Diabetic neuropathy

Diagnosis

The doctor will perform a physical examination (for example checking the overall muscle strength and tone, sensitivity to touch, vibration, temperature, pain, and the tendon reflexes), comprehensive assessment of the symptoms, and study of the medical history.

The doctor may do the following tests in addition to the physical examination to properly diagnose diabetic neuropathy:

• Nerve conduction testing: evaluates the response of the arms and legs’ nerves transmit electrical signals.
• Electromyography: is also known as needle testing and is frequently combined with nerve conduction studies. It counts the electrical discharges that occur throughout your muscles.
• Filament testing: used to evaluate the sensitivity of the skin to touch by using a soft nylon fiber that is brushing over the skin.
• Sensory testing: a noninvasive test that will evaluate the responsiveness of the nerves by vibration and changes in temperature.
• Autonomic testing: tests used to evaluate the perspiration levels and how the blood pressure varies when the patient changes positions.

Treatment

There is no treatment for diabetic neuropathy but the goals of treatment for the patient with diabetes include the following:

• Prevent progression: In order to prevent nerve damage, blood sugar levels must be maintained consistently. Some of the existing symptoms could become better with good blood sugar control. The ideal range of blood sugar will be based on the patient’s age, the length of time they have had diabetes, and their general health.
• Relieve pain: Although there are numerous prescription drugs for nerve pain brought on by diabetes, not everyone experiences success with them. When choosing any medication, discuss with the doctor about the advantages and potential side effects to determine which one might be most effective for the patient. The following are medications the relieve pain.
• Anti-seizure drugs: There are certain drugs that are used to treat epilepsy that are also used to relieve nerve pain. Drowsiness, vertigo, and hand- and foot-swelling are possible side effects.
• Antidepressants: Some antidepressants can reduce nerve discomfort. The mild to severe discomfort from nerves may be relieved by tricyclic antidepressants. Dry mouth, constipation, tiredness, and difficulty concentrating are some of the side effects.
  • Another class of antidepressant that may relieve nerve pain and has less side effects are serotonin and norepinephrine reuptake inhibitors (SNRIs). Constipation, decreased appetite, drowsiness, and nausea are possible side effects.
  • A combination of an antidepressant and an anti-seizure medication is occasionally used. These medications can also be taken in conjunction with painkillers.

• Controlling complications: Different specialists may be required to care for the patient. These may include a cardiologist who can assist prevent or treat heart problem as well as a urologist who specializes in treating urinary tract issues.
  • The neuropathy-related complications will determine the course of treatment that the patient need:
  • • Digestive: Eating smaller, more frequent meals may assist to ease the minor signs and symptoms of gastroparesis. Other conditions such as diarrhea, constipation, and nausea may be relieved with dietary adjustments and medicines.
    • Urinary tract: bladder concerns can be resolved with a regular urination schedule or timed urination. Urine removal from a nerve-damaged bladder may require self-catheterization. Discuss with the doctor regarding side effects of drugs that could affect the function of the bladder.
    • Orthostatic hypotension: It is recommended that the patient practice getting up gently from sitting or lying position to standing. Overnight high blood pressure can be avoided by sleeping with the bed’s head 4–6 inches higher.
    • Sexual dysfunction: Drugs administered orally or intravenously may enhance sexual function in certain men. Devices that use mechanical vacuums may improve blood flow to the penis. Vaginal lubricants may help women.