Metabolic Neuropathies and Diabetic Neuropathy

00:01 Causes of metabolic neuropathy.

00:03 Diabetes is always on top of that list as is thyroid disease.

00:07 Hepatic failure, your kidneys' failing, uremic neuropathy. That's an important one.

00:14 At the end of this entire section, I wanna walk you through a very, very important, what I call a polyneuropathy nirvana diagram, as we shall see.

00:25 Porphyric neuropathy. What does that mean? You know about -- by chemistry.

00:31 Did you know about your porphyria pathway on your way to produce your heme? And in that porphyria pathway, there are a couple of diseases or biochemical pathologies as you should be familiar with.

00:43 One of them being acute intermittent porphyria.

00:46 Vitamin deficiencies, either B1, B6, or B12.

00:50 Once again, remember B1, that's a problem, thymine.

00:54 B6 require for once again, proper myelination and of course B12.

01:00 Critical care neuropathy. These are metabolic neuropathies. Important ideologies.

01:05 Let's quickly walk through diabetic neuropathy.

01:09 Chronic, progressive, distal, symmetric diabetic polyneuropathy.

01:13 Every single one of there, incredibly important.

01:17 Diabetes in the US, type II diabetes of course, extremely common.

01:22 Chronicity, decades have gone by, and now at this point, you're gonna have symmetric and distal neuropathy taken place.

01:32 Don't we? Most common presentation: small and large fiber involvement.

01:37 Neuropathic pain is usually prominent.

01:40 For example, what about the nerves in the stomach? Would they be lost? Well, absolutely. So, you have paralysis of the stomach. We call this gastroparesis.

01:49 Or maybe your patient has suffered a myocardial infarction and there is no chest pain.

01:54 A silent myocardial infarction. Nerves have been lost.

01:58 Or down in the feet and here once again, the nerves.

02:04 You're worried about decubitus ulcers, aren’t you? The diabetic neuropathy, small, large fibers.

02:09 Neuropathic pain, usually prominent.

02:11 If you're actually wondering about what's happening to your nerves.

02:15 Clinical features. Initial symptoms are severe thigh and back pain with diabetic neuropathy and with diabetic proximal motor neuropath is what we're referring to specifically or diabetic glutinous amyotrophy.

02:31 Followed by hip and thigh muscle weakness and atrophy so you begin initially with thigh and back pain and then followed by hip and thigh muscle weakness and atrophy.

02:43 You put all this together and you call it amyotrophy. Proximal motor.

02:48 We have the diabetic proximal motor neuropathy.

02:53 Continuing with our discussion, acute axonal diabetic polyneuropathy and then with diabetes, remember there's no discrimination here and by that, I mean you could have diabetic mononeuropathy. What's that mean? You could have one nerve that is being affected.

03:09 Maybe radial nerve, maybe the ulnar nerve, maybe the median nerve, maybe the common peroneal nerve.

03:14 You could have the nerves coming out of the spinal cord, radiculopathy, polyradiculopathy, compression neuropathy.

03:24 All are significantly much more common in patients that are diabetic.

03:28 Every single nerve just about in a patient with diabetes over a long period of time, if not properly managed, is at risk for injury.

03:38 Plain and simple. To a pathologist, maybe. Through a doctor, possibly.

03:44 But for the patient, it's a lot of education, isn't it? Management. Well, the most important thing is going to be glycemic control.

03:54 That's your best measure of treatment, and by this we mean what? Lifestyle modification: lose weight, watch your diet.

04:01 And why do I roll my eyes when I do that, because you know, if you've done your rotations or for those of you that are practicing, it's easier said than done.

04:10 The symptomatic management.

04:12 Well, now if you're actually getting into diabetic neuropathy, you need to treat the symptoms.

04:19 Antidepressants. Antiepileptics, especially carbamazepine and perhaps gabapentin.

04:25 Remember carbamazepine? It was actually a first-line drug for trigeminal neuralgia so we know that carbamazepine definitely helps out with people that have neuropathies.

04:35 Tramadol. Opiates, maybe perhaps because of refractory cases.

04:41 The pain is actually intolerable sometimes and -- oh, this is a deadly road, isn't it? The opioid, huge discussion, behavioral science.

04:49 And NSAIDS for entrapment neuropathies as well.