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Webcast Transcript
PORTENOY, MD: Foot ulcers may occur because the patient may not be aware that the skin has been damaged, and that may progress to a deep or non-healing ulcer and be quite a serious complication.
Occasionally, patients experience severe damage to the joints, again, for the same reason. The patient may not be aware that the joint has been injured, and they continue to walk on an injured joint until the damage progresses.
ROY FREEMAN, MD: In addition, there may be an increase in blood pressure or there may be the inability to change blood pressure when moving from a supine, or lying-down, to a standing-up position, so patients will feel dizzy, lightheaded and even faint.
ANNOUNCER: Perhaps one of the most devastating complications of DPN is the loss of sensation which can result in unnoticed injuries. If injuries go unnoticed, they may become infected and possibly gangrenous. In the most extreme cases, the infection can spread to the bone and require amputation.
RUSSELL K. PORTENOY, MD: Occasionally, patients with diabetic polyneuropathy, whether or not pain exists, can experience some very severe complications involving the lower extremities. One of these complications might be a severe infection that might start from the skin and then penetrate more deeply until it involves the bone. Osteomyelitis can result. That's the infection of the bone. And if that cannot be cured and progresses, sometimes it can get so severe that amputation is the only option. These are, fortunately, very uncommon and can partially be prevented by good diabetic control and meticulous foot care.
ANNOUNCER: Patients with diabetes should be aware of several risk factors for the development of peripheral neuropathy.
ROY FREEMAN, MD: The most important risk factor is an elevated blood sugar. In addition, age and duration of diabetes are two other important risk factors. Finally, it's becoming increasingly apparent that the cardiovascular risk factors may also play a role in the evolution of a diabetic peripheral neuropathy
ANNOUNCER: A diagnosis of DPN is based on many findings and should made by a health care professional.
RUSSELL K. PORTENOY, MD: When a patient with diabetes develops symptoms in the feet, like numbness, tingling or pain, and goes to a physician, that physician will first take a history, ask the patient about his or her symptoms, and then do an examination. The examination includes a neurological examination that specifically assesses how the nerves are functioning.
Once the physician makes that judgment, a variety of tests can be done to try to confirm that diagnosis. The physician will probably get some blood tests, both to determine how bad the diabetes is, and also to try to exclude other causes of polyneuropathy.
The physician might also send the patient to another doctor to get an electrical study, what are called nerve conduction studies. The purpose of the nerve conduction studies is to see how well the nerves in the legs and the arms conduct electricity and determine whether they're functioning normally or not. The combination of the history, the examination and the ancillary blood tests and electrical studies is enough to make the diagnosis of diabetic polyneuropathy.
ANNOUNCER: If a person with diabetes thinks they are experiencing peripheral neuropathy, there are several things they should do.
ROY FREEMAN, MD: Firstly, find a physician who understands diabetes and a diabetic peripheral neuropathy. Take control of your disease management by monitoring your diet, develop an exercise program and make sure that your blood glucose is as tightly controlled as possible.
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