Apart from the above described symmetric form of neuropathy there are other diabetes related neuropathies in different classifications:
Asymmetric diabetic neuropathy
showing focal weakness or sensory loss of single nerves, mainly in one upper arm, one thigh or the cranial nerves.
Asymmetric focal and multifocal types of diabetic neuropathy
of neuropathy are less common, but quite dramatic. They are usually acute in the onset with strong muscle weakness and pain in a thigh or upper arm, but this form rarely occurs before the age of 45. The affection of the cranial nerves causes weakness of the eye muscles accompanied by double images or facial numbness and nerve paralysis.
Autonomic dysfunctions in diabetic neuropathy
Many patients with Diabetes also develop dysfunctions of the autonomic nervous system: constipation, diarrhoea (particularly during the night,), abnormal sweating, hypertension, Tachy- and Bradycardia, dysfunction of the bladder and sexual impotence in males. Symptoms are also uncertain gait, imbalance, maybe syncope’s and blurred vision from lack of papillary regulation.
The distinction between the different kinds of diabetic neuropathy is crucial as far as the different approaches to diagnosis and management are concerned, but also regarding the prognosis.
Accordingly, diagnostics and therapy of polyneuropathies are manifold and difficult. The therapeutic aim must be to prevent the deterioration of the nerves itself on the one hand and to treat the illnesses causing polyneuropathy on the other hand.
The most essential part of the evaluation of diagnosis and therapy are – apart from an intensive neurological examination – the electro diagnostic studies of the nerves. The examination comprises Electromyography (EMG) and nerve conduction velocity (NCV). The EMG involves recording electrical potentials by an electrode placed into the muscle, both at rest and during voluntary contractions. The NCV is carried out by stimulating the motor and/or sensory nerves electrically. From the data recorded, informative characteristics of the recorded forms of waves can be determined, thus leading to a clear picture and appropriate treatment.
In the long-term, by way of Diabetes and Complications Control, trial patients who controlled their diabetes meticulously showed significantly less neuropathy. When symptoms of neuropathy occur in patients suffering from diabetes or early signs of polyneuropathic pain patterns as described above, occur, an early neurological examination is of the essence.