Diabetic sensability multiple neuropathy ● more common in female o Average age of onset is 58. 7 year ● Course of dm>15 years ymptoms of sense Numbness type: large medullated fibers Pain type: little medullated fibers and nonmedullated fibers Numbness-pain type
Diabetic sensability multiple neuropathy ⚫ more common in female ⚫ Average age of onset is 58.7year ⚫ Course of DM> 15years ⚫ Symptoms of sense – Numbness type：large medullated fibers – Pain type：little medullated fibers and nonmedullated fibers – Numbness-pain type
o Nervous symptom examination parasthesia Lower limbs pallesthetic disturbance or dissapear Tendon reflex low or dissappear Sensory ataxia Paratrophy symptoms Charcot arthropathy, ischemic gangrenosis and foot ulcer
⚫ Nervous symptom examination – parasthesia – Lower limbs pallesthetic disturbance or dissapear – Tendon reflex low or dissappear – Sensory staxia – Paratrophy symptoms – Charcot arthropathy、ischemic gangrenosis and foot ulcer
Diabetic autonomic neuropathy ● Pupil disease Cardiovascular parafunction Fixed heart rate Postural hypertension Su udden cardiac deai the o Gestrophageal diarrhea Neuropathic bladder, erectile failure ● Abnormal sweating
Diabetic autonomic neuropathy ⚫ Pupil disease ⚫ Cardiovascular parafunction – Fixed heart rate – Postural hypertension – Sudden cardiac death ⚫ Gestrophageal ,diarrhea ⚫ Neuropathic bladder,erectile failure ⚫ Abnormal sweating
Laboratory tests o Glucosuria: associated with renal threshold of sugar (only for clue) ● Ketonuria bLood sugar: plasma glucose, POD OHBAlc: 2-3 months blood sugar level Fructosamine: 2 3 weeks blood sugar level ●OGTT:2 hour specimen iNsulin and c-peptide release test
Glucosuria：associated with renal threshold of sugar (only for clue) Ketonuria Blood sugar：plasma glucose，POD HBA1c：23 months blood sugar level Fructosamine：23 weeks blood sugar level OGTT：2 hour specimen Insulin and C-peptide release test Laboratory tests
Diagnosis
Diagnosis