ldwnjdiabetic neuropathy final[1]

7/25/2019 LdwnjDiabetic Neuropathy Final[1]

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Diabetic Neuropathy


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Diabetic Neuropathy

About 60-70% of people with

diabetes have mild to severeforms of nervous system damage,

including

!mpaired sensation or pain in the feet

or hands "lowed digestion of food in the

stomach

#arpal tunnel syndrome

$ther nerve problems

ore than 60% of nontraumatic

lower-limb amputations in the

&nited "tates occur among people

with diabetes'


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(is) *actors

+lucose control

Duration of diabetes

Damage to blood vessels

echanical inury to nerves

Autoimmune factors

+enetic susceptibility

ifestyle factors "mo)ing

Diet


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.athogenesis of Diabetic

Neuropathy

etabolic factors

/igh blood glucose

Advanced glycation end products

"orbitol

Abnormal blood fat levels

!schemia

Nerve fiber repair mechanisms


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Diagnostic ests

Assess symptoms - muscle wea)ness,muscle cramps, pric)ling, numbness or

pain, vomiting, diarrhea, poor bladder

control and se1ual dysfunction

#omprehensive foot e1am ")in sensation and s)in integrity

2uantitative "ensory esting 32"4

5-ray

Nerve conduction studies

lectromyographic e1amination 3+4

&ltrasound


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#lassification of Diabetic

Neuropathy

"ymmetric polyneuropathy

Autonomic neuropathy

.olyradiculopathy

ononeuropathy


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"ymmetric .olyneuropathy

ost common form of diabetic

neuropathy

Affects distal lower e1tremities and

hands 3stoc)ing-glove8 sensoryloss4

"ymptoms9"igns

.ain

.aresthesia9dysesthesia

oss of vibratory sensation


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#omplications of .olyneuropathy

&lcers #harcot arthropathy

Dislocation and stress fractures

Amputation - (is) factors include .eripheral neuropathy with loss of protective

sensation

Altered biomechanics 3with neuropathy4

vidence of increased pressure 3callus4

.eripheral vascular disease

/istory of ulcers or amputation

"evere nail pathology


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reatment of "ymmetric

.olyneuropathy

+lucose control

.ain controlricyclic antidepressants

opical creams

Anticonvulsants

*oot care


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ssentials of *oot #are

1amination

Annually for all patients

.atients with neuropathy - visual inspection of

feet at every visit with a health care professional

Advise patients to &se lotion to prevent dryness and crac)ing

*ile calluses with a pumice stone

#ut toenails wee)ly or as needed Always wear soc)s and well-fitting shoes

Notify their health care provider immediately if

any foot problems occur


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Autonomic neuropathy

Affects the autonomic nervescontrolling internal organs

.eripheral

+enitourinary +astrointestinal

#ardiovascular

!s classified as clinical or subclinicalbased on the presence or absence of

symptoms


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.eripheral Autonomic

Dysfunction

#ontributes to the followingsymptoms9signs Neuropathic arthropathy 3#harcot foot4

Aching, pulsation, tightness, cramping, dry s)in,pruritus, edema, sweating abnormalities

:ea)ening of the bones in the foot leading to

fractures

esting Direct microelectrode recording of postglanglionic

# fibers

+alvanic s)in responses

easurement of vascular responses


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.eripheral Autonomic

Dysfunction, cont'

reatment

*oot care9elevate feet when sitting

liminate aggravating drugs

(educe edema

midodrine

diuretics

"upport stoc)ings

"creen for #;D


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+enitourinary Autonomic

Neuropathy

"ign9"ymptom reatmentation

(etrograde eaculation Antihistamine

rectile dysfunction "ildenafil, tadalafil

Dyspareunia ubricants= estrogencreams


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+astrointestinal Autonomic

Neuropathy "ymptoms9"igns

+astroparesis resulting in anore1ia, nausea,

vomiting, and early satiety

Diabetic enteropathy resulting in diarrhea and

constipation

reatment $ther causes of gastroparesis or enteropathy

should first be ruled out +astroparesis - "mall, fre?uent meals,

metoclopramide, erythromycin

nteropathy - loperamide, antibiotics, stool

softeners or dietary fiber


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#ardiovascular Autonomic

Neuropathy

"ymptoms9"igns

1ercise intolerance

.ostural hypotension

reatment

Discontinue aggravating drugs

#hange posture 3ma)e postural

changes slowly, elevate bed4

!ncrease plasma volume


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.olyradiculopathy

umbar polyradiculopathy 3diabetic

amyotrophy4

high pain followed by muscle wea)ness

and atrophy

horacic polyradiculopathy "evere pain on one or both sides of the

abdomen, possibly in a band-li)e pattern

Diabetic neuropathic cache1ia .olyradiculopathy @ peripheral neuropathy

Associated with weight loss and depression


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.olyradiculopathy, cont'

.olyradiculopathies are diagnosed

by electromyographic 3+4 studies

reatment

*oot care

+lucose control

.ain control


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ononeuropathy

.eripheral mononeuropathy

"ingle nerve damage due to compression

or ischemia

$ccurs in wrist 3carpal tunnel syndrome4,

elbow, or foot 3unilateral foot drop4 "ymptoms9"igns

numbness

edema

pain

pric)ling


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#ranial mononeuropathy Affects the B pairs of nerves that are

connected with the brain and control sight,

eye movement, hearing, and taste

"ymptoms9"igns

unilateral pain near the affected eye

paralysis of the eye muscle

double vision

ononeuropathy multiple1

ononeuropathy, cont'


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ononeuropathy, cont'

reatment

*oot care

+lucose control

.ain control


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$ther reatment $ptions

Aldose reductase inhibitors

A# inhibitors

:eight control 1ercise


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(eferences

American Diabetes Association.reventive *oot #are in Diabetes3.osition "tatement4'Diabetes Care B7 3"uppl'4 "6C-"6, B00

*eldman, #lassification of diabetic neuropathy' !n UpToDate.

:ellesley, A, &poDate, B00C

National Diabetes !nformation #learinghouse' Diabetic Neuropathies:

The Nerve Damage of Diabetes.


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(eferences, cont'

*eldman, .athogenesis and prevention of diabetic

polyneuropathy' !n UpToDate.:ellesley, A, &poDate, B00C'

*eldman, , c#ulloch, DE reatment of diabetic neuropathy' !n

UpToDate.:ellesley, A, &poDate, B00C'

"tevens, F Diabetic autonomic neuropathy' !n UpToDate.

:ellesley, A, &poDate, B00C'

*eldman, #linical manifestations and diagnosis of diabetic

polyneuropathy' !n UpToDate.:ellesley, A, &poDate, B00C'

ldwnjdiabetic neuropathy final[1]

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