Diabetic neuropathic cachexia: a rare manifestation of diabetic neuropathy.

Diabetic neuropathic cachexia is characterized by bilateral, painful neuropathy usually involving the anterior thighs, with dramatic weight loss. The cause is unknown. Most patients to date have been middle-aged type 2 diabetics on oral agents, and it has rarely been reported in patients with type 1 diabetes. Most patients recover spontaneously, although residual deficits may persist. No specific therapy has been found useful. Antidepressants aid in managing neuropathy and depression. Therapy of painful neuropathy is challenging. Tramadol, dextromethorphan, topical capsaicin, clonidine, tricyclic antidepressants, and gabapentin are often effective. Opioids are rarely beneficial and carry a high risk of addiction. Proper nutrition is essential to avoid further deterioration.