How is diabetic neuropathy diagnosed?

Diabetic neuropathy can be diagnosed taking into account a reported symptomatology, besides the clinical history and a physical examination of the patient. During the examination, the doctor is likely to check strength, muscle tone, osteotendinous reflexes, and sensitivity to touch, temperature, and vibration. The following complementary tests are also usually carried out according to each case:

  • Electroneurography-Electromyography (ENG-EMG): this test records the conduction of the nerve impulse (to evaluate mainly the speed and amplitude of it), as well as the muscle activity.
  • Filament test: touch sensitivity can be assessed by using a soft nylon fibre known as “monofilament”.
  • Quantitative sensitivity test: this non-invasive test is used to evaluate how the nerves respond to the vibration and temperature changes.
  • Autonomic tests: in case there are symptoms and / or signs compatible with an autonomic neuropathy, your doctor may request special tests to analyse the blood pressure in different positions (for example the test of the inclined table or «tilt test») as well as a sweat test.

The American Diabetes Association advices that everybody with diabetes mellitus should perform a complete podiatric examination. This should be carried out by a physician or a specialist in that anatomical region (podiatrist), at least once a year. In addition, the doctor should check the feet of the diabetic patient in each visit to verify that there are no ulcers, cracked skin, blisters and / or irregularities in the bones and / or joints.

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Treatment for diabetic neuropathy

ND is a frequent serious complication of DM. However, its evolution can be prevented or delayed with an adequate control of the blood glucose levels and a healthy lifestyle. Nevertheless, a therapeutic treatment is not known to date yet.

Decrease the disease progression

Keeping constant levels of blood glucose may help to avoid or delay the progression of the ND and even improve some of the existing symptoms. Your doctor will determine the best target level for you according to several factors, such as age, time of evolution of the DM, your general health status and the presence of other diseases. For many diabetics, Mayo Clinic usually recommends the following blood glucose levels:

  • 80-120 mg / dL (4.4-6.7 mmol / L) for people aged ≤ 59 who do not have other diseases.
  • 100-140 mg / dL (5.6-7.8 mmol / L) for people aged ≥ 60 years or those with other intercurrent diseases, such as heart, lung and / or kidney diseases.

To help slowing down the progression of the nerve injuries, you must perform the following actions:

  • Follow the doctor’s recommendations for good foot care.
  • Keep your blood pressure under control.
  • Follow a healthy eating plan.
  • Perform regular physical activity
  • Keep a healthy weight.
  • Give up smoking.
  • Avoid alcohol.

Drugs for diabetic neuropaty

There are several drugs to relieve neuralgia, but they are not suitable for everyone. Moreover, most of these drugs have side effects that should be contrasted with the benefits they offer. There are also a number of alternative therapies, such as capsaicin cream (made with chilies), physiotherapy or acupuncture, which can help with pain relief. Doctors often use them in combination with medications, but some may be effective on their own. Treatments to relieve pain may include the following drugs:

  • Antiepileptics: although drugs such as gabapentin, pregabalin and carbamazepine are used in the treatment of epilepsy, they are also indicated in the treatment of neuropathic pain. Side effects may include sleepiness, dizziness, extremities edema, etc.
  • Antidepressants: tricyclic antidepressants, such as amitriptyline (especially this one), desipramine and imipramine, can provide relief for mild-moderate symptoms of neuropathic pain. They interfere with the nociceptive chemical processes of the brain, but can also cause side effects, such as dry mouth, sweating, weight gain, constipation, dizziness, etc. For some patients, antidepressants called “serotonin and noradrenaline reuptake inhibitors,” such as duloxetine, can relieve pain with fewer side effects. Possible side effects of the serotonin and norepinephrine reuptake inhibitors include nausea, drowsiness, dizziness, decreased appetite, constipation, etc.

More ways to treat diabetic neuropathy

In order to control complications and restore the functions of systems and devices, there are specific treatments such as the following:

  • Problems of the urinary tract: so called antispasmodics (anticholinergics). Behavioural techniques, such as urinating at certain times, and certain devices, such as pessaries (rings inserted into the vagina to prevent loss of urine), may be useful to treat loss of bladder control. The most effective can be a combination of these therapies.
  • Digestive problems: to relieve mild signs and symptoms of gastroparesis (such as indigestion, belching, nausea and / or vomiting), doctors suggest eating smaller portions more frequently, reducing saturated fats in the diet, and increase the percentage of vegetable fiber. Changes in the diet and medication can help relieve diarrhea, constipation and / or nausea.
  • Low blood pressure on standing (orthostatic hypotension): this usually improves simply taking measures related to our lifestyle, such as avoiding alcohol, drinking plenty of water and sitting or standing slowly. The doctor may advice an abdominal girdle (a compression support for the abdomen) and / or elastic compression stockings. There are many medications that, alone or in combination, can be used to treat orthostatic hypotension (e.g. fludrocortisone).
  • Sexual dysfunction: it is possible that sildenafil, tadalafil and vardenafil can improve sexual functions in some men, but these medications are not effective or safe in all patients (so their prescription should be personalised). Mechanical vacuum devices can increase blood flow to the penis. In addition, men and women (especially the latter) may feel relieved about their dyspareunia by using lubricants during intercourse.

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(This post has been written by Moisés León Ruiz, specialist in Neurology)

Bibliography:

Patient Care and Health Information. Diseases and conditions Diabetic neuropathy. Diagnosis and treatment. Mayo Foundation for Medical Education and Research [updated 24 Feb 2018; cited 25 Sep 2018]. Available at: https://www.mayoclinic.org/es-es/diseases-conditions/diabetic-neuropathy/diagnosis-treatment/drc-20371587.