Diabetic peripheral neuropathy

Diabetes mellitus leads to several recognizable clinicopathologic neuropathic syndromes. Diagnosis and evaluation requires a thorough history and neurologic examination, electrophysiologic studies, blood studies and, in selected cases, cerebrospinal fluid analysis and nerve and muscle biopsy. Microangiopathy is the leading cause of diabetic neuropathy associated with metabolic, vascular ischemic and immunologic injury. Tight glycemic control and symptomatic therapy is beneficial in a minority of patients but does not prevent the relentless progression of symptoms and signs. Intravenous immune globulin is a novel therapy in patients with mononeuropathy multiplex, primary demyelinating neuropathy and peripheral nerve T-cells microvasculitis associated with C5b-9 membrane attack complex protein deposits.