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Neuropathy and Foot Exam - Diabetes Symposia

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Neuropathy and Foot Exam - Diabetes Symposia presented at Hôpital Sacré Coeur in Milot, Haiti. ...

Neuropathy and Foot Exam - Diabetes Symposia presented at Hôpital Sacré Coeur in Milot, Haiti.

CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.

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Neuropathy and Foot Exam - Diabetes Symposia Presentation Transcript

  • 1. Diabetic Neuropathy andElements of the Foot Exam Rosa Matonti RN, MSN, CDE, CNS Diabetes Educator Patients Hospitalisés Université de lHôpital du Nouveau-Mexique États-Unis dAmériqueTéléavertisseur 505-951-4352 505-925-6100 Bureau rmatonti@salud.unm.edu Hôpital Sacré-Coeur, Milot, Haïti 10 au 14 janvier 2011
  • 2. ObjectivesAt the end of the presentation theparticipant will be able to:•  Define the risk factors associated with diabetic neuropathy.•  Define the classifications of diabetic neuropathy.•  Illustrate the treatment options for the various classifications.•  Complete a foot assessment.
  • 3. Diabetic Neuropathy•  About 60-70% of people with diabetes have mild to severe forms of nervous system damage, including:  Impaired sensation or pain in the feet or hands  Slowed digestion of food in the stomach  Carpal tunnel syndrome  Other nerve problems•  More than 60% of nontraumatic lower-limb amputations in the United States occur among people with diabetes.
  • 4. Risk Factors•  Glucose control•  Duration of diabetes•  Damage to blood vessels•  Mechanical injury to nerves•  Autoimmune factors•  Genetic susceptibility•  Lifestyle factors – Smoking – Diet
  • 5. Classification of Diabetic Neuropathy• Symmetric polyneuropathy• Autonomic neuropathy• Polyradiculopathy• Mononeuropathy
  • 6. Symmetric Polyneuropathy•  Most common form of diabetic neuropathy•  Affects distal lower extremities and hands (“stocking-glove” sensory loss)•  Symptoms/Signs – Pain – Paresthesia/dysesthesia – Loss of vibratory sensation
  • 7. Cell metabolismNeuropathic ulcer on heel
  • 8. Diagnostic Tests•  Assess symptoms - muscle weakness, muscle cramps, prickling, numbness or pain•  Comprehensive foot exam –  Skin sensation and skin integrity –  Quantitative Sensory Testing (QST) –  X-ray•  Nerve conduction studies•  Electromyographic examination (EMG)
  • 9. Complications of Polyneuropathy •  Ulcers •  Charcot arthropathy •  Dislocation and stress fractures •  Amputation - Risk factors include: – Peripheral neuropathy with loss of protective sensation – Altered biomechanics (with neuropathy) – Evidence of increased pressure (callus) – Peripheral vascular disease – History of ulcers or amputation – Severe nail pathology
  • 10. Treatment of Symmetric Polyneuropathy•  Glucose control•  Pain control – Tricyclic antidepressants – Topical creams – Anticonvulsants•  Foot care
  • 11. Essentials of Foot Care•  Examination – Annually for all patients – Patients with neuropathy - visual inspection of feet at every visit with a health care professional•  Advise patients to: – Use lotion to prevent dryness and cracking – File calluses with a pumice stone – Cut toenails weekly or as needed – Always wear socks and well-fitting shoes – Notify their health care provider immediately if any foot problems occur
  • 12. Treatment•  Antidepressant drugs –  amitriptyline 25-150 mg qhs –  doxepin – duloxetine•  Antiseizure medications –  gabapentin –  pregabalin 50-100 mg tid (decrease in CKD –  carbamazepine – Valproate
  • 13. Treatment•  Caspsasin cream•  Lidocaine cream•  TENS unit (Transcutaneous Electrical Nerve Stimulation)•  Cannabinoids
  • 14. Treatment of infections•  Wound care•  Anitbiotics
  • 15. Polyradiculopathy•  Lumbar polyradiculopathy (diabetic amyotrophy) – Thigh pain followed by muscle weakness and atrophy•  Thoracic polyradiculopathy – Severe pain on one or both sides of the abdomen, possibly in a band-like pattern•  Diabetic neuropathic cachexia – Polyradiculopathy + peripheral neuropathy – Associated with weight loss and depression
  • 16. Polyradiculopathy, cont.•  Polyradiculopathies are diagnosed by electromyographic (EMG) studies•  Treatment – Foot care – Glucose control – Pain control
  • 17. Mononeuropathy•  Peripheral mononeuropathy – Single nerve damage due to compression or ischemia – Occurs in wrist (carpal tunnel syndrome), elbow, or foot (unilateral foot drop) – Symptoms/Signs •  numbness •  edema •  pain •  prickling
  • 18. Mononeuropathy, cont.•  Cranial mononeuropathy – Affects the 12 pairs of nerves that are connected with the brain and control sight, eye movement, hearing, and taste – Symptoms/Signs •  unilateral pain near the affected eye •  paralysis of the eye muscle •  double vision•  Mononeuropathy multiplex
  • 19. Mononeuropathy, cont.•  Treatment – Foot care – Glucose control – Pain control