How is a diabetic neuropathy diagnosed?
The diagnosis of a diabetic neuropathy is usually made from the reported symptomatology, the clinical history and a physical examination. On 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 case5:
Electroneurography-Electromyography (ENG-EMG) (main support test): records the conduction of the nerve impulse (to evaluate mainly the speed and amplitude of it), as well as a record of 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 the sweat test.
The American Diabetes Association recommends that everybody with diabetes mellitus should perform a complete podiatric examination, 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 each visit to verify that there are no ulcers, cracked skin, blisters and / or irregularities in the bones and / or joints5.
What is the treatment of 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 lifestyle1. Nevertheless, a therapeutic treatment is not known to date. The ND treatment is symptomatic and focuses on the following points5:
Decrease the progression of the disease: it is possible that constantly maintaining the blood glucose level within the target level helps to avoid or delay the progression of the ND and may even improve some of the existing symptoms. Your doctor will determine the best objective level for you according to several factors, such as the 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. And 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 slow 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.
Alleviate pain: there are several medications used to relieve neuralgia, but they do not work for everyone, and most of these drugs have side effects that should be compared 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, edema of extremities, etc.
Antidepressants: tricyclic antidepressants, such as amitriptyline (especially this one), desipramine and imipramine, can provide relief for mild-moderate symptoms of neuropathic pain, by interfering 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 treatment of diabetic neuropathy
Control complications and restore the functions of systems and devices: there are specific treatments for many of the complications of the ND, among them are the following:
Problems of the urinary tract: antispasmodics (anticholinergic); 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 some 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 with measures related to the lifestyle, such as avoiding alcohol, drinking plenty of water and sitting or standing slowly. The doctor may recommend 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 improve sexual functions in some men, but these medications are not effective or safe in all patients (so their prescription should be individualized). 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.
Good controls and good records with Insulclock
For a good control of our diabetes is essential to have a record book in which we write down everything related to our diabetes: glucose, insulin, sports nutrition…
From Insulclock we realized the difficulty of making this continuous record both in an app and in a traditional paper diabetic diary. Incorporating this information in an automated and real way is our goal and little by little we are achieving it. You want to know more? Keep reading.
Moisés León Ruiz, specialist in Neurology
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.