocal neuropathies of cranial, truncal and peripheral nerves among patients with long standing diabetes and age over 50. The length dependent DN hardly improves over period of time when compared to focal or multifocal neuropathy which is usually self-limiting after a course of few relapses. Therefore, adequate attention should be paid on early clinical diagnosis, identifying sub types and complications to tailor the appropriate treatment or to initiate preventive measures to avoid the devastating consequences of DN.