Figure 1. Nerve injury-prone areas and alteration of the peripheral nervous system in diabetic neuropathy. Diabetic neuropathy primarily affects distal sensory systems (1), eventually causing radiculopathy (2), mononeuropathy (3), and autonomic neuropathy or treatment-induced neuropathy (4) (part A). Sensory neurons transmit their terminal information from the periphery to the dorsal horn of the spinal cord (part B); contrarily, spinal cord-residing motor neurons relay information to the periphery. The Schwan cells myelinate axons and play a crucial role in preserving axonal functions. Therefore, in response to cellular injuries, such as diabetes, damaged Schwan cells or axons lead to neuronal cell body damage. These changes also include Schwan cell-axon transport, change in protein expression, demyelination, and degeneration. Adopted from REF [50].
(1) Diabetic peripheral neuropathy
: 주로 symmetric한 distal polyneuropathy
(2) Hyperglycemic neuropathy
: 혈당조절과 함께 좋아지는 neuropathy, 주로 DM초기
(3) Insulin neuritis
: 인슐린으로 당조절이 빠르게 되면서 발생하는 가역적인 neuropathy
(4) Diabetic amyotrophy
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DM with back pain, lower leg weakness
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Sensory는 intact한 일종의 lumbar plexopathy (오래 DM을 앓던 사람)
(5) Diabetic peripheral neuropathy 치료
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Tight blood sugar control 중요
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NSAIDs는 큰 효과가 없고, 오히려 renal, cardiac effect 때문에 안 쓰는 것이 좋음
•
Pregabalin : Strong evidence
•
Gabapentin, Sodium valproate, Amitriptylin, Venlafaxine, Duloxetine. Opiate,
Capsaicin, Electrical nerve stimulation : Moderate evidence
