Diabetes

Diabetes mellitus may be associated with multiple peripheral nerve disorders. It can cause mononeuropathies of the cranial nerves, proximal atrophy affecting the femoral and lumbar roots, as well as peripheral neuropathy. The latter is the most common in patients with longstanding disease.

Diabetic peripheral neuropathy is symmetric and involves both sensory and motor nerves. The symptoms are gradually progressive and may begin with numbness, tingling or a burning sensation in the feet. The discomfort progresses in a proximal direction over time, with pain often occuring later in the course of the disease. Some patients may describe hypersensitivity to touch of the lower extremity. In other individuals, the feet may have lost sensibility, a contributing factor in the development of poorly healing foot ulcers.

The trearment of the neuropathic pain is multifaceted. The first and most successful therapy is improved glucose control. Following this, pharmacological options include the use of antidepressants, such as amitryptiline and desipramine. Anticonvulsants, such as carbamazepine, phenytoin, clonazepam, and gabapentin have also been used with varying degrees of success. Reports also suggest that oral mexilitene and topical capsaicin cream may also be of some benefit.