[Diagnosis and therapy of diabetic polyneuropathy]

Distinction is made between peripheral and autonomic neuropathy. The former is usually painful, while the latter is especially associated with cardiovascular, gastrointestinal and urogenital disturbances. In the diagnosis of peripheral neuropathy, a basic neurological examination (reflex status, vibratory sense) takes precedence over measuring the velocity of nerve conduction and determining the temperature and pain thresholds. The diagnostic approach to the autonomic disturbances is organ-specific (testing of cardiovascular reflexes, sonographic and scintigraphic determination of gastric emptying, infusion urography and uroflowmetry). Early diagnosis and optimal diabetes control are the therapeutic consequences. Symptomatic treatment includes the administration of analgesics, antidepressants and carbamazepine. A newer drug being currently tried is mexiletine. High doses of alpha-liponic acid as well as the fat-soluble B vitamins are used for causal therapy. Clinical trials with aldose reductase inhibitors and gamma-linolenic acid are under way.