Back, leg, and hip problems (Sciatica, Fibromyalgia)
Facial nerve problems
HIV infection or AIDS
Duration of diabetes
Damage to blood vessels
Mechanical injury to nerves
What is it?
Diabetic neuropathies are a family of nerve disorders caused by diabetes. ( nerve supplying to various organs are affected)
Longer and uncontrolled diabetes is the root cause of Diabetic Peripheral neuropathy. (DPN)
Neuropathies lead to numbness and sometimes pain and weakness in the hands, arms, feet, and legs
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
Other nerve problems
Diabetic Neuropathy is ONE of the most commonly encountered neuropathic pain syndromes in clinical practice.
Am J Health Syst Pharm. 2004;61:160-176;
General Epidemiology of Diabetic Peripheral Neuropathy
252 million diabetics worldwide
Foot problems account for largest number of hospital bed days used for diabetic patients
1-4% of diabetics develop foot ulcer annually, 25% in lifetime
45-75% of all lower extremity amputations are in diabetics
85% of these preceded by foot ulcer
Two-thirds of elderly patients undergoing amputation do not return to independent life
– Burning, stabbing or tingling pain, numbness & prickling sensation
– Sharp pains or cramps
– Extreme sensitivity to touch (allodynia)
– Can result in sleep interference, depression, anxiety & severe disability
– Numbness or insensitivity to pain or temperature
– Loss of balance and coordination
Symptoms (Pain) often worse at night
Patients are most dejected by this phenomenon of heightened pain at night
This occurs since stimulation is reduced at night as compared to activity during the daytime.
Therefore perception of pain heightens during nighttime
Pathophysiology: Diabetic Foot Ulceration
Sensory Loss of protective sensation Motor Abnormal foot biomechanics Autonomic Reduced skin compliance and lubrication Ulceration Infection Vascular insufficiency
Complications of Polyneuropathy
Dislocation and stress fractures
Diabetic Foot Ulcers
Diabetic Foot Ulcer- Basics
Foot problems are a major cause of morbidity and mortality in people with diabetes.
In people with neuropathy or peripheral vascular disease, minor trauma to the foot can lead to skin ulceration, infection and to gangrene, resulting in amputation.
Appropriate management can prevent or heal diabetic foot ulcers, thereby reducing the amputation rate.
Characteristics demonstrated to confer high risk of ulceration include previous ulceration, neuropathy, structural deformity, peripheral vascular disease, other microvascular complications and smoking.
Screening to identify at risk patients
ASK about factors associated with foot ulceration: