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Diabetic Sensory Neuropathy

Neuropathy

Neuropathy

Damage to nerves. In people with diabetes, neuropathy is generally caused by high blood sugar levels, but there are other possible causes of neuropathy, such as a B vitamin deficiency, injury, some drugs, and cancer. Excess glucose from the blood can infiltrate the nerves, interfering with their function by disrupting the electrical impulses they carry. Depending on which nerves are affected, neuropathy takes two main forms: sensory neuropathy and autonomic neuropathy. Sensory neuropathy affects the sensory nerves, the nerves responsible for sensation throughout the body. It most commonly affects the feet, legs, hands, and arms. The symptoms may include numbness or a loss of sensation, coldness, tingling, burning, and extreme sensitivity to touch. Sensory neuropathy, especially in the feet, can cause people to be unaware of an injury, which, in conjunction with poor wound healing, can set the stage for a foot ulcer. Autonomic neuropathy affects the nerves that control the involuntary functions of the internal organs. Depending on the exact nerves affected, autonomic neuropathy can cause the following problems: When it affects the cardiovascular system, autonomic neuropathy can cause heart attack, rapid heartbeat at rest (when you are sitting or lying down), very high blood pressure during exercise, and a condition called orthostatic hypotension. (Orthostatic hypotension is caused by damage to the nerves that control contraction of the blood vessels. It is characterized by a drop in blood pressure when a person stands up or sits up from a lying position, causing weakness or dizziness.) Autonomic neuropathy can also cause the nerves to the heart to fail to speed up or slow down the heart rate in response to exercise. When the nerves controlling the stomach are affected, a Continue reading >>

Peripheral Neuropathy And Diabetes

Peripheral Neuropathy And Diabetes

Peripheral neuropathy is nerve damage caused by chronically high blood sugar and diabetes. It leads to numbness, loss of sensation, and sometimes pain in your feet, legs, or hands. It is the most common complication of diabetes. About 60% to 70% of all people with diabetes will eventually develop peripheral neuropathy, although not all suffer pain. Yet this nerve damage is not inevitable. Studies have shown that people with diabetes can reduce their risk of developing nerve damage by keeping their blood sugar levels as close to normal as possible. What causes peripheral neuropathy? Chronically high blood sugar levels damage nerves not only in your extremities but also in other parts of your body. These damaged nerves cannot effectively carry messages between the brain and other parts of the body. This means you may not feel heat, cold, or pain in your feet, legs, or hands. If you get a cut or sore on your foot, you may not know it, which is why it's so important to inspect your feet daily. If a shoe doesn't fit properly, you could even develop a foot ulcer and not know it. The consequences can be life-threatening. An infection that won't heal because of poor blood flow causes risk for developing ulcers and can lead to amputation, even death. This nerve damage shows itself differently in each person. Some people feel tingling, then later feel pain. Other people lose the feeling in fingers and toes; they have numbness. These changes happen slowly over a period of years, so you might not even notice it. Because the changes are subtle and happen as people get older, people tend to ignore the signs of nerve damage, thinking it's just part of getting older. But there are treatments that can help slow the progression of this condition and limit the damage. Talk to your doctors Continue reading >>

Nerve Damage (diabetic Neuropathies)

Nerve Damage (diabetic Neuropathies)

What are diabetic neuropathies? Diabetic neuropathies are a family of nerve disorders caused by diabetes. People with diabetes can, over time, develop nerve damage throughout the body. Some people with nerve damage have no symptoms. Others may have symptoms such as pain, tingling, or numbness—loss of feeling—in the hands, arms, feet, and legs. Nerve problems can occur in every organ system, including the digestive tract, heart, and sex organs. About 60 to 70 percent of people with diabetes have some form of neuropathy. People with diabetes can develop nerve problems at any time, but risk rises with age and longer duration of diabetes. The highest rates of neuropathy are among people who have had diabetes for at least 25 years. Diabetic neuropathies also appear to be more common in people who have problems controlling their blood glucose, also called blood sugar, as well as those with high levels of blood fat and blood pressure and those who are overweight. What causes diabetic neuropathies? The causes are probably different for different types of diabetic neuropathy. Researchers are studying how prolonged exposure to high blood glucose causes nerve damage. Nerve damage is likely due to a combination of factors: metabolic factors, such as high blood glucose, long duration of diabetes, abnormal blood fat levels, and possibly low levels of insulin neurovascular factors, leading to damage to the blood vessels that carry oxygen and nutrients to nerves autoimmune factors that cause inflammation in nerves mechanical injury to nerves, such as carpal tunnel syndrome inherited traits that increase susceptibility to nerve disease lifestyle factors, such as smoking or alcohol use What are the symptoms of diabetic neuropathies? Symptoms depend on the type of neuropathy and which Continue reading >>

Diabetic Neuropathy: Practice Essentials, Background, Anatomy

Diabetic Neuropathy: Practice Essentials, Background, Anatomy

Author: Dianna Quan, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP more... Diabetic neuropathy is the most common complication of diabetes mellitus (DM), affecting as many as 50% of patients with type 1 and type 2 DM. Diabetic peripheral neuropathy involves the presence of symptoms or signs of peripheral nerve dysfunction in people with diabetes after other possible causes have been excluded. [ 1 ] In type 1 DM, distal polyneuropathy typically becomes symptomatic after many years of chronic prolonged hyperglycemia, whereas in type 2, it may be apparent after only a few years of known poor glycemic control or even at diagnosis. Symptoms include the following: Sensory Negative or positive, diffuse or focal; usually insidious in onset and showing a stocking-and-glove distribution in the distal extremities Motor Distal, proximal, or more focal weakness, sometimes occurring along with sensory neuropathy (sensorimotor neuropathy) Autonomic Neuropathy that may involve the cardiovascular, gastrointestinal, and genitourinary systems and the sweat glands Physical examination should include the following assessments: Peripheral neuropathy testing Gross light touch and pinprick sensation; vibratory sense; deep tendon reflexes; strength testing and muscle atrophy; dorsal pedal and posterior tibial pulses; skin assessment; Tinel testing; cranial nerve testing Autonomic neuropathy testing Objective evaluation of cardiovagal, adrenergic, and sudomotor function in a specialized autonomic laboratory; may be preceded by bedside screening to assess supine and upright blood pressure and heart rate, with measurement of sinus arrhythmia ratio Two classification systems for diabetic neuropathy are the Thomas system and the symmetrical-versus-asymmetrical system. The Thomas system (modified Continue reading >>

Sensory Neuropathy - Symptoms, Dysesthesia, Treatment & Complications

Sensory Neuropathy - Symptoms, Dysesthesia, Treatment & Complications

Sensory neuropathy can affect the hands, feet, legs and arms Sensory neuropathy occurs if the body's sensory nerves become damaged. People with diabetes have an increased risk of neuropathy as high blood glucose levels over long periods of time can damage the nerves. Sensory neuropathy may also be called polyneuropathy as it affects a number of different nerve centres. Sensory neuropathy starts from the extremities of the body such as the feet or hands and can develop to affect the legs and arms. The symptoms of sensory neuropathy will be present at the part of your body where the nerves are affected: Reduced ability to sense pain or extreme temperatures Sharp stabbing pains which may be noticeable at night People with sensory neuropathy may experience dysesthesia, which translates as abnormal sensation. Extremely sensitive skin to the extent where clothes and bedding can cause intense pain People with diabetes experiencing sensory should aim to keep their blood glucose levels under tight control to help prevent neuropathy from developing. People with diabetes experiencing neuropathic pain may first be prescribed an oral painkiller called duloxetine . Alternatives to duloxetine include amitriptyline and pregabalin . People who do not respond to the aforementioned treatments may be prescribed tramadol . A further alternative is to use topical lidocaine which is a local anaesthetic that may be prescribed as a cream, gel or spray. People with sensory neuropathy will typically have difficulty sensing causes of pain and heat which can result in unnoticed injury being sustained. Partly because the feet are less easy to see than the hands, the feet are particularly vulnerable to damage going unnoticed in people with neuropathy and developing into a serious health risk. Cuts, Continue reading >>

National Coverage Determination (ncd) For Services Provided For The Diagnosis And Treatment Of Diabetic Sensory Neuropathy With Loss Of Protective Sensation (aka Diabetic Peripheral Neuropathy) (70.2.1)

National Coverage Determination (ncd) For Services Provided For The Diagnosis And Treatment Of Diabetic Sensory Neuropathy With Loss Of Protective Sensation (aka Diabetic Peripheral Neuropathy) (70.2.1)

National Coverage Determination (NCD) for Services Provided for the Diagnosis and Treatment of Diabetic Sensory Neuropathy with Loss of Protective Sensation (aka Diabetic Peripheral Neuropathy) (70.2.1) Select the Print Complete Record, Add to Basket or Email Record Buttons to print the record, to add it to your basket or to email the record. Expand All All sections on the page are Expanded Collapse All All sections on the page are Collapsed Services Provided for the Diagnosis and Treatment of Diabetic Sensory Neuropathy with Loss of Protective Sensation (aka Diabetic Peripheral Neuropathy) Please Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service. Presently, peripheral neuropathy, or diabetic sensory neuropathy, is the most common factor leading to amputation in people with diabetes. In diabetes, sensory neuropathy is an anatomically diffuse process primarily affecting sensory and autonomic fibers; however, distal motor findings may be present in advanced cases. Long nerves are affected first, with symptoms typically beginning insidiously in the toes and then advancing proximally. This leads to loss of protective sensation (LOPS), whereby a person is unable to feel minor trauma from mechanical, thermal, or chemical sources. When foot lesions are present, the reduction in autonomic nerve functions may also inhibit wound healing. Diabetic sensory neuropathy with LOPS is a localized illness of the feet and falls within the regulation's exception to the general exclusionary rule (see 42CFR411.15(l)(1)(i)). Foot exams for people with diabetic sensory neuropathy with LOPS are reasonable and necessary to allow for early intervention in serious complications that typically afflict diabetics with the disease. Effecti Continue reading >>

Diabetic Neuropathy (nerve Damage) - An Update

Diabetic Neuropathy (nerve Damage) - An Update

Nerve damage or diabetic neuropathy resulting from chronically high blood glucose can be one of the most frustrating and debilitating complications of diabetes because of the pain, discomfort and disability it can cause, and because available treatments are not uniformly successful. Some patients find some relief from this nerve damage or neuropathy by keeping blood sugars as closely controlled as possible, getting regular exercise and keeping their weight under control. Using non-narcotic pain relievers consistently throughout the day—rather than waiting until nighttime when symptoms can become more severe—also seems to help if pain is the major symptom. Surprisingly, clinicians have also found that certain antidepressants may be helpful and can take the edge off the pain of neuropathy. Although pain or numbness in the legs or feet may be the most common complaint from people diagnosed with neuropathy, it is not the only symptom of this complication. Neuropathy can cause a host of different types of symptoms, depending on whether nerves in the legs, gastrointestinal tract, or elsewhere in the body are affected. If you have any of these symptoms, neuropathy may be the culprit: inability to adequately empty the bladder of its contents, resulting in frequent infections; nausea, vomiting, abdominal fullness or bloating, diarrhea, or constipation; low blood pressure upon standing that causes fainting or dizziness; inability to lift the foot or new deformities of the foot, or foot ulcers; trouble achieving or maintaining an erection. Although physicians have found some medications and other treatments that help ease these symptoms in some people, prevention continues to be the key. "Hemoglobin A1C readings should ideally be at 7.0% or lower. Those that are consistently n Continue reading >>

Treatment Of Diabetic Sensory Polyneuropathy

Treatment Of Diabetic Sensory Polyneuropathy

Treatment of Diabetic Sensory Polyneuropathy Lindsay Zilliox: [email protected] * Address: Department of Neurology, University of Maryland, School of Medicine, 3S-129, 110 South Paca Street, Baltimore, MD 21201-1595, USA, [email protected] The publisher's final edited version of this article is available at Curr Treat Options Neurol See other articles in PMC that cite the published article. No current disease-modifying treatments have been shown definitively in randomized clinical trials to reduce or reverse diabetic sensory polyneuropathy (DSP). It is increasingly recognized that individuals with prediabetes or impaired glucose regulation can already have a small-fiber neuropathy, or mild DSP, in which sensory axons of both small and larger diameter are damaged. Small-fiber neuropathy is frequently associated with pain, and these patients may present to a neurologist for evaluation before the underlying glucose dysregulation has been diagnosed. It is important to identify these individuals, because aggressive diabetic control and lifestyle interventions can delay the onset of diabetes and may reverse small-fiber neuropathy associated with early diabetes mellitus. Although treatment currently focuses on pain associated with DSP, attention should be paid to potential risk factors for neuropathy. For example, glycemic control and hyperlipidemia should be improved with diet, exercise, and medications. Hypertension that is a risk marker for more severe neuropathy should be treated. Angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers not only treat hypertension but also may directly reduce the progression of neuropathy. Class I or II clinical studies support the use of sodium valproate, pregabalin, duloxetine, amitriptyline, gabapenti Continue reading >>

Diabetic Neuropathy

Diabetic Neuropathy

Disorders of peripheral nerves are among the most frequent neurological complications of diabetes. The number of patients with diabetic neuropathy worldwide is increasing along with the prevalence of diabetes itself. Diabetes can affect peripheral sensory and motor nerves, thoracic nerves, cranial nerves or autonomic nerves. Diabetic neuropathy can manifest itself in multiple ways. It can affect multiple sensory and motor nerves in distal parts of the limbs (diabetic polyneuropathy) or affect one nerve at a time (diabetic mononeuropathy). It can also primarily affect the autonomic nerves and cause diabetic autonomic neuropathy. Symptoms The symptoms of diabetic neuropathy depend on the type of neuropathy. In diabetic polyneuropathy, the patients may experience unusual sensations (paresthesias), numbness and pain in their hands and feet. In addition there may be weakness of the muscles in the feet and hands. In diabetic mononeuropathy, the symptoms depend on which nerve is affected. For example it can affect thoracic nerves and cause numbness and pain in the chest wall or it can affect cranial nerves and cause sensory or motor deficits in the face. In diabetic autonomic neuropathy, the patients may experience persistent nausea, vomiting, diarrhea, constipation, incontinence, sweating abnormalities or sexual dysfunction. Diagnosis Diagnosis of diabetic neuropathies is based on history, clinical examination and supporting laboratory investigations. These include electromyography with nerve conduction studies, skin biopsies to evaluate cutaneous nerve innervation, and nerve and muscle biopsies for histopathological evaluation. Treatment Treatment of diabetic neuropathies depends on optimum diabetic control, exercise and weight loss to reduce insulin resistance, and symptoma Continue reading >>

Quantitative Sensory Testing And Risk Factors Of Diabetic Sensory Neuropathy

Quantitative Sensory Testing And Risk Factors Of Diabetic Sensory Neuropathy

The goal of this study was to identify risk factors for diabetic peripheral sensory neuropathy in type 2 diabetes mellitus in a Chinese population. Peripheral sensory neuropathy was detected by quantitative sensory testing (5.07/10 g monofilament, neurometer and 128-Hz Riedel Seiffert graduated tuning fork). Those who had two or more abnormal quantitative sensory testings were defined as having diabetic sensory neuropathy. Of the 558 non-insulin dependent diabetes mellitits subjects, 62 (11.1%) had peripheral neuropathy. In 59 (10.6%) detection was by monofilament testing, 45 (8.1%) by graduated tuning fork, and 189 (33.9%) by neurometer. In a multivariate logistic regression model, age and insulin therapy were significantly associated with peripheral neuropathy. Age, serum triglyceride, height, and fasting plasma glucose were independently associated with large fiber neuropathy. Our results confirm the previously identifed multiple risk factors of diabetic neuropathy. Different quantitative sensory testings detect different nerve fiber defects. The weak correlation between these tests indicates the need to use more than one test in screening for diabetic neuropathy. Key words Quantitative sensory testingDiabetic neuropathy Received: 2 June 1998 Received in revised form: 23 September 1998 Accepted: 10 October 1998 This is a preview of subscription content, log in to check access. Continue reading >>

Diabetic Neuropathy

Diabetic Neuropathy

Print Overview Diabetic neuropathy is a type of nerve damage that can occur if you have diabetes. High blood sugar (glucose) can injure nerve fibers throughout your body, but diabetic neuropathy most often damages nerves in your legs and feet. Depending on the affected nerves, symptoms of diabetic neuropathy can range from pain and numbness in your extremities to problems with your digestive system, urinary tract, blood vessels and heart. For some people, these symptoms are mild; for others, diabetic neuropathy can be painful, disabling and even fatal. Diabetic neuropathy is a common serious complication of diabetes. Yet you can often prevent diabetic neuropathy or slow its progress with tight blood sugar control and a healthy lifestyle. Symptoms There are four main types of diabetic neuropathy. You may have just one type or symptoms of several types. Most develop gradually, and you may not notice problems until considerable damage has occurred. The signs and symptoms of diabetic neuropathy vary, depending on the type of neuropathy and which nerves are affected. Peripheral neuropathy Peripheral neuropathy is the most common form of diabetic neuropathy. Your feet and legs are often affected first, followed by your hands and arms. Signs and symptoms of peripheral neuropathy are often worse at night, and may include: Numbness or reduced ability to feel pain or temperature changes A tingling or burning sensation Sharp pains or cramps Increased sensitivity to touch — for some people, even the weight of a bed sheet can be agonizing Muscle weakness Loss of reflexes, especially in the ankle Loss of balance and coordination Serious foot problems, such as ulcers, infections, deformities, and bone and joint pain Autonomic neuropathy The autonomic nervous system controls your hea Continue reading >>

Diabetic Neuropathy

Diabetic Neuropathy

Diabetic neuropathies are nerve damaging disorders associated with diabetes mellitus. These conditions are thought to result from a diabetic microvascular injury involving small blood vessels that supply nerves (vasa nervorum) in addition to macrovascular conditions that can accumulate in diabetic neuropathy. Relatively common conditions which may be associated with diabetic neuropathy include third, fourth, or sixth cranial nerve palsy[1]; mononeuropathy; mononeuropathy multiplex; diabetic amyotrophy; a painful polyneuropathy; autonomic neuropathy; and thoracoabdominal neuropathy. Signs and symptoms[edit] Illustration depicting areas affected by diabetic neuropathy Diabetic neuropathy affects all peripheral nerves including sensory neurons, motor neurons, but rarely affects the autonomic nervous system. Therefore, diabetic neuropathy can affect all organs and systems, as all are innervated. There are several distinct syndromes based on the organ systems and members affected, but these are by no means exclusive. A patient can have sensorimotor and autonomic neuropathy or any other combination. Signs and symptoms vary depending on the nerve(s) affected and may include symptoms other than those listed. Symptoms usually develop gradually over years. Symptoms may include the following: Trouble with balance Numbness and tingling of extremities Dysesthesia (abnormal sensation to a body part) Diarrhea Erectile dysfunction Urinary incontinence (loss of bladder control) Facial, mouth and eyelid drooping Vision changes Dizziness Muscle weakness Difficulty swallowing Speech impairment Fasciculation (muscle contractions) Anorgasmia Retrograde ejaculation (in males) Burning or electric pain Pathogenesis[edit] The following factors are thought to be involved in the development of dia Continue reading >>

Diabetic Neuropathydiabetic Neuropathy Symptoms, Causes, Diagnosis, And Treatment

Diabetic Neuropathydiabetic Neuropathy Symptoms, Causes, Diagnosis, And Treatment

Diabetic neuropathy definition and facts Diabetes is thought to damage nerves as a result of prolonged elevated levels of blood glucose. Peripheral neuropathy most commonly causes: Autonomic neuropathy causes symptoms related to dysfunction of an organ system, such as: Diagnosis of diabetic neuropathy is usually done by a clinical exam. There is no cure for diabetic neuropathy, but treatments are available to manage the symptoms. Diabetic nerve pain may be controlled by medications such as tricyclic antidepressants, duloxetine (Cymbalta), or certain antiseizure medications. Keeping tight control of blood sugar levels is the best way to prevent diabetic neuropathy and other complications of diabetes. Diabetic Peripheral Neuropathy: Improve Diabetes Nerve Pain What are the symptoms and signs of diabetic neuropathy? The symptoms and signs of diabetic neuropathy depend upon the type of neuropathy that is present. Signs and symptoms can also vary in severity among affected people. Signs and symptoms of diabetic peripheral neuropathy include: Numbness or tingling of the feet and lower legs Pain or burning sensations Loss of sensation in the feet or lower legs Sometimes, but less commonly, these symptoms can occur in the hands or arms Signs and symptoms of diabetic proximal neuropathy include: Pain, usually on one side, in the hips, buttocks, or thighs Signs and symptoms of diabetic autonomic neuropathy depend upon the organ system that is involved and can include: Feeling full after eating a small amount Inability to empty the bladder completely Decrease in vaginal lubrication in women Rapid resting heartbeat Signs and symptoms of diabetic focal neuropathy also depend upon the location of the affected nerve. The symptoms can appear suddenly. It usually does not cause a long t Continue reading >>

What Is Peripheral Neuropathy?

What Is Peripheral Neuropathy?

Peripheral neuropathy refers to a problem with the peripheral nerves. These nerves send messages from the central nervous system, the brain and the spinal cord to the rest of the body. The peripheral nerves tell the body when, for example, the hands are cold. It can lead to tingling, prickling, numbness, and muscle weakness in various parts of the body. Peripheral neuropathy can affect a range of different nerves, so it can impact a variety of locations in different ways. It can affect a single nerve, or several nerves at the same time. It is also associated with a number of different underlying medical conditions. Sometimes there is no identifiable cause. It affects some 20 million people in the United States (U.S.). Here are some key points about peripheral neuropathy. More detail is in the main article. Neuropathy is a common complication of a number of different medical conditions. It can involve the autonomic nerves, the motor nerves, and the sensory nerves. Sometimes it affects a single nerve or nerve set, for example, in Bell's Palsy, which affects a facial nerve. Physical trauma, repetitive injury, infection, metabolic problems, and exposure to toxins and some drugs are all possible causes. Treatment Treatment either targets the underlying cause, or it aims to provide symptomatic pain relief and prevent further damage. In the case of diabetic neuropathy, addressing high blood sugars can prevent further nerve damage. For toxic causes, removing the exposure to a suspected toxin, or stopping a drug, can halt further nerve damage. Medications can relieve pain and reduce burning, numbness, and tingling. Drug treatment for neuropathic pain Medications that may help include: Opioid painkillers come with warnings about safety risks. Doctors can also prescribe skin patch Continue reading >>

Diabetic Neuropathy Clinical Presentation: History, Physical Examination, Classification Of Diabetic Neuropathy

Diabetic Neuropathy Clinical Presentation: History, Physical Examination, Classification Of Diabetic Neuropathy

Diabetic NeuropathyClinical Presentation Author: Dianna Quan, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP more... In type 1 diabetes mellitus , distal polyneuropathy typically becomes symptomatic after many years of chronic prolonged hyperglycemia. Conversely, patients with type 2 diabetes mellitus may present with distal polyneuropathy after only a few years of known poor glycemic control; sometimes, these patients already have neuropathy at the time of diagnosis. Since diabetic neuropathy can manifest as a wide variety of sensory, motor, and autonomic symptoms, a structured list of symptoms can be used to help screen all diabetic patients for possible neuropathy. Sensory neuropathy usually is insidious in onset and shows a stocking-and-glove distribution in the distal extremities. Sensory symptoms may be negative or positive, diffuse or focal. Negative sensory symptoms include feelings of numbness or deadness, which patients may describe as being akin to wearing gloves or socks. Loss of balance, especially with the eyes closed, and painless injuries due to loss of sensation are common. Positive symptoms may be described as burning, prickling pain, tingling, electric shocklike feelings, aching, tightness, or hypersensitivity to touch. Motor problems may include distal, proximal, or more focal weakness. In the upper extremities, distal motor symptoms may include impaired fine hand coordination and difficulty with tasks such as opening jars or turning keys. Foot slapping and toe scuffing or frequent tripping may be early symptoms of foot weakness. Symptoms of proximal limb weakness include difficulty climbing up and down stairs, difficulty getting up from a seated or supine position, falls due to the knees giving way, and difficulty raising the arms above the shoul Continue reading >>

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