16: Diabetic Neuropathy - Fang Flashcards
** ______ of diabetic pts have mild to severe forms of nervous system damage
60-70%
including: impaired sensation or pain in the feet or hands, slowed digestion of food in stomach, carpal tunnel syndrome, other nerve problems
more than ___ of non-traumatic LL amputation in the US occur among ppl with DM
60%
number one overall reason amputation is trauma
*** risk factors peripheral neuropathy
- **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)
*** pathology of peripheral neuropathy
- axonal loss, focal demyelination and regeneration
- decreased conduction velocity and decreased sensory thresholds
*** 4 classifications of diabetic neuropathy
- symmetric polyneuropathy
- autonomic neuropathy
- polyradiculopathy
- mononeuropathy
most common form of diabetic neuropathy
symmetric polyneuropathy “stocking-glove”
s/s
- pain
- paresthesia/dysesthesia
- loss of vibratory sensation
*** 4 complications of polyneuropathy
- ulcers
- charcot arthropathy (joint deterioration)
- dislocation and stress fractures
- amputation
callus formation and ischemia –>
ulceration
tx symmetric polyneuropathy
- glucose control
- pain control (TCAs, topical creams, anticonvulsants)
- foot care
describe autonomic neuropathy
- affects the autonomic . controlling internal organs (peripheral, genitourinary, GI, cardiovascular)
clinical or subclinical based on presence or absence of symptoms
tx autonomic neuropathy
- foot care/ elevated feet when sitting
- eliminate aggravating drugs
- reduce edema (midodrine, diuretics)
- support stokcings
- screen for CVD
genitourinary autonomic neuropathy: s/s; what is tx?
A. bladder dysfunction
B. retrograde ejaculation
C. erectile dysfunction
D. dyspareunia (pain while having sex)
A. voluntary urination; catheterization
B. antihistamine
C. sildenafil, tadalafil
D. lubricants; estrogen creams
s/s gastrointestinal autonomic neuropathy
- gastroparesis resulting in anorexia, nausea, vomiting, and early satiety
- diabetic enteropathy resulting in diarrhea and constipation
tx gastrointesinal autonomic neuropathy
rule out other cuases first
gastroparesis - small, frequent meals, metoclopramide, erythromycin
enteropathy - loperamide, antibiotics, stool softeners or dietary fiber
cardiovascular autonomiv neuropathy s/s include exercise intolerance and postural hypotension. what is the tx?
- discontinue aggravating drugs
- change posture (make postural changes slowly, elevate bed )
- increase plasma volume
thigh pain followed by m. weakness and atrophy might be..
lumbar polyradiculopathy (diabetic amyotrophy)
severe pain on one or both sides of the abdomen, possibly in a band-like pattern might be…
thoracic polyradiculopathy
polyradiculopathy + peripheral neuropathy =
diabeteic neuropathic cachexia
associated with WL and depression
diagnosis and tx of polyradiculopathy
diagnosed by EMG studies
tx: foot care, glucose control, pain control
single nerve damage due to compression or ischemia =
peripheral mononeuropathy
- occurs in wrist, elbow or foot (unilateral foot drop)
s/s = numbness, edema, pain, prickling
tx: foot care, glucose control, pain control
s/s = unilateral pain near affected eye, paralysis of eye muscle, double vision =
cranial mononeuropathy a type of mononeuropathy
affects 12 pairs of nn. that are connected with brain and control sight, eye movement, hearing and taste
other newer drugs for diabetic neuropathy
- aldose reductase inhibitors
- ACE inhibitors
- weight control
- exercise
** two most common underlying factors contribution to development of example pt diabetic neuropathy
- 28 years of diabetes
- poor glucose control evidenced by HbA1C level
