Pathophysiology of DiabeticNeuropathyZhijie Xi, MDGuanghua Hospital Affiliated to Shanghai University of Traditional Chinese MedicineDiabetic Peripheral Neuropathy Can Progress Over TimeSymptoms (numbness, prickling, pain)ReflexesPressure Sensation (Monofilament)Vibratory SensationNerve Conduction AbnormalitiesSubclinicalClinicalTimeSignsOnset ofClinical Diseases•Symptoms may occur any time and intermittently•Patients may or may not have symptoms of diabetic peripheral neuropathy•Patients frequently do not report symptoms to their physicians until the symptoms are severe•The majority of signs of diabetic peripheral neuropathy are not evident at the onset of diabetesSymptoms and Signs of Diabetic Peripheral NeuropathySymptoms• Numbness or loss of feeling (asleep or “bunched up sock under toes” sensation)• Prickling/Tingling• Aching Pain• Burning Pain• Lancinating Pain• Unusual sensitivity or tenderness when feet are touched (allodynia)Signs• Diminished vibratory perception• Decreased knee and ankle reflexes• Reduced protective sensation such as pressure, hot and cold, pain• Diminished ability to sense position of toes and feetSymptoms and signsprogress from distal to proximal over timeDiabetic Peripheral Neuropathy Severity ScaleRatingDescription0No neuropathy1Subclinical diabetic peripheral neuropathy2aClinical diabetic peripheral neuropathy with symptoms, mild to moderate2bClinical diabetic peripheral neuropathy insensate foot, loss of feeling/negative symptoms3Disability/late stageEffects of Diabetic Peripheral NeuropathyNeuropathyMotorSensoryAutonomic↓ nociception↓ Proprioception,Unawarenessof foot positionReduced sweatingDry skinFissures andcracksMuscle wastingFoot weaknessPostural deviationDeformities, stressand shear pressuresTraumaStress on bones & jointsPlantar pressureCallus formationInfectionUlcerSimple Tests of Large-Fiber Function The PNS is comprised of both neurons and SCs Pathways Implicated in Diabetic Neuropathy PathogenesisBioenergetic Mechanisms of Nerve Injury in Diabetes Peripheral Mechanisms Contributing to Neuropathic Pain in Diabetic Neuropathy Thanks for your attention!
