Neuropathy and Foot Exam - Diabetes Symposia

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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

  1. 1. Diabetic Neuropathy and Elements of the Foot Exam Rosa Matonti RN, MSN, CDE, CNS Diabetes Educator Patients Hospitalisés Université de l'Hôpital du Nouveau-Mexique États-Unis d'Amérique Téléavertisseur 505-951-4352 505-925-6100 Bureau rmatonti@salud.unm.edu Hôpital Sacré-Coeur, Milot, Haïti 10 au 14 janvier 2011
  2. 2. Objectives At the end of the presentation the participant 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. 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. 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. 5. Classification of Diabetic Neuropathy • Symmetric polyneuropathy • Autonomic neuropathy • Polyradiculopathy • Mononeuropathy
  6. 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. 7. Cell metabolism Neuropathic ulcer on heel
  8. 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. 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. 10. Treatment of Symmetric Polyneuropathy • Glucose control • Pain control – Tricyclic antidepressants – Topical creams – Anticonvulsants • Foot care
  11. 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. 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. 13. Treatment •  Caspsasin cream •  Lidocaine cream •  TENS unit (Transcutaneous Electrical Nerve Stimulation) •  Cannabinoids
  14. 14. Treatment of infections •  Wound care •  Anitbiotics
  15. 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. 16. Polyradiculopathy, cont. •  Polyradiculopathies are diagnosed by electromyographic (EMG) studies •  Treatment – Foot care – Glucose control – Pain control
  17. 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. 18. •  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 Mononeuropathy, cont.
  19. 19. Mononeuropathy, cont. •  Treatment – Foot care – Glucose control – Pain control

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