Diabetic Proximal Neuropathy
Diabetic proximal neuropathy or femoral neurophagy, diabetic amytrophy, or lumbosacral radioplexus is a nerve disorder that is a complication of diabetes mellitus. This disorder affects the buttocks, thighs, hips and legs. Proximal diabetic neuropathy is a peripheral nerve disease characterized by pain, muscle wasting and weakness. Diabetic neuropathy is common and is a complication associated with diabetes. This disorder is defined as the sensory nerve damage. There are different ways which are suggested through which diabetes will damage the nerves that allow people to feel pain. All the various ways are related to the increase in blood sugar lever over a long duration of time. Diabetic proximal neuropathy is one of the 4 types of diabetic neuropathies. Diabetic proximal neuropathy can occur in type 1 and type 2 diabetes mellitus but it is also found in type 2 diabetes patients. This is the second most common diabetic neuropathy and can be managed over time and with treatment. Signs and Symptoms of Diabetic Proximal Neuropathy Diabetic proximal neuropathy signs and symptoms will depend on the affected nerves. The first pain that is reported by most patients is the pain in the hips, buttocks, thighs and legs. This pain will mostly affect one side of the body and will either start gradually seeming mild at first and can come as a sudden occurrence. The pain is usually followed by intense weakness in the proximal muscles in the lower limb and this can lead to the patient being unable to stand from a sitting position without any assistance. This kind of weakness will start in a unilateral manner but can later spread bilaterally. Diabetic proximal neuropathy will mostly be accompanied by peripheral nerve malfunction, musclefasciculation, and small but involuntary twitches Continue reading >>
Diabetic Amyotrophy: What Is It?
After answering the question what is diabetes, you may continue to ask what diabetic amyotrophy is and get an answer that goes: it is a type of neuropathy experienced by Type 2 diabetic patients, the outcome of which is pain, weakness, etc. Obviously, your second question could be: what is neuropathy in the first place? To get the basic facts right, neuropathy is inflammation of the nerves that are outside the brain and spinal cord. Hence this condition is often called peripheral neuropathy. The inflammation could be due to injury to the nerves or a result of some metabolic disorder. Incidentally, Diabetics suffer from some form of neuropathy. Coming back to our topic of discussion, diabetic amyotrophy is a painful condition characterized by muscle wasting and weakness. It primarily affects the muscles of the thigh and pelvic girdle. The pain can also affect toes, feet, legs, hands and arms. It is also known by other names including proximal diabetic neuropathy or lumbosacral radiculoplexus neuropathy, Bruns-Garland Syndrome, etc. Diabetic Neuropathy can be of Different Types They can be classified as peripheral, autonomic, proximal, or focal, depending on the nerves damaged by diabetes. Diabetic amyotrophy is in essence peripheral neuropathy, the most common type, characterized by damage of nerves of the arms and legs. What are the Early Symptoms of Diabetic Amyotrophy? Generally affecting more Type 2 diabetic patients than Type 1, severe pain and weakness of thigh muscles along with that of hip and buttocks at night is one of the early signs. Such pain and subsequent weakness may be centralized on one side and gradually move on to the other side also. The pain could also affect the shin and feet. Other symptoms include loss of knee and ankle reflex. Other symptoms , Continue reading >>
How To Treat Muscle Loss In Diabetics
Diabetes mellitus has many symptoms, including overactive bladder, excessive thirst and hunger, weight loss, a tingling sensation in the digits, and weakened vision. Another lesser known symptom of diabetes is muscle loss. The diabetic mechanism of muscle loss is multifactorial. In other words, diabetes can contribute to muscle loss in several ways. The three main ways muscle loss may occur in diabetics includes: 1. Muscle contracture and disuse It is common for patients with diabetes to suffer from hardened muscles, or muscles that have contracted as a result of thickening soft tissue. This type of general diabetic muscle contracture can be pervasive, and makes it much harder for a patient to move or use their muscles. Movement becomes limited, and muscle disuse that leads to atrophy is the result. 2. Atherosclerosis While atherosclerosis and diabetes are not directly related, diabetes can promote atherosclerosis, or the thickening of arterial walls. This contributes to restricted blood flow, which can cause cramps, pain, or general discomfort. In severe cases, the lack of oxygenated blood to localized areas of muscle can cause infarction, or tissue death caused by restricted blood flow. Infarctions of the heart can lead to heart attacks. 3. Nerve damage Lastly, infarction can cause the death of motor and sensory neurons that are involved in muscle movement and blood supply. The death of these vital neurons can further contribute to muscle disuse and atrophy, and can lead to muscle twitching and pain. An uncomfortable type of muscle atrophy in which the muscles of the shoulders and hips waste away, known as “limb girdle wasting”, is common in diabetics and often referred to as diabetic amyotrophy. In all three cases, muscle loss occurs slowly, but is pervasive and Continue reading >>
Diabetic Proximal Neuropathy
Approved by: Krish Tangella MD, MBA, FCAP Diabetic Neuropathy is a type of nerve damage that affects individuals who have diabetes. Diabetic Proximal Neuropathy is a motor neuropathy that affects ones movement. It is the second most common kind of Diabetic Neuropathy, the most common being diabetic peripheral neuropathy. What are the other Names for this Condition? (Also known as/Synonyms) What is Diabetic Proximal Neuropathy? (Definition/Background Information) Diabetic Neuropathy is a type of nerve damage that affects individuals who have diabetes. The term neuropathy indicates nerve dysfunction causing symptoms such as weakness and loss of sensation. There are four types of Diabetes-Related Neuropathy. These include: Diabetic Proximal Neuropathy is a motor neuropathy that affects ones movement. It is the second most common kind of Diabetic Neuropathy, the most common being diabetic peripheral neuropathy. Elevated levels of blood sugar cause injury to nerve fibers throughout the body. The underlying pathology of the condition is not clearly understood The symptoms of Proximal Neuropathy due to Diabetes vary from mild to disabling, and could include sudden severe pain in the thighs, hips, buttocks and legs The condition usually affects one side of the body, but may spread to the other side as well. A weakness in the legs is also reported in Proximal Neuropathy Medication and physical therapy may help in controlling the muscle weakness or pain Who gets Diabetic Proximal Neuropathy? (Age and Sex Distribution) Individuals with non-insulin dependent diabetes mellitus (NIDDM) appear to have an earlier onset of Diabetic Proximal Neuropathy symptoms than those with insulin-dependent diabetes mellitus (IDDM) The symptoms are more prevalent in those with type-2 diabetes Preval Continue reading >>
Proximal Diabetic Neuropathy
Proximal diabetic neuropathy, more commonly known as diabetic amyotrophy, is a nerve disorder that results as a complication of diabetes mellitus. It can affect the thighs, hips, buttocks or lower legs. Proximal diabetic neuropathy is a peripheral nerve disease (diabetic neuropathy) characterized by muscle wasting or weakness, pain, or changes in sensation/numbness of the leg.[1] Diabetic neuropathy is an uncommon complication of diabetes. It is a type of lumbosacral plexopathy, or adverse condition affecting the lumbosacral plexus. There are a number of ways that diabetes damages the nerves, all of which seem to be related to increased blood sugar levels over a long period of time. Proximal diabetic neuropathy is one of four types of diabetic neuropathy.[2] Proximal diabetic neuropathy can occur in type 2 and type 1 diabetes mellitus patients however, it is most commonly found in type 2 diabetics.[3] Proximal neuropathy is the second most common type of diabetic neuropathy and can be resolved with time and treatment.[4] Signs & symptoms[edit] Signs and symptoms of proximal diabetic neuropathy depend on the region of the plexus which is affected. The first symptom is usually pain in the buttocks, hips, thighs or legs. This pain most commonly affects one side of the body and can either start gradually or come on suddenly. This is often followed by variable weakness in the proximal muscles of the lower limbs. These symptoms, although often beginning on one side, can also spread to both sides.[1] Weakness in proximal diabetic neuropathy is caused by denervation of the specific muscles innervated by regions of the plexus affected and can thus these muscles may start exhibiting fasciculations. Note that diabetic amyotrophy is a condition caused by diabetes mellitus, but sepa Continue reading >>
My Muscles Are Wasting
Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Join the community hi everyone, just wondering if any of you are in the same situation as me. i have muscles wasting in my one arm, calves and now both hands.my doc seems to clam up when i see him about it. is there anyone who has same problem. i would appreciate any feedback. I'm sorry to hear about the wasting musle in your arm, have they offered you any physio to see if they can help to stop it wasting completely. My friend has muscle waste from her Lupus and they have reffered her to see a pain physio at the Royal free, they can't stop what happened but they have given her some gentle exercise to stop it getting any worse. Ask for a second opinion or see another doctor. Tracey is right... don't allow this to be brushed off or ignored, ask to see a specialist. Two thoughts that strike me are: to ask if you are on a statin -- there can be side-effects related to muscle breakdown -- and the other is to wonder about neuropathy? I agree with the contributor if you are on statins. If you are on statins I would suggest you discuss with your GP about stopping or changing them real soon. While for many people they are a good med and don't have side effects e.g. for me, for some they do cause muscle pains and degradation and should be changed to another type or stopped. thank you for your comments, i am on statins and quite a high dose and have stopped them several times,but each time i have been put straight back on them when i have next blood test....when i next see my specialist, i think this will have to be discussed in detail and see if there is any other option...the neuropathy, well, what can i say. i have both peripheral and autonomic, . . Rob, I feel for you, I've go Continue reading >>
Muscle Wasting: Causes, Symptoms And Diagnosis
Conditions list medically reviewed by George Krucik, MD, MBA Muscle atrophy is when muscles waste away. The main reason for muscle wasting is a lack of physical activity. This can happen when a disease or injury makes it difficult or impossible for you to move an arm or leg. A symptom of atrophied muscles... Read More Muscle atrophy is when muscles waste away. The main reason for muscle wasting is a lack of physical activity. This can happen when a disease or injury makes it difficult or impossible for you to move an arm or leg. A symptom of atrophied muscles is an arm that appears smaller, but not shorter, than the other arm. You should schedule an appointment with your doctor if you think you are experiencing muscle atrophy. Your doctor will determine what treatment you need. In some cases, muscle wasting can be reversed with a proper diet, exercise, or physical therapy. One of your arms or legs is noticeably smaller than the other. You are experiencing marked weakness in one limb. You have been physically inactive for a very long time. Contact your doctor to have a complete medical examination if you believe you may have muscle atrophy or if you are unable to move normally. You may have an undiagnosed condition that requires treatment. Your doctor will be able to provide you with diet and exercise options. Unused muscles can waste away if you are not active. Even after it begins, this type of atrophy can often be reversed with exercise and improved nutrition. Muscle atrophy can also happen if you are bedridden or unable to move certain body parts due to a medical condition. Astronauts, for example, can also experience some muscle atrophy after a few days of weightlessness. lack of physical activity for an extended period of time alcohol-associated myopathy, a pain a Continue reading >>
Can Diabetic Neuropathy Be Reversed?
Diabetic neuropathy refers to nerve damage caused by diabetes. Neuropathy is a common condition impacting 60 to 70 percent of adults with diabetes. However, it mainly concerns those with uncontrolled blood sugar levels or those who have had diabetes for more than 25 years. The nerve damage caused by diabetic neuropathy is irreversible but there are ways to lessen symptoms and prevent further harm. Contents of this article: What is diabetic neuropathy? Diabetic neuropathy is a family of progressive nerve disorders related to type 1 and 2 diabetes. Although research is still taking place on this type of nerve damage, doctors think that blood sugars may damage nerve cells by impairing nerve fibers and reducing or confusing signaling. However, nerve damage is likely to be caused by a combination of factors, such as how the immune system functions, genetics, smoking, or alcohol use. Neuropathy can cause a range of symptoms, including pain, loss of sensation, numbness, tingling, and muscle weakness. Although neuropathy can occur wherever there are nerves, it tends to affect the legs and feet. Those with diabetic neuropathy tend to: have poor blood sugar control be over the age of 40 be overweight or obese have had diabetes for at least 10 to 25 years, depending on the severity Types Diabetic neuropathy is typically divided into four categories depending on which nerves are affected. Peripheral neuropathy Nerve damage that impacts the ability of the peripheral nerves to sense things, such as temperature and touch. Peripheral neuropathy most commonly affects the arms, hands, legs, feet, and toes, often causing pain or loss of feeling. It is the most common form of diabetic neuropathy. Proximal neuropathy Nerve damage resulting in pain in the hips, thighs, pelvis, and buttocks. Continue reading >>
Muscle Weakness
A Progressive Late Complication in Diabetic Distal Symmetric Polyneuropathy Abstract The aim of the study was to determine the progression of muscle weakness in long-term diabetes and its relation to the neuropathic condition. Thirty patients were recruited from a cohort of 92 diabetic patients who participated in a study on muscular function 6–8 years earlier. Nine subjects were nonneuropathic, 9 had asymptomatic neuropathy, and 12 had symptomatic neuropathy. Thirty matched control subjects who participated in the initial studies were also included. At follow-up, isokinetic dynamometry at the ankle, electrophysiological studies, vibratory perception thresholds, and clinical examination (neuropathy symptom score and neurological disability score [NDS]) were repeated. The annual decline of strength at the ankle was 0.7 ± 1.7% in control subjects, 0.9 ± 1.9% in nonneuropathic patients, 0.7 ± 3.1% in asymptomatic neuropathic patients, and 3.2 ± 2.3% in symptomatic neuropathic patients. In the symptomatic patients, the decline of muscle strength at the ankle was significant when compared with matched control subjects (P = 0.002) and with the other diabetic groups (P = 0.023). Also, the annual decline of muscle strength at the ankle was related to the combined score of all measures of neuropathy (r = −0.42, P = 0.03) and to the NDS (r = −0.52, P = 0.01). In patients with symptomatic diabetic neuropathy, weakness of ankle plantar and dorsal flexors is progressive and related to the severity of neuropathy. Diabetic polyneuropathy presents with sensory disturbances. Later on, motor disturbances can occur in more severe conditions, leading to distal weakness and atrophy of the muscles of the lower leg and foot. Accordingly, inability to walk on heels is used to identif Continue reading >>
Proximal Muscle Wasting In A 55 Year Old Diabetic Male Patient With Diabetic Lumbosacral Radiculoplexoneuropathy. He Had Severe Pain And Weight Loss For Three Months.
... duration, symptoms are aggravated at night, and manifest more in feet than hands. Sometimes acute DN pain is associated with weight loss and depression and has been termed as diabetic neuropathic cachexia. 12 This syndrome commonly occurs in men, and can occur at any time in the course of both type I and type II diabetes. It is self limiting and responds to symptomatic treatment. In these patients amyloidosis, heavy metal toxicity, Fabrys disease, and HIV should be excluded. Chronic painful DN refers to painful neuropathy occurring over more than six months. These patients may develop tolerance to drugs and even get addicted. Neuropathy can develop even before the onset of clinically diagnosable diabetes mellitus, which is known as impaired glucose tolerance neuropathy. Symptoms, electrodiagnostic studies, and reduced nerve fibre density are consistent with small fibre neuropathy although the changes are less prominent compared with their florid diabetic counterparts. 13 The patients with undiagnosed painful neuropathies therefore should undergo a glucose tolerance test. 14 In patients with newly diagnosed diabetes, intermittent pain and paresthesia in distal lower limbs may suggest hyperglycaemic neuropathy, which improve as the hyperglycaemia is controlled. In DN, sensory loss renders the patient vulnerable to foot injuries, ulcers, and foot destruction. Foot care therefore is integral part of DN management. Diabetic autonomic neuropathy affects various organs of the body resulting in cardiovascular, gastrointestinal, urinary, sweating, pupils, and metabolic disturbances. Because of diversity of symptoms, autonomic DN often goes unnoticed by both the patient and the physician. Autonomic nerve involvement can occur as early as one year after the diagnosis of DM. D Continue reading >>
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Diabetic Lumbosacral Plexopathy
Author: Divakara Kedlaya, MBBS; Chief Editor: Milton J Klein, DO, MBA more... Proximal neuropathy in diabetes mellitus (DM) is a condition in which patients develop severe aching or burning and lancinating pain in the hip and thigh. This is followed by weakness and wasting of the thigh muscles, which often occur asymmetrically. This disabling condition occurs in type 1 and type 2 DM. Bruns first described the disorder in patients with DM in 1890. [ 1 ] In 1955, Garland coined the term diabetic amyotrophy, although the name Bruns-Garland syndrome is also used to describe the condition. [ 2 , 3 , 4 ] Diabetic amyotrophy, which is distinct from other types of diabetic neuropathy, usually has its onset during or after middle age (although it can occur in younger individuals). Concomitant distal, predominantly sensory neuropathy may exist. The results of most electrodiagnostic studies are consistent with the presence of a neurogenic lesion that could be associated with lumbosacral plexopathy, radiculopathy, or proximal crural neuropathy. [ 5 , 6 , 7 , 8 ] However, the exact cause of diabetic lumbosacral plexopathy is not known. [ 9 ] If, as often occurs, the pathology of lumbosacral plexopathyinvolves not only the plexus but also the root and nerve levels, thedisorder is called lumbosacral radiculoplexus neuropathy. [ 10 ] For more information, see Type 1 Diabetes Mellitus , Type 2 Diabetes Mellitus , Diabetic Neuropathy , and Electrophysiology . In evaluating suspected diabetic lumbosacral plexopathy, neural and electrophysiologic studies are generally helpful. Laboratory tests used to diagnose or assess control of diabetes mellitus (eg, fasting blood glucose, hemoglobin A1C) should be performed. In addition, lumbar puncture results may show elevated cerebrospinal fluid (C Continue reading >>
Diabetic Proximal Neuropathy: Getting At The Root Of The Problemnew Insights Into Diagnosis And Treatment
Diabetic proximal neuropathy is among the most unusual and disabling forms of peripheral neuropathy, causing major suffering among affected individuals. Alternately referred to as lumbosacral radiculoplexus neuropathy, femoral neuropathy, diabetic neuropathic cachexia, or diabetic amyotrophy, the condition is characterized by severe, typically asymmetric leg pain and weakness, predominantly proximal to the muscles around the hip and knee. Although monophasic, diabetic proximal neuropathy is associated with prolonged morbidity due to relentless pain and focal weakness, according to Anthony J. Windebank, MD, Professor of Neurology at the Mayo Clinic College of Medicine in Rochester, MN. Because patients usually improve with time, physicians may underappreciate their pain and suffering. At the peak of their illness, patients are typically confined to a wheelchair and even if mobile, unable to work. Even after recovery, most are left with residual weakness. Complicating the situation, experts told Neurology Today, is that the symptoms often mimic those of other, more common illnesses, which can result in misdiagnosis and unnecessary, inappropriate treatments. Despite numerous studies, the underlying pathogenesis of diabetic proximal neuropathy is still not clearly understood. But research done in the last few years is providing new insights into its natural history, diagnosis, and treatment. Diabetic proximal neuropathy often begins so abruptly that patients can recall the exact day the symptoms began, Dr. Windebank said. The disease develops acutely, reaches a plateau, and gradually improves over time. The initial pain can be sharp or lancinating, or deep or burning, said P. James B. Dyck, MD, Consultant of Neurology and Co-Director of the Peripheral Nerve Laboratory at t Continue reading >>
Diabetic Proximal Neuropathy, The Muscle Wasting From Diabetes
Diabetic proximal neuropathy, or amyotrophy, is the muscle weakness and wasting caused by years of high blood sugar. But you can prevent and even reverse it. Diabetic proximal neuropathy is only one of the diabetic neuropathies. Like all the others it is the result of long-term high blood sugar. It is not as well known as the numbness and tingling of fingers and toes that nearly every type 2 diabetic deals with from the beginning of diabetes. That's because not everyone with type 2 diabetes has the symptoms of muscle wasting and weakness of diabetic proximal neuropathy. Also called diabetic amyotrophy (myo- for muscles and -trophy for breaking down), this neuropathy arrives after years and years of too much glucose in your blood. Diabetic peripheral neuropathy starts with pain in the muscles of your thighs, hips, buttocks or legs. In rare cases it also affects your shoulders, too. But wherever it shows up, the pain is usually on only one side, or on one side more than the other. If the cause of the muscle wasting is diabetic nerve disease, it is always in older adults who have had diabetes for a while. Type 2 diabetes has been damaging the blood vessels that supply nerves with oxygen, destroying the nerve pathways slowly over time. The effect is weakness in your legs. You cannot stand up from a chair without help. Your knee and ankle reflexes become weaker and disappear. That's one reason doctors check your reflexes at each physical. They gently tap your knee and ankle joints with a small hammer as they measure your responses. If diabetic proximal neuropathy continues the result is quadriparesis, the medical term for extreme weakness in the arms and legs. That's why it is called muscle wasting. There are other causes for muscle wasting that need to be ruled out, such as Continue reading >>
Excessive Loss Of Skeletal Muscle Mass In Older Adults With Type 2 Diabetes
Go to: Abstract A loss of skeletal muscle mass is frequently observed in older adults. The aim of the study was to investigate the impact of type 2 diabetes on the changes in body composition, with particular interest in the skeletal muscle mass. We examined total body composition with dual-energy X-ray absorptiometry annually for 6 years in 2,675 older adults. We also measured mid-thigh muscle cross-sectional area (CSA) with computed tomography in year 1 and year 6. At baseline, 75-g oral glucose challenge tests were performed. Diagnosed diabetes (n = 402, 15.0%) was identified by self-report or use of hypoglycemic agents. Undiagnosed diabetes (n = 226, 8.4%) was defined by fasting plasma glucose (≥7 mmol/l) or 2-h postchallenge plasma glucose (≥11.1 mmol/l). Longitudinal regression models were fit to examine the effect of diabetes on the changes in body composition variables. Older adults with either diagnosed or undiagnosed type 2 diabetes showed excessive loss of appendicular lean mass and trunk fat mass compared with nondiabetic subjects. Thigh muscle CSA declined two times faster in older women with diabetes than their nondiabetic counterparts. These findings remained significant after adjusting for age, sex, race, clinic site, baseline BMI, weight change intention, and actual weight changes over time. Type 2 diabetes is associated with excessive loss of skeletal muscle and trunk fat mass in community-dwelling older adults. Older women with type 2 diabetes are at especially high risk for loss of skeletal muscle mass. Longitudinal changes in thigh muscle CSA (cm2) by baseline diabetes status in the Health ABC Study, stratified by sex Without diabetes Undiagnosed diabetes Diagnosed diabetes P n 1,290 125 214 Men Model 1 −13.0 ± 0.8 −17.6 ± 2.2 −14.0 ± 1 Continue reading >>
Why Do Injections Cause Atrophy?
I am 80 years old and have used insulin for 48 years. For years, I used my thighs as an injection site and noticed that the fat on the inside of my right thigh began to atrophy. I am fairly trim, only 5 pounds over my high school weight.Now I inject into my "love handles." The atrophy continues to the point that I can see my femoral artery and several large veins. My muscle function is not adversely affected. Why does this happen? What can I do about it? John R. Ring, Dallas, Texas Injecting insulin has been associated both with loss of fat tissue and with fat growth. A loss of fat tissue under the skin is known as lipoatrophy or lipodystrophy. In extreme cases, this can cause muscle tissues and bones to be more visible. Some people may be more prone to such fat loss than others. Lipoatrophy is uncommon and can often be a sign of an insulin allergy. You should contact your health care provider right away to see whether a change in the type of insulin you use is needed. Growth of fat tissue, or fat hypertrophy, is very common. It may appear as lumps, or cyst-like formations under the skin where insulin has been injected. Both fat loss and fat growth may be caused by repeated injections in the same areas. Growth of fat tissue because of repeated injections can be prevented or reduced by regular rotation of injection sites. The most commonly recommended sites are the middle abdominal area just above the belt line, avoiding an area 2 inches from the belly button, and the upper thigh. Loss of fat tissue may be a sign of insulin allergy and should be discussed with your care provider as soon as possible. Continue reading >>
