Tuesday, April 27, 2010

Diabetic Peripheral Neuropathy

Diabetic Peripheral Neuropathy is the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes after exclusion of other causes.
Neuropathies are characterized by a progressive loss of nerve fibers

Noninvasive Testing

  • Nerve conduction studies and Electromyography- A test commonly used to evaluate the function and the ability of electrical conduction of the motor and sensory nerves.
  • Quantitative sensory testing
  • Autonomic Function Tests
  • Monofilament testing - If the patient does not feel the wire at 4 or more at 10 testing sites- the test is positive for neuropathy


Pathophysiology of Diabetic Peripheral Neuropathy

Result from vascular disease:
  • Endothelial dysfunction
  • Deficiency of myoinositol-altering myelin synthesis
  • Chronic hyperosmolarity-causing edema of nerve trunks
  • Increased sorbitol and fructose


Diabetic Neuropathy can contribute to Structural foot deformities

Hammertoes

Bunions

Metatarsal deformities

Charcot foot

Eventual tissue breakdown

The symptoms of peripheral neuropathy include the following

  • Hyperesthesia-Is a condition that involves an abnormal increase in sensitivity to stimuli of the senses.
  • Paresthesia- Is a sensation of tingling, pricking, or numbness of a person's skin. It is more generally known as the feeling of "pins and needles".
  • Dysesthesia-It is defined as an unpleasant, abnormal sense of touch, and it may or may not be, considered as a kind of pain.
  • Radicular pain-Is pain "radiated" along the dermatome (sensory distribution) of a nerve due to inflammation or other irritation
  • Anhydrosis-Means lack of sweating.


Peripheral Neuropathy Signs

  • Loss of sensation in the foot- Results in repetitive stress
  • Injuries and fractures
  • Loss of vibratory and position sense
  • Loss of deep tendon reflexes
  • Trophic ulceration
  • Foot drop


Treatment


Diet

  • Patients with diabetic neuropathy should develop a realistic diet for lowering blood glucose. This should be guided by a nutritionist or doctor

Medicines widely used to help with painful symptoms

  • Selective serotonin and norepinephrine reuptake inhibitors- example:Duloxetine (Cymbalta)
  • Tricyclic antidepressants- example: Amitriptyline (Elavil)
  • Anticonvulsants- example:Gabapentin (Neurontin)
  • Pregabalin (Lyrica)- FDA approved for neuropathic pain associated with diabetic peripheral neuropathy or postherpetic neuralgia.
  • Capsaicin cream (Capsacin)- A natural chemical derived from plants of Solanaceae. This is a topical medicine and is the active component of chili peppers.
  • Neuremedy (Benfotiamine)- For the nutritional management of peripheral neuropathy.

No comments: