Diabetic Neuropathy and Associated Dizziness

Causes and Screening

The American Diabetes Association recommends that all patients with type 1 diabetes for ≥5 years and all patients with type 2 diabetes should be assessed annually for autonomic neuropathy 1, 6
Diabetic autonomic neuropathy is a major cause of dizziness in diabetic patients with neuropathy, manifesting as orthostatic hypotension, resting tachycardia, syncope, and exercise intolerance 1, 5
Symptoms of diabetic peripheral neuropathy typically include numbness, tingling, pain, and weakness in a length-dependent pattern 2, 3
Up to 50% of diabetic peripheral neuropathy may be asymptomatic but still increases risk for complications 4

The American Diabetes Association recommends screening for autonomic neuropathy by asking about symptoms of orthostatic intolerance, syncope, exercise intolerance, and gastrointestinal/urinary symptoms 1
Diagnostic approach for peripheral neuropathy includes assessing small-fiber function (pinprick and temperature sensation) and large-fiber function (vibration perception and 10-g monofilament) 2, 3
Cardiovascular autonomic testing (heart rate variability with deep breathing) and orthostatic blood pressure measurements are recommended for diagnosing autonomic neuropathy 1, 2

The American Diabetes Association recommends optimizing glucose control to prevent or delay neuropathy development in type 1 diabetes and slow progression in type 2 diabetes 1, 6
Treatment for neuropathic pain includes gabapentinoids, serotonin-norepinephrine reuptake inhibitors (duloxetine), tricyclic antidepressants, and sodium channel blockers 1, 6
Nonpharmacologic measures (adequate salt intake, compressive garments) and pharmacologic treatments are recommended for orthostatic hypotension 4