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.