Abstract
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.
Highlights
Diabetes is one of the oldest known diseases, well recognized for over thousands of years
The diabetic polyneuropathy (DN) is a significant cause of diabetic foot lesions[2]
The physicians need to be vigilant in managing diabetic patients and should always be aware of the symptoms that help in early identification to initiate the appropriate management of DN
Summary
Diabetes is one of the oldest known diseases, well recognized for over thousands of years. Patients with DN may present with multiple neurological problems involving somatic (proximal/distal) and autonomic nerves, often affecting legs and feet. It has recently been identified as an emerging problem in the developing countries including Sri Lanka contributing to substantial morbidity and mortality leading to huge economic burden. Clinical features The diversity in clinical presentations of DN depends on the types, number and anatomical pattern of nerve fibers affected and the duration of illness (Table 1)[3]. Serious and the most common type of nerve injury is primarily caused by sustained high blood glucose in long-standing diabetics, 15 -20 years, after initial diagnosis regardless of its types[4]. The main fiber types in DN and their symptoms are given
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