Neuropathy Flashcards
How should screening take place?
Use a 10g monofilament or vibration using 128Hz tuning fork.
**can help identify asymptomatic patients
What is the only preventative measure for onset and progression?
Intensive glycemic control
What four classes are used to treat neuropathic pain?
Anticonvulsants
Antidepressants
Opioids
Topical nitrate spray
What are 5 risk factors for development of peripheral neuropathy?
High BG HIGH TG Smoking HIGH BP High BMI
What reduction in pain from baseline is considered clinically meaningful response?
30-50% reduction.
Few patients will have complete relief.
Is surgical release of distal
Lower limb nerves a recommended treatment?
No. Lack of evidence and foot and ankle surgery is risky for patient with diabetes.
When should screening start for peripheral neuropathy?
At diagnosis for type two.
Type one After 5 years diagnosis and those 5 years are past puberty
What percentage of D patients will Develop neuropathy?
In how many years?
Is this type one or two?
40-50%
10 years after diagnosis (type one OR two same)
What are the three most common manifestations of autonomic neuropathy?
Cardiovascular
Gastrointestinal
Genitourinary.
Can affect ANY part of the systems.
What percentage of pts are asymptomatic?
50%
How often should a patient with diabetes have their feet checked by a professional?
At least yearly
Should diabetics soak their feet?
No
What 2 conditions predispose a diabetic for foot ulceration?
Neuropathy and peripheral arterial disease
What test is a significant and independent predictor of future foot ulceration and possible amputation?
Loss of sensation to 10g monofilament on dorsal plantar surface.
Which characteristics are risk factors for foot ulceration?
Peripheral neuropathy Peripheral arterial disease Previous ulceration Structural deformity Limited joint mobility High A1C Microvascular complications Onchomycosis
Wound classification uses A to D and 0 to 3.
Describe
A. No infection.
B. Infection
C. Ischemia
D. Infection AND Ischemia.
- Pre or post ulcer but completely epithelialized.
- Superficial wound
- Wound penetrates to tendon or capsule.
- Wound penetrates to bone or joint
Erythema and swelling on the foot may be a sign of what? (2)
Cellulitis
Charcot foot
Management of foot ulcer should address what 5 areas:
Glycemic control Off load pressure Infection Lower extremity vascularity status Local wound care
Foot assessment by a health care provider should include assessment of:
Skin changes Structural abnormalities Skin temperature Evaluation for neuropathy and PAD Ulcerations Evidence of infection
What is the ankle brachial index used for?
Peripheral arterial assessment of thr foot
How do foot deformities happen secondary to neuropathy?
Poor circulation leads to motor neuropathy which results in weakness and wasting of muscles of foot. This can cause foot deformities such a hammer toe, Charcot, loss of arches, claw toes. Etc.
If a patient cuts their foot, how many days so you wait of “not healing” before going to dr?
3 days
What are the six risk factors for neuropathy?
Elevated glucose Elevated TG high BMI Hypertension Smoking Duration of diabetes
Is diabetes the leading cause of neuropathy in North America?
Yes
What are some signs of cardiac autonomic neuropathy?
Heart rate variability
Postural hypotension
Testing tachycardia
Measuring BP while supine and then while upright, if there is a fall of greater than 20mmHg without an appropriate increase in HR what is this a sign of?
AND how do you treat it??
Postural hypotension
caused by Cardiac autonomic neuropathy
Treat with increase of salt and fluids, reducing exacerbating drugs, compression stockings, elevate head of bed.
Meds: midodine. Flodrocortisone.
Gastrointestinal neuropathies can show up as
Gastroparesis
Constipation or diarrhea
Incontinence
Bladder dysfunction in autonomic neuropathy can show up as
Loss of sensation
Disposition to infection
Inability to empty
Autonomic neuropathy can show up as sudomotor as normalities which are;
Loss of sweating in extremities Inappropriate truncal sweating Dry skin Heat intolerance Gustatory sweating which is excessive sweating in head and neck triggered by food consumption or smell of food.
What is Charcot foot
Charcot foot is a condition causing weakening of the bones in the foot that can occur in people who have significant nerve damage (neuropathy). The bones are weakened enough to fracture, and with continued walking, the foot eventually changes shape.
How is Charcot treated?
Immobilization for months
Sometimes surgery
What specific dressings are recommended?
None. Use general wound healing principles of moist wound environment and and off loading pressure
Which test predict micro vascular complications? Which is the best indicator of CVD?? A1c 2hr PP IN OGGT FBG
All of them.
A1C.
Diet for gastroparesis
Lower fibre Cooked soft. More frequent smaller meals Chew good more Basically stuff easier to digest in smaller positions because of delayed gastric emptying
