Due to neuropathy 85% of diabetic foot ulcer pt. lose their limb,which is preventable.
Every 20 sec some diabetic Patient loses their limb some were due to diabetic complication.
Diagnosis of diabetic neuropathy is based solely on the history and examination and additional testing is needed. Up to 50% of diabetic Peripheral neuropathies may be asymptomatic.
PNS consist of:Large myelinated fibers, A alpha fibers and A beta fibers. Thinly myelinated fibers(A-Delta), Unmyelinated fibers, the C fibers
Large myelinated fibers:- serve muscle control as well as touch, vibration and position.
Smaller myelinated fibers:- Cold thermal perception and cold pain.
Symptoms:-Positive:- persistent burning or dull pain, paroxysmal , electric shock type or stabbing pain.
Dysaesthesias (painful paraesthesias)
Evoked pain (hyperalgesia ,allodynia)
Negative:- numbness (dead feeling)
Hypoalgesia, analgesia
Hypoaesthesia ,anesthesia
How to assess :-
Clinical examination
Large fiber test:-tuning fork 128hz
Small fiber:- either temperatue / pinprick test
Annual 10-g monofilament test to assess for feet at risk for ulceration and amputation.
Presented with :-
Acute painful neuropathy
Neuropathic ulcer,
Charchot Neuroarthopathy.
Ipwish Touch Test :- can be done at home to rule out peripheral neuropathy by patients relatives or caretaker.
Treatment:
Mostly it managed conservative only like Gabapentin, pregabalin, duloxetine, nortriptyline , amitriptyline and topical therapies. Keep blood sugar in control.
To be completed by the person with diabetes
Please take a few minutes to answer the following questions about the feeling in your legsand feet. Check yes or no based on how you usually feel.
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