Page 99 - The lraternational Journal of the Royal Society of Thailand.indd
P. 99

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



                         Regarding the prevention of this condition, glucose control should be optimized
                  to prevent or delay the development of   neuropathy in patients with type 1 diabetes
                  and to slow the progression of neuropathy in people with type 2 diabetes. The control
                  of blood pressure and serum lipid can reduce the risk or slow the progression of
                  diabetic neuropathy as well (Feldman et al, 2019; Ziegler et al, 2022).




                  Table 1 Difference between large and small fiber neuropathy




                                       Large fiber neuropathy          Small fiber neuropathy nerve
                                                                      fiber
                   Normal function  Pressure, balance, proprio-       Nociception, Protective sensation,
                                       ception, deep-seated pain      temperature

                   Symptoms            Numbness, tingling, poor       Pain: burning, electric shocks,
                                       balance, wasting, weakness stabbing
                                                                      Thermal imperception

                   Physical Exam-      Reduced or absent              Reduced or absent
                   ination             -  Ankle reflexes              -  Pinprick sensation
                                       -  Vibration perception        (symmetrical, distal to proximal)
                                       -  10-g monofilament           -  Thermal discrimination
                                       -  Proprioception




                  Autonomic neuropathy

                  Clinical manifestations

                         Autonomic nervous system involvement, so called autonomic neuropathy,
                  occasionally coexists with small fiber polyneuropathy. It can present with non-specific
                  systemic symptoms due to its control in internal organs (Freeman R, 2020). Again, some

                  of  them  are  asymptomatic  and  could  be  diagnosed  only  with  screening  tests.
                  Therefore, screening for autonomic dysfunction is recommended in the work up for
                  all polyneuropathy (Price et al, 2022).

                         Diabetic autonomic neuropathy encompasses a group of disorders caused by
                  impairment  of  the  sympathetic  and  parasympathetic  nervous  system.  Cardiac

                  autonomic neuropathy (CAN) can present as generalized weakness, light-headedness
                  or frank syncope accompanied by orthostatic tachycardia or bradycardia and exercise
                  intolerance.






                        Kongkiat Kulkantrakorn                                                            91
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