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Lamanya menderita DM
Kontrol gula darah (HbA1C)
Umur
Hipertensi
Dislipidemia
Merokok
Penyakit vaskuler perifer
Faktor genetik ???
Patogenesis Metabolik
Polyol pathway (Akumulasi Sorbitol)
Myo-inositol
Na/K ATP-ase
Patogenesis Vaskuler
Ischemik akibat mikroangiopati
Patogenesis Imunologi/inflamasi
Sensorimotor
Acute painful or Chronic Selective Small Fiber Painful
Autonomic
Acute motor
I.
Symmetrical Polyneuropathies
a. Fixed Deficits
b. Episodic symptoms
I.
Symmetrical Polyneuropathies
Fixed deficits:
Distal sensory polyneuropathy (DSPN)
Variants: acute, severe DSPN in early onset diabetes
Autonomic neuropathy
Episodic symptoms:
Diabetic neuropathic cahexia
Hyperglycemic neuropathy
Treatment induced diabetic neuropathy
Urogenital
disfungsi ereksi, ejakulasi retrograde,
ggn.nyeri testis
Fungsi Sudomotor :
Anhidrosis, berkeringat banyak (saat
makan)
Respirasi :
sleep apneu
Fungsi Pupil :
miosis , reaksi pupil lambat
Diabetic Amyotrophy
Bruns-Garland Syndrome (Bruns melaporkan
pertama kali thn 1890 dan Garland pd thn
1950)
Proximal Diabetic Neuropathy
Ischemic mononeuropathy multiplex
Femoral Neuropathy or
Femoral-sciatic Neuropathy
CRANIAL
NEUROPATHIES :
DIABETIC THORACOABDOMINAL/
TRUNCAL RADIKULOPATI
- Nyeri/ rasa terbakar/ rasa ditusuk/rasa
diikat
- Sekitar perut/dada bawah
- Asimetris/ unilateral
- Hipestesi pada kulit
- Kelemahan otot dinding perut
- Usia > 50 tahun dengan Polineuropati
- Riwayat penurunan Berat badan
LIMB
MONONEUROPATHIES :
Kombinasi pemeriksaan :
-
Vibrasi
Proprioseptif
Taktil
Nyeri
Suhu
Cardiovaskuler test
Gastro-intestinal test
Bladder function test (Cystometry, Sphincter EMG,
Uroflometry, Urethral pressure profile,
Electrophysiologic test of bladder innervation)
Terapi nyeri :
GASTRO-INTESTINAL :
Gastroparesis :
Non-farmakologi :
Farmakologi :
Diare :
Antibiotik broadspectrum
Cholestyramine
Loperamide
Neurogenic Bladder :
Hipotensi Ortostatik
Non-farmakologi :
Farmakologi :
Ibuprofen, Indometacin (prostaglandin inhibitor)
Efedrin (simpatomimetik)/ midodrine (alfa agonis)
Dihidroergotamin ( dgn caffein+Indometacin+Yohimbin)