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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