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Condition/Disorder Synonyms

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  • Diabetic polyneuropathy

  • Metabolic polyneuropathy

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ICD-9-CM Codes

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  • 250.60 Diabetes mellitus with neurological manifestations type 2 or unspecified type not states as controlled

  • 357.2 Polyneuropathy in diabetes

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ICD-10-CM Code

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  • E13.40 Diabetes, diabetic (mellitus) with neuropathy

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Preferred Practice Pattern1

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Key Features

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Description

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  • Damage to peripheral sensory (most common) and/or motor neurons

  • Most likely due to demyelination, inflammation, ischemia or infarction from as yet poorly understood metabolic abnormality

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Essentials of Diagnosis

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  • Distinct clinical syndromes include

    • Distal, symmetrical, primarily sensory polyneuropathy affecting feet and legs in a chronic, slowly progressive manner (most common)

      • Usually unnoticed by patient until fairly progressed

      • Most common complaint is persistent numbness or tingling, worse at night

    • Acute ophthalmoplegia affecting cranial nerve III (oculomotor) and less often cranial nerve VI (abducens) on one side

    • Acute mononeuropathy of limbs or trunk, including painful thoracolumbar radiculopathy

    • Acute or sub-acute painful, asymmetrical, predominantly motor multiple neuropathy affecting upper lumbar roots and proximal leg muscles (diabetic amyotrophy)

    • Symmetrical, proximal motor weakness and wasting, usually without pain, with variable sensory loss, pursing sub-acute or chronic course

    • Autonomic neuropathy involving bowel, bladder, sweating, circulatory reflexes

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General Considerations

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  • Sensory loss puts patient at risk for skin tears, skin breakdown

  • Sensory and motor loss can result in loss of normal forces on joints, particularly foot and ankle, causing joint deformity over time

  • Sensory and motor loss puts patient at higher risk for injury, acute and repetitive

  • Peripheral nerve damage most common in lower extremities, but may occur in the upper extremities

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Demographics

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  • 15% of patients with diabetes have symptoms of polyneuropathy

  • 50% of cross-sectional sample of people with diabetes have evidence of peripheral nerve damage on nerve conduction velocity testing

  • Less than 10% have clinical neuropathy on diagnosis of diabetes

  • Infrequent in people under 30 years of age

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Clinical Findings

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Signs and Symptoms

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  • Numbness

  • Tingling

  • Weakness, muscle atrophy

  • Loss or impairment of deep tendon reflexes, vibration, proprioception

  • Pain, burning, stabbing

  • Impaired balance

  • Altered gait

  • Impaired vision

  • Orthostatic hypotension

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Functional Implications

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  • Fall risk with mobility on uneven or unpredictable surfaces

  • Injury risk with items of unknown sharpness or temperature

  • Impaired driving due to lower-extremity neuropathy or ophthalmoplegia

  • Difficulty with fine motor tasks (writing, grooming, cooking, feeding, bathing)

  • Difficulty with gross motor tasks (transfers, gait, stair climbing, dressing)

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Possible Contributing Causes

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  • Cardiovascular risk factors associated with “metabolic syndrome” thought to be risk factors for diabetic polyneuropathy: triglyceride levels, body mass, hypertension

  • Poorly controlled diabetes results in higher likelihood of developing ...

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