FAQ’s on Diabetic Neuropathy
What is diabetic neuropathy?
Diabetes is associated with a lot of complications, particularly to the nerves and the microvasculature. Patients who suffer from chronic uncontrolled diabetes are at risk for damage to their eyes (retinopathy), their nerves (neuropathy) and their kidneys (nephropathy).
Diabetic neuropathy refers to the nerve damage that results from diabetes. The symptoms of this condition vary, depending on the affected nerves and the severity of the diabetes. It can present as a mild numbness, to tingling, or to severe debilitating pain. It is estimated that 8% of newly diagnosed diabetics will have neuropathy, and over 50% of those with long-standing disease are affected. Patients suffering from this condition typically have other co-morbid conditions, which necessitate treatment with multiple drugs.
The stages of diabetic neuropathy are as follows:
- N0 – No neuropathy
- N1 – Signs but no symptoms of neuropathy (asymptomatic)
- N2a – Mild symptoms with sensory, motor or autonomic symptoms; patient is able to walk on heels
- N2b – Symptoms are more severe; patient is unable to heel-walk
- N3 – Neuropathy is disabling
What causes diabetic neuropathy?
Diabetic neuropathy follows progressive damage from the elevated blood sugar levels of diabetes. Microvascular disease is theorized to contribute to the pathological changes in the nerves. Protein kinase C (PKC) and advanced glycated end products have also been implicated in the disease. High blood glucose has been shown to slow nerve conduction and weaken the walls of capillaries.
How is diabetic neuropathy diagnosed?
Diagnosis of this condition is made after a medical workup and complete physical examination. Your physician may also request other laboratory examinations such as fasting blood glucose, Hemoglobin A1c, and Vitamin B12 levels to confirm the diabetes, as well as to rule out other conditions. Electromyography and nerve conduction velocity tests may also be helpful in assessing the extent of damage from the neuropathy. Recently, studies have experimented with using adhesive indicator tests as a rapid screening tool for diabetic neuropathy, with promising results.
How is diabetic neuropathy treated?
Controlling the neuropathy requires control of the underlying condition of diabetes. Stable glycemic control is necessary if you want to halt the progression of the disease. This is managed with oral hypoglycemic agents such as metformin. If the patient presents with pain, then pain management is necessary. This is usually accomplished with NSAIDs, opioid-based medications, or even drugs for neuralgia. Complementary and alternative medicine treatments such as direct current stimulation and acupuncture have been shown to provide benefits to patients, although large-scale studies are still needed for further verification.
Therapy also has to address the other conditions associated with diabetic neuropathy. Studies have shown that patients with diabetic neuropathy also exhibit cognitive impairments such as difficulty multitasking. Sleep apnea has also been associated with diabetic neuropathy. Therapeutic modalities such as whole-body vibration have been shown to improve outcomes for patients with complications.
Neuropathy affecting the autonomic pathway (i.e., affecting the internal organs such as the bladder) is treated depending on the affected structures. If the urinary system is affected, the physician may start medications or recommend self-catheterization. If the symptoms are persistent, surgery may be recommended.
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Kim YJ, Ku J, Kim HJ, et al. (2013). Randomized, sham controlled trial of transcranial direct current stimulation for painful diabetic polyneuropathy. Annals of Rehabilitation Medicine. doi: 10.5535/arm.2013.37.6.766
Rucker JL, Jernigan SD, McDowd JM, Kluding PM. (2013). Adults With Diabetic Peripheral Neuropathy Exhibit Impairments in Multitasking and Other Executive Functions. Journal of Neurologic Physical Therapy. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/24384943
Tsapas A, Liakos A, Paschos P, et al. (2013). A simple plaster for screening for diabetic neuropathy: A diagnostic test accuracy systematic review and meta-analysis. Metabolism: Clinical and Experimental. doi: 10.1016/j.metabol.2013.11.019