16: Diabetic Neuropathy - Fang

Question 1

** ______ of diabetic pts have mild to severe forms of nervous system damage

Answer 1

60-70%

including: impaired sensation or pain in the feet or hands, slowed digestion of food in stomach, carpal tunnel syndrome, other nerve problems

Question 2

more than ___ of non-traumatic LL amputation in the US occur among ppl with DM

Answer 2

60%

number one overall reason amputation is trauma

Question 3

*** risk factors peripheral neuropathy

Answer 3

• **poor glucose control
• **duration of diabetes over 25 years
• damage to blood vessels
• mechanical injury to n. (carpal tunnel syndrome)
• autoimmune factor (inflammation of the n. due to autoimmune dysfunction can aggravate neuropathy)
• genetic susceptibility
• lifestyle factors (smoking, alcohol abuse bc damage blood vessels)

Question 4

*** pathology of peripheral neuropathy

Answer 4

• axonal loss, focal demyelination and regeneration

- decreased conduction velocity and decreased sensory thresholds

Question 5

*** 4 classifications of diabetic neuropathy

Answer 5

• symmetric polyneuropathy
• autonomic neuropathy
• polyradiculopathy
• mononeuropathy

Question 6

most common form of diabetic neuropathy

Answer 6

symmetric polyneuropathy “stocking-glove”

s/s

• pain
• paresthesia/dysesthesia
• loss of vibratory sensation

Question 7

*** 4 complications of polyneuropathy

Answer 7

• ulcers
• charcot arthropathy (joint deterioration)
• dislocation and stress fractures
• amputation

Question 8

callus formation and ischemia –>

Answer 8

ulceration

Question 9

tx symmetric polyneuropathy

Answer 9

• glucose control
• pain control (TCAs, topical creams, anticonvulsants)
• foot care

Question 10

describe autonomic neuropathy

Answer 10

• affects the autonomic . controlling internal organs (peripheral, genitourinary, GI, cardiovascular)

clinical or subclinical based on presence or absence of symptoms

Question 11

tx autonomic neuropathy

Answer 11

• foot care/ elevated feet when sitting
• eliminate aggravating drugs
• reduce edema (midodrine, diuretics)
• support stokcings
• screen for CVD

Question 12

genitourinary autonomic neuropathy: s/s; what is tx?

A. bladder dysfunction
B. retrograde ejaculation
C. erectile dysfunction
D. dyspareunia (pain while having sex)

Answer 12

A. voluntary urination; catheterization

B. antihistamine

C. sildenafil, tadalafil

D. lubricants; estrogen creams

Question 13

s/s gastrointestinal autonomic neuropathy

Answer 13

• gastroparesis resulting in anorexia, nausea, vomiting, and early satiety
• diabetic enteropathy resulting in diarrhea and constipation

Question 14

tx gastrointesinal autonomic neuropathy

Answer 14

rule out other cuases first

gastroparesis - small, frequent meals, metoclopramide, erythromycin

enteropathy - loperamide, antibiotics, stool softeners or dietary fiber

Question 15

cardiovascular autonomiv neuropathy s/s include exercise intolerance and postural hypotension. what is the tx?

Answer 15

• discontinue aggravating drugs
• change posture (make postural changes slowly, elevate bed )
• increase plasma volume

Question 16

thigh pain followed by m. weakness and atrophy might be..

Answer 16

lumbar polyradiculopathy (diabetic amyotrophy)

Question 17

severe pain on one or both sides of the abdomen, possibly in a band-like pattern might be…

Answer 17

thoracic polyradiculopathy

Question 18

polyradiculopathy + peripheral neuropathy =

Answer 18

diabeteic neuropathic cachexia

associated with WL and depression

Question 19

diagnosis and tx of polyradiculopathy

Answer 19

diagnosed by EMG studies

tx: foot care, glucose control, pain control

Question 20

single nerve damage due to compression or ischemia =

Answer 20

peripheral mononeuropathy

• occurs in wrist, elbow or foot (unilateral foot drop)

s/s = numbness, edema, pain, prickling

tx: foot care, glucose control, pain control

Question 21

s/s = unilateral pain near affected eye, paralysis of eye muscle, double vision =

Answer 21

cranial mononeuropathy a type of mononeuropathy

affects 12 pairs of nn. that are connected with brain and control sight, eye movement, hearing and taste

Question 22

other newer drugs for diabetic neuropathy

Answer 22

• aldose reductase inhibitors
• ACE inhibitors
• weight control
• exercise

Question 23

** two most common underlying factors contribution to development of example pt diabetic neuropathy

Answer 23

• 28 years of diabetes

- poor glucose control evidenced by HbA1C level