Diabetic Neuropathy

The incidence of prediabetes and diabetes has exploded across the world along with the complications of these diseases. The most common complication is neuropathy. The forms of neuropathy can produce different symptoms but a frequent one is symmetric polyneuropathy. Diabetic neuropathy is a loss of sensory function usually beginning in the lower extremities and it is frequently described as painful. Over time, at least 50% of diabetics develop neuropathy; of those that develop neuropathy 30-50% will have painful symptoms. The pain from the neuropathy can be intense and disruptive of the care of oneself, one’s home and family/friend interactions.

Cause and Symptoms of Diabetic Neuropathy

It remains uncertain exactly how poor blood sugar control causes neuropathy but long sensory nerve fiber extensions called axons dying back to the nerve cell body in thought to be present. Because longer nerves are preferentially affected, the symptoms are detected in the feet and hands first. Close control of blood sugar can usually stop the progression in insulin dependent or type 1 diabetics but not as much in non-insulin dependent or type 2 diabetics. Loss of sensation in the feet and sometimes the hands occurs first followed by painful burning that is noxious. Patients complain of numb feet and burning feet which they sense at the same time. Weakness in the feet and legs and unsteadiness when standing and walking can also occur.

Diagnosis of Diabetic Neuropathy

The findings in the history of constant numbness, tingling, weakness and unsteadiness in feet, legs, hands and arms signify possible neuropathy. Signs on physical exam include loss or reflexes, loss of sensation, muscle weakness, and loss of gait stability. EMG/NCV nerve functions studies can demonstrate abnormalities but are uncommonly needed for diagnosis. Biopsy of the skin usually shows decreased density of small nerve fibers. It is also essential that other correctable causes of neuropathy be considered and eliminated which may require further testing of blood samples. In complex cases imaging studies of the peripheral nerves can help as well.

Treatment of Diabetic Neuropathy

The first line of treatment for the painful symptoms include medications that modify nerve impulse transmission such as anticonvulsants, serotonin and noradrenalin reuptake inhibitors and tricyclic antidepressants. More recent advances in spinal cord stimulation have been shown to be 17x more likely to alleviate pain over conservative treatment and 86% of patients experienced treatment success at 1 year after placement of the spinal cord stimulator. The study terminated at 5 years with the majority of patients still judging their pain relief as significant. The providers at PCI are experts at trial, implantation, and management of spinal cord stimulators.

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