Ok...i know exam is over,results are out. But i would like to share these article as a revision for one of the most important disease in Medicine, diabetes.
Diabetes can affect all 3 division of the nervous system: sensory,motor and autonomic nervous system. The most common early presentation of diabetic neuropathy will be numbness of the extremities commonly described as "gloves and socks" numbness. It is a form of peripheral neuropathy and because of that, it affects all dermatomes. Therefore, during examination of diabetic foot to look for numbness one need not test according to dermatomes. Sensation is loss for both pain and light touch and for some reason, temperature sensation is not affected. Loss of proprioception is also an early sign, however, patient often does not notice this because the dominating or main problem to the patient is often sensory loss. The patient may also complaint of gait instability. Therefore, this sign must be elicited by the examining doctor.
In the motor division, neuropathy can take 3 forms : Acute painful neuropathy, diabetic amyotrophy and mononeuropathy. Acute painful neuropathy cause burning pain in lower limbs, typically at night. In severe cases even light touch can become intolerable. It can be precipitated by drugs such as itraconazole, commonly used to treat fungal infection in diabetic patients. Diabetic amyotrophy cause painful,marked wasting of the quadriceps femoris muscle. In extreme cases it cause absent knee jerk reflex. Diabetic mononeuropathy refer to involvement of only 1 nerve. The most common mononeuropathy is the carpal tunnel syndrome. Diabetes can also affect the cranial nerves, especially cranial nerve VII and III, causing diploplia. If more than 1 nerve is affected, the condition is called mononeuritis multiplex.
Autonomic neuropathy manifest in form of postural hypotension,atonic bladder with urinary retention, diarrhea etc.In long standing uncontrolled diabetes, gastroparesis can happen leading to uncontrollable nausea and vomiting mimicking intestinal obstruction. Diabetic patient often complain of syncope, lethargy, dizziness. Note that sometimes, these signs can be a side effect of the oral hypoglycaemic agent, e.g. diarrhea may be caused by Metformin.
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One of the non-pharmaceutical approaches to reducing diabetic peripheral neuropathy is electrostimulation of the lower extremity region. At one time, NIH published a folder on PN and reviewed the various treatment methods, and estim was mentioned. Since then Univ of Texas San Antonia orthopedic/podiatry staff published a study using a home estim and conduction stocking with silver fibers for DPN. Relief of symptoms occurred with 30 days with relief continuing after termination of estim treatment by the Prizm Medical HVPC estim unit and their silver conductive stocking. Side effects with this type of therapy are much rarer than the drug therapies being used for peripheral neuropathy. Many physical therapists use estim routinely to solve various conditions, yet many physicians are unaware of how or when to order this technology due to lack of exposure to estim modalities during their training and training that focuses on pharmaceutical interventions or surgical procedures. Home estim for PN does work and side effects are rare.
Haha, never knew that I had a transcutaneous electrical stimulation unit at home till I googled what was it. Well, it was used as palliative care and pain medicine for neuropathic pain. Well, individual responses are different. Similar methods had been used in acupuncture with a a electrostimulation machine as well. It can be considered one of the physiotherapy methods, so I reckoned all we need to do is refer them to a physio instead of becoming a salesman and offer any blatant immediate treatment.
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