Nerve Damage

Detection and surveillance

Detection and surveillance of nerve damage are a routine part of Annual Review

Enquire yearly for :

painful and other symptomatic neuropathy

erectile impotence in men

Enquire for other manifestations of autonomic neuropathy if:

other complications ( especially kidney )

before anaesthesia

erratic blood glucose control

Management of painful neuropathy

Counsel for the depressing and disabling nature of the condition
Consider initially :
		bed foot cradles for night-time problems
		simple analgesia taken in advance of diurnal symptoms
		contact dressings
Consider therapeutic trials of:
		tricyclic drugs ( amitriptyline )
		carbamazepine at high doses ( 600-1200 mg/day )

Management of autonomic neuropathy

Erectile impotence
		sildenafil may be helpful if not contraindicated ( beware of nitrate therapy )
		intracavernosal / intraurethral alprostadil can be useful in some men
		referral to professionals with specialist expertise can be useful for:
	advice on vacuum devices, or mechanical or surgical prostheses vascular investigation and reconstruction psychological assistance
Gastroparesis
		investigation using radiological or radioisotope methods may help in diagnosis
		investigation of cardiovascular autonomic neuropathy may help diagnosis
		cisapride and domperidone are worth a trial
Diabetic nocturnal diarrhoea
		investigation must exclude other causes of intestinal upset
		may be helped by high doses of codeine, loperamide or diphenoxylate, or by erythromycin / tetracycline
Gustatory sweating
		explanation and counselling are often required
		try topical or oral anticholinergic agents