Diabetic Neuropathy Disease Health Article

Diagnosis

Diabetic neuropathy is diagnosed on the basis of a clinical evaluation, analyzing the patient's history, symptoms and the physical exam. During the exam, the doctor may check blood pressure and heart rate, muscle strength, reflexes, and sensitivity to position, vibration, temperature, or a light touch.

The physician may also do other tests to help determine the type and extent of nerve damage:

• A comprehensive foot exam assesses skin, circulation, and sensation. Other tests include checking reflexes and assessing vibration perception.
• Nerve conduction studies check the transmission of an electrical current through a nerve. This test allows the doctor to assess the condition of all the nerves in the arms and legs.
• Electromyography (EMG) shows how well muscles respond to electrical signals transmitted by nearby nerves. This test is often done at the same time as nerve conduction studies.
• Quantitative sensory testing (QST) uses the response to stimuli, such as pressure, vibration, and temperature, to check for overt neuropathy. QST is increasingly used to recognize sensation loss and excessive irritability of nerves
• Heart rate variability shows how the heart responds to deep breathing and to changes in blood pressure and posture.
• Nerve or skin biopsies are used in research settings

Treatment team

Proper management of diabetic patients requires a skilled team including collaborating specialists. Depending on the qualifications of the patient's primary physician, other professionals are recruited as needed, such as an ophthalmologist, podiatrist, cardiologist, nutritionist, nurse educator, neurologist, vascular surgeon, endocrinologist, gastroenterologist and urologist. A nurse educator can ease the interface between otherwise independent specialists. Without such a team mentality, the diabetic patient is often set adrift, forced to cope with conflicting instructions and unneeded repetition of tests.

Treatment

The first step is to bring blood glucose levels down to the normal range to prevent further nerve damage. Blood glucose monitoring, meal planning, exercise, and oral drugs or insulin injections are needed to control blood glucose levels. Although, symptoms may get temporarily worse when blood sugar is first brought under control, over time, maintaining normal glucose levels helps lessen neuropathic symptoms. Importantly, good blood glucose control may also help prevent or delay the onset of further complications.

Additional treatments depend on the type of nerve problem in consideration, and are include:

• Foot care—Clean the feet daily, using warm water and a mild soap. Inspect the feet and toes every day for cuts, blisters, redness, swelling, calluses, or other problems. Always wear shoes or slippers to protect feet from injuries, and prevent skin irritation by wearing thick, soft, seamless socks. Schedule regular visits with a podiatrist.
• Pain relief—To relieve pain, burning, tingling, or numbness, the physician may suggest aspirin, acetaminophen, or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. People with renal disease should use NSAIDs only under a doctor's supervision. A topical cream called capsaicin is another option. Tricyclic anti-depressant medications such as amitriptyline, imipramine, and nortriptyline, or anticonvulsant medications such as carbamazepine or gabapentin may relieve pain in some people. Codeine may be prescribed for a short time to relieve severe pain. Also, mexiletine, used to regulate heartbeat, has been effective in reducing pain in several clinical trials.
• Gastrointestinal problems—To relieve mild symptoms of stomach discomfort, doctors suggest eating small, frequent meals, avoiding fats, and eating less fiber. When symptoms are severe, the physician may prescribe erythromycin to speed digestion, metoclopramide for the same reason and to help relieve nausea, or other drugs to help regulate digestion or reduce stomach acid secretion.
• Urinary and sexual problems—To treat urinary tract infections, physicians can prescribe antibiotics and suggest drinking plenty of fluids. Several methods are available to treat erectile dysfunction caused by neuropathy, including taking oral drugs, using a mechanical vacuum device, or injecting a vasodilating drug into the penis before intercourse. In women, vaginal lubricants may be useful when neuropathy causes vaginal dryness.

Recovery and rehabilitation

Physical therapy may be a useful adjunct to other therapies, especially when muscular pain and weakness are a manifestation of the patient's neuropathy. The physical therapist can instruct the patient in a general exercise program to maintain his/her mobility and strength.

Occupational therapy may be necessary in cases where a person loses a limb due to secondary complications and needs functional training to regain his/her independence.