Neuropathy is one of the major reasons of morbidity in diabetes mellitus (DM). We presented a 64-year-old male who was a case of type 2 DM for >6 years. He presented with orthopnea and respiratory failure secondary to bilateral phrenic neuropathy and resultant diaphragmatic palsy. Clinical examination, ultrasound, and nerve conduction studies confirmed the bilateral involvement of the phrenic nerves. Phrenic neuropathy may be an important, albeit a rare complication of diabetes, and hence, diaphragmatic dysfunction associated with diabetic phrenic neuropathy should be considered in any patient with unexplained breathlessness, orthopnea, and respiratory failure.
Wein TH, Albers JW. Diabetic neuropathies. Phys Med Rehabil Clin N Am 2001;12:307-20, ix.
Ziegler D. Current concepts in the management of diabetic polyneuropathy. Curr Diabetes Rev 2011;7:208-20.
Tang EW, Jardine DL, Rodins K, Evans J. Respiratory failure secondary to diabetic neuropathy affecting the phrenic nerve. Diabet Med 2003;20:599-601.
White JE, Bullock RE, Hudgson P, Home PD, Gibson GJ. Phrenic neuropathy in association with diabetes. Diabet Med 1992;9:954-6.
Rice AL, Ullal J, Vinik AI. Reversal of phrenic nerve palsy with topiramate. J Diabetes Complications 2007;21:63-7.
Elefteriades J, Singh M, Tang P, Siegel MD, Kenney B, Pandey A, et al. Unilateral diaphragm paralysis: Etiology, impact, and natural history. J Cardiovasc Surg (Torino) 2008;49:289-95.
Patel AS, O'Donnell C, Parker MJ, Roberts DH. Diaphragm paralysis definitively diagnosed by ultrasonography and postural dependence of dynamic lung volumes after seven decades of dysfunction. Lung 2007;185:15-20.
Reichel G, Bruns W, Rabending G. Classification of diabetic neuropathy from pathogenetic aspects. Endokrinologie 1982;79:321-36.
Yesil Y, Ugur-Altun B, Turgut N, Ozturk ZA, Kuyumcu ME, Yesil NK, et al. Phrenic neuropathy in diabetic and prediabetic patients without neuromuscular complaint. Acta Diabetol 2013;50:673-7.
Gayan-Ramirez G, Gosselin N, Troosters T, Bruyninckx F, Gosselink R, Decramer M, et al. Functional recovery of diaphragm paralysis: A long-term follow-up study. Respir Med 2008;102:690-8.
Versteegh MI, Braun J, Voigt PG, Bosman DB, Stolk J, Rabe KF, et al. Diaphragm plication in adult patients with diaphragm paralysis leads to long-term improvement of pulmonary function and level of dyspnea. Eur J Cardiothorac Surg 2007;32:449-56.
Celli BR. Respiratory management of diaphragm paralysis. Semin Respir Crit Care Med 2002;23:275-81.