short notes for ophthalmologists
- needs good control of diabetes/blood pressure (see targets)
- first line Cymbalta...duloxetine 60mg once a day (120mg day maximum
dose; side effects: nausea, dry mouth, headache, sleepiness, dizziness see)
- second line Pregabalin (side effects: sleepiness, dizziness) see. Dose
150 to 600 mg per day given in either two or three divided doses dose.
- alternatives amitriptyline , Gababpentin
- beware: carpal tunnel and serious cervical spine problems can cause
pain, just like diabetic neuropathy. Low B12 can also cause a sensory
- link for patients
- Obstructive sleep apnoea can make the neuropathy worse, as can alcohol (as it is neurotoxic)
- neuropathy can increase temporarily if diabetic control suddenly improves, but this type of neuropathy later does start to improve: good diabetic and blood pressure control is very helpful
- see 2011 The Toronto Expert Panel on Diabetic Neuropathy
- different types of neuropathy
- acute painful neuropathy
- focal neuropathy (self-limiting)
- pressure palsy
- automomic neuropathy
- types of automnomic neuropathy
- sudomotor..sweaty skin
- standing and blood pressure
- valsalva manaouvre and pulse
- and other standard tests
- pain from neuropathy
- worse at night
- throbbing, stabbing, numbness, buring, shooting, electric shocks, pins and needles
- reducing the peripheral oedeam schanging the drugs may help
- pain is from lack of input into the spinal cord..then the spinal cord amplifies signals that it does receive.
- neuropathy is from small fibre nerve damage; patients may not be diabetic, but may be pre-diabetic. Need GTT or 1 hour GTT.
- at time of diagnsosi 10% of type 2 patietns have retinopathy, about the same as retinopathy. and 5% of patients develop it a year.