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PT 680 Clinical Medicine > Diabetic Peripheral Neuropathy > Flashcards

Diabetic Peripheral Neuropathy Flashcards

1
Q

A1C, fasting blood sugar test, and glucose tolerance test results for diabetes

A

6.5% or greater
126 mg/dL or above
200 mg/dL or above

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2
Q

A1C, fasting blood sugar test, and glucose tolerance test results for prediabetes

A

5.7-6.4%
100-125 mg/dL
140-199 mg/dL

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3
Q

A1C, fasting blood sugar test, and glucose tolerance test results that are considered normal

A

below 5.7%
99 mg/dL or below
140 mg/dL or below

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4
Q

what does subclinical mean

A

not detectable or producing effects that are not detectable by the usual clinical tests
- clinical tests may be positive, but does the patient have sx???

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5
Q

what structures does DPN affect

A

damage to the nerve and also the blood vessel

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6
Q

does DPN affect CNS or PNS

A

PNS

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7
Q

autonomic nervous system

A

described as the visceral nervous system or visceral motor system; motor fibers that stimulate smooth involuntary muscles, cardiac muscle, stomach and intestines
- sympathetic (fight or flight) and parasympathetic (rest and digest)

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8
Q

somatic nervous system

A

provides sensory and motor innervation to all body parts; sensations of touch, pain, temperature and position of sensory receptors; innervates skeletal muscle (both voluntary and reflexive movement)

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9
Q

does DPN affect autonomic or somatic NS

A

affects both and can be focal or diffuse

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10
Q

what type of neuropathy is DPN

A

metabolic –> can affect the body in many ways

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11
Q

what aspect of diabetes can injure nerves throughout the body

A

high blood sugar/glucose

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12
Q

what aspects of PNS does DPN affect (what cells)

A

nerve cells and Schwann cells (myelination to PNS)

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13
Q

what nerves does DPN most commonly affect

A

feet and legs first, then hands and arms (less common)

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14
Q

describe the systemic effects chronic hyperglycemia can have on the body

A
  • increase sorbitol and fructose levels which affect sodium/potassium and APT within peripheral nerves
  • causes microcirculatory ischemia to afferent peripheral nerves
  • excess sorbitol damages schwann cells
  • alterations in insulin levels alters gene expression of neurotrophic factors
  • promotes loss of myelinated and unmyelinated axons
  • nodes of ranvier are affected which slows nerve conduction velocity
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15
Q

does DPN affect prox to distal or distal to prox

A

distal to proximal

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16
Q

what is sorbitol

A

sugar

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17
Q

what are some s/s of DPN

A
  • numbness/reduced ability to feel pain/temp
  • tingling/burning
  • sharp pains/cramps
  • mm weakness
  • extreme sensitivity to touch (bed sheets can become painful)
  • foot problems - ulcerations, infections, bone and joint damage
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18
Q

what type of DPN is rapidly reversible

A

hyperglycemic neuropathy

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19
Q

NCV

A

nerve conduction velocity

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20
Q

describe hyperglycemic neuropathy

A

occurs in newly diagnosed or poorly controlled DM; distal symmetric sensory changes causes burning, tingling, numbness; sx resolved when blood sugar is controlled; NCV issues can still exist

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21
Q

what types of DPN are generalized symmetric polyneuropathies

A

acute sensory
chronic sensorimotor
autonomic

22
Q

describe acute sensory DPN

A
  • rapid onset of severe burning/sharp pain
  • hypersensitivity worse at night
  • can improve if blood glucose is stabilized long term
23
Q

describe chronic sensorimotor DPN

A
  • most common (50%)
  • sensory loss
  • small fibers = pain
  • large fibers = painless paresthesia with loss of proprioception/vibration
  • mild motor weakness
  • “walking on clouds”
24
Q

describe autonomic DPN – when is sympathetic and parasympathetic systems most affected with type 1 and 2

A
  • sympathetic and parasympathetic affected with type 1 and 2
  • parasympathetic more affected with type 2
25
Q

types of focal DPN

A

cranial
focal limb

26
Q

what is most affected with cranial DPN

A

somatic division CN 3 (mostly), sometimes CN 8

27
Q

what nerves are most affected with focal limb DPN

A

median, ulnar, peroneal

28
Q

what can be used on patients that are hypoglycemic

A

glucose pen or sugar tablets
- make sure to always have orange juice, milk or candy available for these patients

29
Q

DPN cardiovascular affects

A

tachycardia
exercise intolerance
orthostatic hypotension
dizziness

30
Q

DPN gastrointestinal affects

A

esophageal motility dysfunction
diarrhea
constipation

31
Q

DPN genitourinary affects

A

neurogenic bladder
bladder urgency/incontinence
erectile dysfunction

32
Q

other affects DPN can have

A

sweating/heating intolerance
dry skin
pupillary dysfunction, blurred vision

33
Q

how to diagnose DPN

A

at least 2 abnormalities from NCV and sensory tests
- 128 Hz tuning fork for vibration
- 1-g monofilament
- BP and HR response at rest, standing and with exercise

history, blood tests (HbA1C)
sensory testing: vibratory testing, monofilament testing, temperature, sharp/dull sensation

34
Q

what is often the first sign of DPN during PT exam

A

loss of vibration

35
Q

etiology of DPN

A
  • high blood sugar (glucose): chemical changes in Ns - impairs nerve ability to transmit signals
  • metabolic factors: high triglycerids and cholesterol (obesity increases risk of development)
  • inherited factors
36
Q

treatment DPN

A
  • control blood sugar (single most important factor)
  • medications (to control blood sugar, to control pain, improve vascular dysfunction)
  • pt education
  • exercise and active lifestyle
37
Q

what type of medication can be used to improve vascular dysfunction

A

ACE inhibitors - BP medications to improve peripheral blood flow

38
Q

retinopathy

A

affects eyes

39
Q

nephropathy

A

affects kidneys

40
Q

vestibular neuropathy

A

affecting CN 8 –> can lead to subclinical changes in vestibular system

41
Q

what types of impairments would you expect to see during PT exam for DPN

A

sensory impairment
visual impairment
vestibular impairment (VOR and VSR)

42
Q

aerobic exercise prescription for type 2 DM

A
  • 3-7 days/week
  • at least 150 minutes/week at mod to vigorous
  • greater benefits > 300 minutes/week
  • no more than 2 consecutive days without aerobic exercise (improve insulin sensitivity)
43
Q

strength training prescription for type 2 DM

A
  • > 2 days/week (not consecutive)
  • major muscle groups
  • mod to vigorous intensity
  • 8-10 exercises
  • > 1 set of 10-15 reps
44
Q

flexibility prescription for type 2 DM

A

> 2 days/week
at least 10 minutes/day

45
Q

balance training for type 2 DM

A

treat if at risk for falls

46
Q

moderate exercise RPE

A

5-6/10

47
Q

vigorous exercise RPE

A

7-8/10

48
Q

strength dosing

A

60-70% 1 rep max

49
Q

when should screening for DPN be done for type 1 vs 2

A
  • screen immediately after T2D diagnosis
  • or 5 years after T1D diagnosis
  • with screenings every year with endocrinologist
50
Q

optimized glycemic control most common for which type of DM

A

type 1

PT 680 Clinical Medicine (18 decks)

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