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A 55 year old patient with type 2 diabetes is reviewed in the diabetic clinic. Which of the following is a feature of diabetic neuropathy to watch out for?

A. Cervical myelopathy
B. Brisk reflexes
C. Muscle hypertrophy
D. Loss of vibration sense
E. Myotonia

Answer: d) loss of vibration sense. Autonomic neuropathy to the gut, bladder and sexual organs (impotence) can occur. A 3rd nerve mononeuropathy can occur. Motor neuropathy can cause muscle wasting, and sensory neuropathy causes vibration sensory loss. With myotonia, prolonged contraction of muscle fibres associated with muscle dystrophy is due to genetic causes of muscle protein abnormality and is not neurologically dependent.