Presentation
present the importance regarding the impacts of diabetic neuropathic deficits on patients' functional capacity. [ncbi.nlm.nih.gov]
Peripheral sensory neuropathy Sensory neuropathy most commonly presents as symptomless symmetrical sensory loss in distal extremities i.e. feet and less commonly hands. [nhshighland.scot.nhs.uk]
Associated autonomic symptoms may be present. Examination shows distal loss of pinprick, temperature, touch and vibration sense. with reduced or absent Ankle jerks and weakness of toe flexors and extensors may be present. [jpma.org.pk]
Entire Body System
- Weight Gain
Most people have some insulin resistance as they age, but inadequate exercise and excessive weight gain make it worse, greatly increasing the likelihood of developing type 2 diabetes.Type 2 diabetes can occur at any age, but it most commonly begins in [icdlist.com]
The concern arises from the fact that as blood glucose travels outside of ideal levels, additional complications including; death, coma, behavioral abnormalities, muscle weakness, and weight gain arise. [drmarkg.com]
Common adverse effects for both are dry mouth, drowsiness, dizziness, peripheral oedema, weight gain, and diarrhoea. NNH for minor side-effects is 6–7 for either. [academic.oup.com]
But side effects can be bothersome and include dry mouth, sweating, weight gain, constipation and dizziness. Serotonin and norepinephrine reuptake inhibitors (SNRIs) may ease pain with fewer side effects. [drugs.com]
[…] loss Improvement: After control of diabetes & weight gain Rapidly reversible diabetic neuropathies Hyperglycemic Time: Newly diagnosed, untreated diabetes Clinical: Asymptomatic Laboratory: Reduction of nerve conduction velocities Glycemic-control, Diabetes [neuromuscular.wustl.edu]
- Tall Stature
Risk Factors Risk factors associated with more severe symptoms: smoking poor glycaemic control advanced age long duration of Diabetes disease heavy alcohol intake tall stature! [physio-pedia.com]
- Malaise
Many diabetic foot infections may be treated on an outpatient basis with oral antibiotics in the absence of systemic manifestation, such as fever, chills, and malaise. [ahcmedia.com]
Gastrointestinal
- Abdominal Bloating
Other symptoms include: Diarrhea Constipation Abdominal bloating Feeling full after eating very little Nausea or vomiting after meals Unintentional weight loss Urinary hesitancy or incontinence A sense that the bladder doesn't fully empty Impotence Symptoms [agingcare.com]
People with diabetes may present with early satiety; feeling of fullness; abdominal bloating or upper abdominal pain and discomfort. Consider gastroscopy if possibility of alternative cause for obstructive symptoms. [nhshighland.scot.nhs.uk]
Autonomic neuropathy, or damage to the nerves that control the function of organs and glands, may manifest with a wide variety of symptoms, including: Nausea, vomiting, or abdominal bloating after meals Urinary symptoms, such as incontinence, difficulty [emedicinehealth.com]
- Nocturnal Diarrhea
[…] and constipation; nocturnal diarrhea Treatment Gastrointestinal Autonomic Neuropathy Other causes of gastroparesis or enteropathy should first be ruled out Gastroparesis - Small, frequent meals, metoclopramide, erythromycin Enteropathy - loperamide, [quizlet.com]
Nocturnal diarrhea Profuse watery diarrhea May persist for hours to several days Can be accompanied by fecal incontinence Associated with somatic & autonomic neuropathy More common in type 1 diabetes Rule out drug toxicity: Metformin Fecal incontinence [neuromuscular.wustl.edu]
- Abdominal Distension
Abdominal distension. Dysphagia. Diarrhoea. Gustatory sweating, anhidrosis. Tends to be associated with peripheral neuropathy. People with both types 1 and 2 are affected. [patient.info]
- Abdominal Bloating After Meals
Autonomic neuropathy, or damage to the nerves that control the function of organs and glands, may manifest with a wide variety of symptoms, including: Nausea, vomiting, or abdominal bloating after meals Urinary symptoms, such as incontinence, difficulty [emedicinehealth.com]
Cardiovascular
- Palpitations
[…] erectile dysfunction ) in men Dizziness or fainting Constipation or diarrhea Blurred vision Heat intolerance or decreased ability to sweat Hypoglycemia unawareness : Low blood sugar levels ( hypoglycemia ) are associated with trembling, sweating, and palpitations [emedicinehealth.com]
Normally when blood sugar level is too low, symptoms such as sweating, shaking and palpitations occur. In diabetics with autonomic neuropathy, these symptoms may not occur, making hypoglycemia (low blood sugar) difficult to recognize. [gluxus.com]
Musculoskeletal
- Foot Deformity
Foot risk factors include peripheral neuropathy, peripheral arterial disease, and foot deformities. [ahcmedia.com]
This nerve damage can lead to the foot problems often associated with diabetes, including foot deformities, infections, ulcers, and amputations. [endocrineweb.com]
Patients with foot deformities and loss of their protective threshold should get regular care from a podiatrist. [health.am]
Motor neuropathy plays a role in the development of gait instability and falls, Charcot’s joint disease, plantar ulceration and foot deformity. [podiatrytoday.com]
- Numbness of the Feet
Symptoms can range from pain and numbness in your feet to problems with the functions of your internal organs, such as your heart and bladder. What Is Diabetic Neuropathy? Diabetic neuropathy is nerve damage that is caused by diabetes. [niddk.nih.gov]
Peripheral neuropathy most commonly causes : pain, burning, tingling, and numbness of the feet and lower legs. [medicinenet.com]
Skin
- Ulcer
DM 2 w diabetic neuropathic foot ulcer, DM 2 w diabetic neuropathic heel and midfoot ulcer, DM 2 w diabetic neuropathic toe ulcer, DM 2 w diabetic neuropathy, DM 2 W diabetic peripheral neuropathy, DM 2 w diabetic peripheral sensory neuropathy, DM 2 [healthresearchfunding.org]
DM 2 w diabetic neuropathic foot ulcer DM 2 w diabetic neuropathic heel and midfoot ulcer DM 2 w diabetic neuropathic toe ulcer DM 2 w diabetic neuropathy DM 2 W diabetic peripheral neuropathy DM 2 w diabetic peripheral sensory neuropathy DM 2 W diabetic [icd9data.com]
In the absence of infection, thorough debridement of the ulcer with removal of the perimeter callus and removal of any “high point” along the periphery of the ulcer will prevent undo pressure over the ulcer. [ahcmedia.com]
Association grant to develop a scale to assess patients’ cognitive and emotional representations of neuropathy and is currently funded by the National Institutes of Health (NIH) to study the effects of stress on wound healing in diabetic neuropathic foot ulceration [books.google.com]
Usual locations of ulcers in the diabetic foot. Ulceration is particularly likely to occur over the dorsal portion of the toes and on the plantar aspect of the metatarsal heads and the heel. [quizlet.com]
- Skin Ulcer
The skin of the extremities may feel pruritic and may display thinning, hair loss, dryness, flaking, cracks, increased callus formation, and nail dystrophies. These skin changes increase the risk of ulceration. [aafp.org]
Necrotic skin, if present, needs to be debrided thoroughly to properly evaluate the depth of the ulcer and to remove any skin or soft tissue that may impede the healing process. [ahcmedia.com]
- Erythema
The typical presentation of an infected ulcer includes erythema, edema, malodor, rubor, calor, and purulent drainage. Colonizers do not exhibit symptoms of infection. [ahcmedia.com]
There is sometimes a palpable and tender mass and erythema; consider infection first. It usually occurs in poorly controlled diabetes with advanced microvascular complications. MRI will demonstrate the infarction and associated muscle oedema. [diabetesincontrol.com]
Psychiatrical
- Fear
Altered proprioception can also increase risk of falling and fear of falling. All of these complications can affect physical activity and health-related quality of life. [effectivehealthcare.ahrq.gov]
Urogenital
- Vaginal Dryness
dryness EVALUATION AND TESTS (Not all evaluation and tests may be necessary.) [peripheralneuropathycenter.uchicago.edu]
Symptoms of nerve damage in these areas includes bladder and bowel problems; erectile dysfunction or vaginal dryness; and problems regulating sweating and body temperature. [rd.com]
dryness) Changes in how you normally sweat Problems regulating body temperature Elevated heart rate while at rest The body may not be able to adequately adjust heart rate or blood pressure, which can cause someone to suddenly feel lightheaded or even [availclinical.com]
Erectile dysfunction in men and vaginal dryness in women. Vision problems. [apmhealth.com]
Symptoms include: diarrhoea (often at night), constipation or both; indigestion, nausea and vomiting; difficulty swallowing; loss of bladder control; changes in vision; erectile dysfunction and problems with ejaculation; vaginal dryness and sexual dysfunction [mydr.com.au]
Neurologic
- Foot Drop
Distribution: Common areas effected Wrist Drop ( Radial Nerve ) Loss of finger flexion and grip ( Median Nerve ) Foot drop (deep peroneal nerve, L4-L5) Recurrent laryngeal nerve Cranial Nerve palsy ( CN 3, CN 4, CN 6 ) Ophthalmoplegia, Ptosis, Diplopia [fpnotebook.com]
[…] care Glucose control Pain control Single nerve damage due to compression or ischemia Occurs in wrist (carpal tunnel syndrome), elbow, or foot (unilateral foot drop) Symptoms/Signs numbness edema pain prickling Mononeuropathies CN III, IV, and VI (and [quizlet.com]
Some of the most common are: axillary nerve dysfunction carpal tunnel syndrome common peroneal nerve dysfunction cranial mononeuropathy femoral neuropathy radial nerve dysfunction ulnar nerve dysfunction unilateral foot drop sciatic nerve dysfunction [healthline.com]
[…] lifting the front part of the foot (foot drop) Pain in the front of the thigh When to see a doctor Call your health care provider for an appointment if you have: A cut or sore on your foot that is infected or won't heal Burning, tingling, weakness or [mayoclinic.org]
Sahani B, Spalding JMK: Diabetes mellitus presenting with bilateral foot drop. Lancet 1969;2:930–931. CrossRef Google Scholar (33). [link.springer.com]
- Sciatica
The technical medical term for that is radiculopathy, although most people refer to it as sciatica. If there’s also shooting nerve pain involved, this form of neuropathy can also be called polyradiculopathy-diabetic amyotrophy. [endocrineweb.com]
- Apathy
Findings are based on resting-state functional connectivity analysis with 20 patients with mild to moderate AD, which were correlated with their scores on neuropsychiatric inventory syndromes (apathy, hyperactivity, affective syndrome, and psychosis) [practicalneurology.com]
- Somnolence
The common adverse effects are nausea, somnolence, sweating, dry mouth, and rarely hepatitis. It also reduces appetite, which can be a useful side-effect in obese patients. It is contraindicated in liver failure, renal failure, and glaucoma. [academic.oup.com]
Workup
(See Workup.) Management of diabetic neuropathy should begin at the initial diagnosis of diabetes. [emedicine.medscape.com]
Increased temperature changes with edema can be quite concerning and complete workup is required to “arrest” the development of breakdown of the arch with subsequent deformity, such as a rocker bottom type of foot. [ahcmedia.com]
Treatment
On the 10th day, we established a decrease in total symptom score by an average of 2.7 +/- 1.4 points and by the end of the treatment period it was improved by 5.9 +/- 1.9 points (p = 0.04). [ncbi.nlm.nih.gov]
المحتويات Aldose Reductase Inhibitors for the Treatment 309 Other Therapeutic Agents for the Treatment 321 Pathophysiology of Neuropathic Pain 339 Treatment of Painful Diabetic Neuropathy 351 Focal and Multifocal Diabetic Neuropathy 367 Hypoglycemia and [books.google.com]
Genitourinary neuropathy Treatment Voluntary urination; catheterization Antihistamine Sildenafil, tadalafil (cialis, viagra) Lubricants; estrogen creams Symptoms/Signs Gastrointestinal Autonomic Neuropathy Gastroparesis resulting in anorexia, nausea, [quizlet.com]
• Optimal glucose control remains the most important prevention and treatment strategies in diabetic polyneuropathy. [medlink.com]
Prognosis
Prognosis for Diabetics with Neuropathy The prognosis for diabetic neuropathy depends largely on how well the underlying condition of diabetes is handled. [agingcare.com]
What Is the Prognosis for Neuropathy? The outlook for nerve damage depends upon its cause. [emedicinehealth.com]
Prognosis [ 7, 9 ] Autonomic neuropathy is associated with a high mortality rate, mainly due to its association with chronic kidney disease, cardiopathy and hypotension. [patient.info]
IVIg: Hastens recovery; dose 2g/kg q month x3 Prognosis Slow recovery over 6 to 24 months after diabetic control Partial or complete Variant syndrome: Diabetic amyotrophy Nosology: Proximal diabetic neuropathy Frequency: Rare Onset: Sub-acute Associations [neuromuscular.wustl.edu]
The prognosis is generally good, and patients typically recover their baseline weight with resolution of the painful sensory symptoms within 1 year. 2. [health.am]
Etiology
Abstract Fifty-one diabetic patients with mononeuropathy were studied to examine possible etiological factors, to determine the relationship with other diabetic complications, and to correlate with the presence and severity of background peripheral and [diabetes.diabetesjournals.org]
Additionally, patients can be referred if the diagnosis is unclear or if a different etiology is suspected. [pharmacytimes.com]
Disease Etiology With over 100 known types of peripheral neuropathy, the pathophysiology of this disease is not quite clear. [endocrinologyadvisor.com]
You can also refer if the diagnosis is unclear or different etiology is suspected. DSPN pain management Pop-Busui mentions pain is often the reason many diabetic neuropathy patients seek help from their providers. [sciencedaily.com]
You can also refer if the diagnosis is unclear or different etiology is suspected. [labblog.uofmhealth.org]
Epidemiology
Epidemiological correlates of diabetic neuropathy. Report from Pittsburgh Epidemiology of Diabetes Complications Study. Diabetes 1989;38:1456–1461. PubMed CrossRef Google Scholar 7. Maser RE, Nielsen VK, Bass EB, et al. [link.springer.com]
Epidemiology and classification of diabetic neuropathy. Shefner JM, Dashe JF, eds. UptoDate. Wolters Kluwer Health. Accessed at: www.uptodate.com. 2013. 2. Rutkove SB. Overview of upper extremity peripheral nerve syndromes. [type2diabetes.com]
Epidemiology and classification of diabetic neuropathy. Waltham, MA, US: UpToDate, Inc. uptodate.com. Information published online, accessed 13th March 2015. Gordon Smith A, Robinson Singleton J. [passeportsante.net]
Epidemiology of Peripheral Neuropathy and Lower Extremity Disease in Diabetes. Curr Diab Rep 2019; 19: 86. 3. Sundara Rajan R, de Gray L, George E. Painful diabetic neuropathy. Contin Educ Anaesth Crit Care Pain 2014; 14: 230–5. 4. [changepain.com]
IV & V collagen: Especially in innermost lamellae Endoneurial microvessles Increased types IV, V and VI collagen around microvessels CNS: Spinal cord atrophy reported with diabetes DIABETIC NEUROPATHIES: SYMMETRIC Chronic Distal: Sensory ± Autonomic Epidemiology [neuromuscular.wustl.edu]
Pathophysiology
المحتويات Aldose Reductase Inhibitors for the Treatment 309 Other Therapeutic Agents for the Treatment 321 Pathophysiology of Neuropathic Pain 339 Treatment of Painful Diabetic Neuropathy 351 Focal and Multifocal Diabetic Neuropathy 367 Hypoglycemia and [books.google.com]
THE PATHOPHYSIOLOGY To better understand the pathophysiology of the disease, the Mayo researchers performed ipsilateral nerve biopsies on the 33 patients in their prospective study. [journals.lww.com]
Disease Etiology With over 100 known types of peripheral neuropathy, the pathophysiology of this disease is not quite clear. [endocrinologyadvisor.com]
Classification, clinical features and pathophysiological basis. Neurologist. 2005;11(2):63-79. [ Links ] 31 Lu B, Hu J, Wen J, Zhang Z, Zhou L, Li T, Hu R. [scielo.br]
Pathophysiology and treatment of painful diabetic neuropathy of the lower extremity. South Med Journal, 91:957-60, 1998. Harris ER, Cowie C. Symptoms of sensory neuropathy in adults with NIDDM in the US population. Diabetes Care, 16:1446-52, 1993. [periodicos.unifesp.br]
Prevention
The statement contains recommendations for physicians on the overall prevention of diabetic neuropathy, highlighting prevention as a key component because of the lack of treatment to reverse this condition. [empr.com]
In type 2 diabetes, work to effectively control glucose to prevent or slow the progression of DSPN. With type 2 diabetes, consider a multifactorial approach with targeting glycemia and other risk factors to prevent CAN. [sciencedaily.com]
Recommendations for overall diabetic neuropathy prevention are as follows: For patients with type 1 diabetes, try to control glucose as soon as possible to prevent or delay the development of DSPN and CAN. [pharmacytimes.com]
These findings might assist both patients and clinicians in better realizing the impacts of neuropathic hands, and planning suitable strategies of intervention or health education to prevent declines in hand functions. © 2017 The Authors. [ncbi.nlm.nih.gov]