Diabetic Neuropathy

Bilateral neuropathy presentation in both feet and hands simultaneously strongly suggests a metabolic rather than structural cause, since mechanical compression tends to be unilateral. Peripheral neuropathy typically begins in the feet and hands because those are the most distal points from the heart and receive the poorest circulation. The retina is neural tissue; capillary damage from elevated glucose causes diabetic retinopathy and eventual vision loss. Peripheral neuropathy begins in the feet because they contain the body's longest nerves, producing numbness and burning that later extends to the hands. Charcot's joints develop when sensory neuropathy eliminates protective pain signals, allowing normal weight-bearing to progressively destroy joint architecture. Gastroparesis arises from neuropathy of the vagus nerve, which innervates the entire gastrointestinal tract and coordinates peristalsis. A full diabetes diagnosis is not required to develop neuropathy; severe insulin resistance or pre-diabetes is sufficient. Diabetic retinopathy is a form of neuropathy affecting the optic nerve and retinal vasculature and is the leading cause of blindness in adults with diabetes. Glucose…