Diabetic Neurology

180 Pages·2010·3.369 MB·English

by  Douglas Zochodne, Gregory Kline, Eric E. Smith, Michael D Hill

Diabetic Neurology Z Diabetic
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About the book About the Authors od
n
Diabetic Neurology offers a unique focus on the DoUgLAS W. ZoCHoDNE M.D. is a Professor in the e Neurology

broad neurological complications of diabetes. Department of Clinical Neurosciences, Faculty of •
This book successfully bridges the clinical divide Medicine, at the University of Calgary; Director of K
between diabetology and neurology with a the faculty’s Neuromuscular Clinic; and Director of lin
comprehensive, practitioner-friendly guide for Clinical Neurophysiology (Adult EMg) for Alberta e
the recognition, investigation and management Health Services. Dr. Zochodne is founder and principal •
of diabetic patients with neurological disease. investigator of the university’s Peripheral Nerve S
The point form format facilitates a thorough Research Laboratory that studies the neurobiology m
summary of the diabetological and neurological of peripheral nerves in diabetes and injury, at the it
h
approach to patients and their related disease university and is a Scientist of the Alberta Heritage
states. Foundation for Medical Research. He graduated from •
medical school at the University of Western ontario H
This book brings together the shared expertise of in London, ontario in 1980 and is President of the ill
four internationally renowned authors to address Peripheral Nerve Society.
the problems Neurologists may encounter in
diabetic patients and the important neurological gREgoRY KLINE M.D. is a Clinical Associate Professor
D
issues to consider in diabetes clinics. In a growing of Endocrinology, Faculty of Medicine, at the University
field, this book is a comprehensive and useful of Calgary; Associate Medical Director of the Foothills ia
reference for Diabetologists, Endocrinologists, osteoporosis Centre in Calgary; and staff member of b
Internists and Neurologists. both Alberta Health Services, Calgary Region, and the
e
city’s Tom Baker Cancer Centre. Dr. Kline is active in
The book presents: research in several endocrine fields including diabetes ti
and obesity. He graduated from medical school at the c
• An overview of diabetes care directed towards University of Western ontario in 1996 and is a Fellow
Neurologists and of neurological basics N
of the Royal College of Physicians and Surgeons of
directed towards diabetologists, including e
Canada.
comprehensive approaches towards the u
“full neurological examination,” a description ERIC E. SMITH M.D. is Assistant Professor in the r
of neurological evaluations, and practical o
Department of Clinical Neurosciences, Faculty of
ways physicians can expand or tailor their l
Medicine, at the University of Calgary; Joint Assistant o
neurological assessments.
Professor of Community Health Sciences; and Joint g
• A summary of various neurological Assistant Professor of Radiology at the University y
presentations, both common and serious, of Calgary. Dr. Smith is the Director of the Cognitive
which both specialties must be cognizant of. Neurosciences Clinic at the Foothills Medical Centre in
Calgary. He graduated with his medical degree from
• A discussion of common and rare conditions Montreal’s Mcgill University in 1998.
that exhibit both neurological and diabetic
complications. MICHAEL D. HILL M.D., M.Sc. is Associate Dean of
Clinical Research and Associate Professor in the
Department of Clinical Neurosciences, Faculty of
Medicine, at the University of Calgary, and Director of
the Stroke Unit of the Calgary Stroke Program. Dr. Hill
graduated with his medical degree from the University
of ottawa in 1993 and received a master’s degree in
Clinical Epidemiology from the University of Calgary in
2003. He is presently on the editorial boards of Stroke
and the Canadian Journal of Neurological Sciences.
Douglas W. Zochodne
Gregory Kline
Eric E. Smith
Telephone House, 69-77 Paul Street, London EC2A 4LQ, UK
52 Vanderbilt Avenue, New York, NY 10017, USA
Michael D. Hill
www.informahealthcare.com
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Diabetic Neurology
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Diabetic Neurology
Douglas W. Zochodne
Department of Clinical Neurosciences
Faculty of Medicine, University of Calgary
Calgary, Alberta, Canada
Gregory Kline
Department of Medicine, Faculty of Medicine
University of Calgary
Calgary, Alberta, Canada
Eric E. Smith
Department of Clinical Neurosciences
Faculty of Medicine, University of Calgary
Calgary, Alberta, Canada
Michael D. Hill
Department of Clinical Neurosciences
Faculty of Medicine, University of Calgary
Calgary, Alberta, Canada
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Firstpublishedin2010byInformaHealthcare,TelephoneHouse,69-77PaulStreet,LondonEC2A4LQ,
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professionals strictly as a supplement to the medical professional’s own judgement, knowledge of the
patient’smedicalhistory,relevantmanufacturer’sinstructionsandtheappropriatebestpracticeguidelines.
Becauseoftherapidadvancesinmedicalscience,anyinformationoradviceondosages,procedures,or
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Dedication
Thisbookisdedicatedtowardourpatientswithdiabetesmellitusinthehopethat
better care and more effective treatments emerge for them.
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Acknowledgment
The authors acknowledge the detailed and timely editorial input by Barbara
Zochodne. We also acknowledge the support of the Faculty of Medicine at the
University of Calgary and our Departments of Clinical Neurosciences and
Medicine. DZ acknowledges the ongoing research support for his work on
diabetes that has been provided by the Canadian Institutes of Health Research,
the Canadian Diabetes Association, and the Juvenile Diabetes Research Foun-
dation.HeisanAHFMRscientist.MHhasbeenfundedbytheHeartandStroke
Foundation of Alberta/NWT/NU and by Alberta Innovates—Health Solutions.
His research has been supported by the CIHR, Heart and Stroke Foundation
Alberta/NWT/NU,andtheNINDS(NIH).Hehasreceivedindustrysupportfrom
Hoffmann-La Roche Canada Ltd., Baxter USA, and Merck Canada in the form
of drug-in-kind support for clinical trials and salary support for clinical fellows
from Bayer Canada.
Dr Smith receives research support from the National Institutes of Neu-
rologicalDisordersandStroke,theCanadianStrokeNetwork,andtheCanadian
Institutes for Health Research, and salary support from the Canadian Institutes
for Health Research.
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Contents
Acknowledgment . . . . . . vii
Introduction . . . . . . . . . . xi
Section 1: Diabetes in neurology
1. Diabetes basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1
2. Neurological basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 13
Section 2: Diagnosis and approach
3. Neurological presentations . . . . . . . . . . . . . . . . . . . . . . . . . .. 35
4. “Red flags” in neurology and diabetes . . . . . . . . . . . . . . . . .. 59
Section 3: Neurological problems in diabetics
5. Acute hyperglycemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 69
6. Hypoglycemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 72
7. Cerebrovascular disease . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 75
8. Neuropathic pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 83
9. Polyneuropathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 88
10. Entrapment neuropathies . . . . . . . . . . . . . . . . . . . . . . . . . . .. 97
ix