*Diabetes Mellitus can be complicated by peripheral neuropathies and the progression of it is as follows :
(1) severe burning sensation of feet (worse at night)
(2) tingling and numbness
(3) loss of sensation
*A diabetic may develop trophic ulcers, gangrene and non-traumatic amputations due to the peripheral neuropathy.
*It is said that the easy development of injuries and delayed healing of ulcers in diabetics especially at the foot is due to :
(1) peripheral neuropathy
(2) vasculopathy
(3) elevated sugar levels (causing more infection)
*Besides peripheral neuropathy, a diabetic may develop radiculopathy (pain at distribution of particular nerve roots) as well, though this condition is usually self-limiting within 1-2years.
*Mononeuritis (inflammation of a single isolated nerve) may also be seen with the most common nerve being involved is the 3rd cranial nerve resulting in symptoms like ptosis, diplopia and miosis.
*Lastly, autonomic neuropathy may accompany peripheral neuropathy in diabetics. Symptoms related to this condition are diarrhoea / constipation, urinary incontinence, cystitis, sexual dysfunction (in males), dyspareunia and loss of sexual desire (in females), palpitations and arrhythmias, postural hypotension.
*Peripheral neuropathy can be examined by these tests :
(1) vibration sense (128Hz tuning fork) -> it is the first sensation to be lost in peripheral neuropathy
(2) position sense
(3) fine and crude touch
(4) pain and temperature
(5) deep tendon reflexes (especially ankle and knee jerks)
(6) DO NOT FORGET to examine the foor for calluses or ulcer and more importantly, check the dorsalis pedis and posterior tibial arteries to confirm the presence of peripheral pulses.