Page 93 - The lraternational Journal of the Royal Society of Thailand.indd

The International Journal of the Royal Society of Thailand
Volume XV-2023

to recognize and manage. Sometimes, both conditions coexist. In this article, both DSPN
and autonomic neuropathy which are of interest will be comprehensively reviewed
for the audience to better understand these well-established conditions.

Patterns of diabetic neuropathy

Several different patterns of neuropathy can present in individuals with
diabetes. Of these, the most common is distal sensorimotor polyneuropathy (DSPN).

Examples of patterns of neuropathy are DSPN, small fiber neuropathy, treatment-
induced neuropathy, radiculoplexopathy or radiculopathy, mononeuropathy, and
autonomic neuropathy or treatment-induced neuropathy (Feldman et al, 2019).

Small fiber neuropathy has the same distribution as DSP, although the
neurological examination and results from nerve conduction velocity studies are
different. Diabetic radiculoplexopathy or radiculopathy often present with acute or
subacute severe focal limb pain and follow by weakness. It can respond to immuno-

therapy and usually improves with time, unlike other types of nerve injury in individuals
with diabetes.

Treatment-induced neuropathy or insulin neuritis is under-recognized. It is
caused by overaggressive glycemic control or rapid reduction of glucose level from
insulin and can manifest with generalized body and limb pain without clear weakness.
In this article, the common forms which are DSPN and autonomic neuropathy will be

discussed.

Distal sensorimotor polyneuropathy (DSPN)

DSPN is the most common form of diabetic complication involving peripheral
nervous system. This condition manifests as a symmetrical, length dependent,

sensorimotor polyneuropathy and results from impaired metabolism and microcirculation
after exposure to chronic hyperglycemia and other cardiovascular risk factors. It is
associated with other cardiovascular risk factors such as obesity, diabetic duration,
age, inadequate blood sugar control, smoking, etc. DSPN is commonly associated with
autonomic involvement, might commence insidiously and if intervention is not

successful, it becomes progressive and chronic (Feldman et al, 2019; Ziegler et al, 2022).

It is quite intriguing that DSPN had different manifestation in each patient. Some
of them had severe pain which coincide with sensory deficit, while some of them are
asymptomatic and may present with painless foot ulcer. The impaired sensory perception
is associated with loss of protective mechanisms from pain or injury. This injury-prone
condition eventually causes diabetic foot ulcer and may lead to limb amputation.

Therefore, early recognition and management is crucial in routine diabetic care.

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