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DIABETES: NEUROPATHIES & NEUROMUSCULAR DISORDERS

Neuromuscular disorders

Symmetric neuropathies
  Chronic
    Distal sensory/autonomic
    Autonomic
    Sensory-motor
  Acute
    Painful
    Reversible
Asymmetric neuropathies
  Lumbosacral plexopathy
  Mononeuropathies
  Mononeuritis multiplex
Predisposition to immune PN
  CIDP
  ? Diabetic amyotrophy
  Perineuritis
Muscle infarction
Overview: Diabetes

Diabetes Classification
  Type 1: IDDM
  Type 2: NIDDM
  Other
Mitochondrial disorders
Neuromuscular disorders
Screening
Metabolic syndrome

Neuropathy: General


From NLM

Drs. Banting and Best In The Laboratory



CLASSIFICATION OF DIABETES MELLITUS

OVERVIEW: DIABETES & NEUROPATHY


DIABETIC NEUROPATHIES: SYMMETRIC

Chronic Acute Diabetic Neuropathies


DIABETIC NEUROPATHIES: ASYMMETRIC

General
Amyotrophy
Lumbosacral plexopathy
Mononeuropathy
Mononeuritis multiplex
Multifocal
Diabetic neuropathy, Ongoing: Wallerian degeneration

Auche MB; Arch Med Exp Anat Pathol 1890;2:635676



DIABETIC MUSCLE INFARCTION (Myonecrosis) 2
Swelling of left distal leg
MRI: Diabetic myonecrosis of L leg
MRI: Diabetic myonecrosis of L thigh (Quadriceps)


ANIMAL MODELS

Streptozotocin

INTERPRETATION OF GLUCOSE TESTING
Glucose Pattern Fasting Glucose Glucose Load
(2 Hours after)
Normal < 100 mg/dl < 139 mg/dl
Impaired fasting 100-125 mg/dl < 139 mg/dl
Impaired tolerance ≤ 125 mg/dl 140-199 mg/dl
Diabetes ≥ 126 mg/dl ≥ 200 mg/dl
Fasting glucose: Overnight fast + Level drawn before 8:30 AM
Glucose tolerance: 75-g oral anhydrous dextrose load after fasting
METABOLIC SYNDROME 10



TRIGLYCERIDES: Increased
Further information
American Diabetes Association


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References
1. Acta Neuropathol 2000;99:539-546
2. Am J Kidney Dis 2000;35:1212-1216, J Clin Neuromusc Dis 2003;5:96102, Indian J Endocrinol Metab 2011;15(Suppl 1):S58-61
3. Neurology 2000;55:83-88
4. Diabetologia 2001;44:1005-1010
5. Diabetes Metab Res Rev 2002;18:260272
6. Brain 2003;126:376-385
7. Diabetes Care 2003;26:15531579
8. J Pediatr 2004;144:281-283, Ann Neurol 2010;67:534541
9. NEJM 2005;352:341-350
10. Diabetes Care 2006;29:2701-2707, Nat Clin Pract Neurol 2006;2:276-282
11. Diabet Med 2006;23:1016-1020
12. Neuro Endocrinol Lett 2005;26:775-779
13. Exp Clin Endocrinol Diabetes 2007;115:327330
14. Diabetes 2009;58:1634-1640
15. Diabetes Care 2009; Oct 21
16. Diabetes Metab 2012; Apr 12
17. Nature Medicine 2012; Online May

4/21/2015