Diagnosis

How is diabetic neuropathy diagnosed?

  • Good history and examination
  • Examine muscle strength and reflexes
  • Examine temperature and vibration
  • Filament test where we test for sensitivity using a soft nylon fiber called monofilament.
  • Nerve conducting studies – these tell us at what speed the nerve impulses are being conducted in your body.

Electromyography (EMG) measures the electrical discharges produced in the muscles.

Quantitative sensory testing – tests how your nerves respond to vibration and temperature changes
Autonomic testing – here your blood pressure is tested in various postures and your ability to sweat

  • Comprehensive foot examination –done every year and at every visit feet checked for cracks, sores, calluses, bone, and joint abnormalities

How is it treated?

Diabetic neuropathy has no cure. The treatment focuses on:

  • Slowing the disease
  • Relieving pain
  • Managing complications and restoring function

How can one slow the progression of the disease?

  • Keep blood sugars under check to slow the progression of diabetic neuropathy and perhaps improve symptoms
  • The target sugar levels recommended are:
  • 80 – 120 mg% for patients below 60 years
  • 100 – 140 mg% for patients over 60 years or those with other medical ailments like heart, lung or kidney problems.
  • For slowing nerve damage the following is recommended:
  • Regular foot care
  • Control BP
  • Healthy diet
  • Regular Physical activity
  • Maintain recommended weight
  • Stop smoking
  • Avoid alcohol or drink in moderation

How does one relieve the pain?

  • Most pain-killers are not helpful or have unacceptable side effects. The recommended plan is:
  • Capsaicin cream (from chili pepper)
  • Acupuncture or physiotherapy
  • Anti-seizure drugs – gabapentin (Neurontin, grabilase) pregabalin (Lyrica), carbamazepine (Carbatrol, Tegretol).>/li>
    These are used for epilepsy and also nerve pain. Side effects are drowsiness, dizziness, and swelling.
  • Antidepressants – tricyclic antidepressant medicines like amitriptyline, desipramine (Norpramin), imipramine (Tofranil) help relieve mild to moderate symptoms but have many side effects like dry mouth, sweating, weight gain, constipation, and dizziness. Serotonin or nor-epinephrine reuptake inhibitors (SNRIs) like duloxetine may relieve pain with a few side effects like reduced appetite, nausea, sleepiness, dizziness, and constipation.