Diabetic Neuropathy & ADA Recommendations

Around the world, millions of people battle the chronic disease diabetes.Diabetic neuropathy, which is nerve damage brought on by prolonged high blood sugar levels, is one of the most prevalent consequences of diabetes. We'll talk about diabetic neuropathy's definition, causes, types, signs and symptoms, diagnostic standards, investigation, and treatment in this blog.

Definition:

Diabetic neuropathy is a type of nerve damage that affects people with diabetes. It develops gradually and affects different parts of the body, including the legs, feet, arms, and hands. Diabetic neuropathy can cause a range of symptoms, including pain, numbness, and tingling in the affected areas.

Causes:

It is unknown what specifically causes diabetic neuropathy. However, a number of factors, including high blood sugar, high blood pressure, excessive amounts of fat and cholesterol in the blood, and inflammation, are thought to be responsible for its development.

Types:

There are four types of diabetic neuropathy:

Peripheral neuropathy: This kind of diabetic neuropathy is the most prevalent, and it primarily affects the feet and legs before moving on to the hands and arms.

Autonomic neuropathy: The nerves that regulate internal systems like the heart, digestive system, and urinary tract are impacted by this type of neuropathy.

Proximal neuropathy: Older persons are more likely to get this type of neuropathy, which affects the hips, buttocks, and thighs.

Focal neuropathy: A sudden weakness or discomfort in the affected area may result from this type of neuropathy, which targets a particular nerve or set of nerves.

Signs and Symptoms:

Depending on the kind of neuropathy and the afflicted nerves, the signs and symptoms of diabetic neuropathy can change. Typical warning signs and symptoms include:

Tingling or numbness in the arms, legs, feet, or hands

In the impacted areas, there may be pain or burning.

Weakness in the muscles and loss of coordination

Digestive issues include gas, diarrhea, and constipation

Urinary issues including incontinence or trouble urinating comfortably

Problems with sex in both men and women.

Eyesight issues include double vision or blurry vision

Diagnostic Criteria:

A physical examination, medical history, and laboratory tests are among the methods used to diagnose diabetic neuropathy. Indicators of nerve injury, such as a loss of sensation, reflexes, and muscle strength, will be sought out by the doctor. Additionally, they may request blood tests to examine renal function, cholesterol, and blood sugar levels.

Investigation:

The following investigations may be required to diagnose diabetic neuropathy:

Electromyography (EMG) and nerve conduction studies (NCS): These tests can be used to identify nerve injury since they track the electrical activity of the muscles and nerves.

Autonomic function tests: These examinations gauge how the autonomic nerve system is working and can be used to identify autonomic neuropathy.

Quantitative sensory testing (QST): This examination gauges the nerves' responsiveness to various stimuli and can identify sensory neuropathy.

Skin biopsy: In this test, a small sample of skin is taken, and it is examined under a microscope to look for signs of nerve injury.

ADA Recommendations for prevention and Management:

Recommendations for the prevention and treatment of diabetic neuropathy have been made by the American Diabetes Association (ADA). These suggestions consist of:

Glycemic control: To stop or slow the onset and progression of diabetic neuropathy, strict glycemic control must be maintained. The ADA advises most persons with diabetes to have a HbA1c goal of less than 7%.

Blood pressure control: For the majority of persons with diabetes, the ADA advises a goal blood pressure of 140/90 mmHg. Target blood pressure for people with albuminuria or renal insufficiency is advised to be less than 130/80 mmHg.

Lipid management: To lower the risk of cardiovascular disease, the ADA suggests statin medication for the majority of persons with diabetes. The desired LDL cholesterol level is 100 mg/dL or less.

Regular foot examinations: To detect any foot issues, including neuropathy, the ADA advises that people with diabetes have a thorough foot examination at least once a year.

Lifestyle modifications: To prevent or delay the start and progression of diabetic neuropathy, the American Diabetes Association (ADA) advises regular exercise, a good diet, and quitting smoking.

Pain management: The ADA advises using drugs such pregabalin, gabapentin, or duloxetine to relieve neuropathic pain brought on by diabetic neuropathy.

Screening for neuropathy: The American Diabetes Association (ADA) advises that all diabetics get a thorough neuropathy exam at the time of diagnosis and then every year after that. Ankle reflex testing, a 10-g monofilament test, and quantitative sensory testing should all be performed throughout the assessment.

It is crucial to note that these suggestions may change based on specific situations, so patients should always speak with their doctor or other qualified healthcare professional for advice on how to avoid and treat diabetic neuropathy.

Dr.Muhammad Arsalan Khan
Diabetes Specialist
MBBS, MSc (Diabetes & Endocrinology)
CCD-BMJ-AKU-RCP (London)

No comments:

Post a Comment

Rheumatic Heart Disease (RHD)

  Rheumatic Heart Disease (RHD)   Introduction: The dangerous disorder known as rheumatic heart disease (RHD), which affects the hear...