This document discusses diabetic neuropathies, which are chronic complications of diabetes that affect the peripheral and autonomic nervous systems. It covers the types and management of diabetic neuropathies, including distal symmetric polyneuropathy, which affects the feet and legs, and cardiovascular autonomic neuropathy. Early recognition and treatment is important to prevent foot injuries and other complications. Management involves glucose control, lifestyle modifications, screening exams and testing, treatment of pain and other symptoms, and education on foot self-care.
This document discusses diabetic neuropathy, its types, risk factors, pathogenesis, and treatment. Diabetic neuropathies are chronic complications of diabetes that manifest in diverse clinical ways. The most common types are distal symmetric polyneuropathy and diabetic autonomic neuropathies. Tight control of blood sugar levels is the primary treatment approach, though additional therapies show some benefits for neuropathic pain relief and prevention of progression. Overall management of this condition remains challenging as existing nerve damage is largely irreversible.
Painful diabetic peripheral neuropathy diagnosis and managementNaveen Kumar
Diabetic peripheral neuropathy, also known as painful diabetic neuropathy (PDN), is a complication of diabetes that often goes undertreated. It occurs when high blood sugar levels damage nerves, especially small nerve fibers that transmit pain and temperature sensations. PDN causes chronic pain symptoms and can significantly reduce patients' quality of life by interfering with sleep, exercise, and mood. While up to 70% of diabetes patients may develop some nerve damage, 10-20% experience the painful form of neuropathy. Early treatment of PDN and glycemic control can help prevent further nerve damage and progression of pain.
This document discusses diabetic neuropathy, including its definition, prevalence, risk factors, clinical presentations, investigations, and types. Some key points:
- Diabetic neuropathy is nerve dysfunction in people with diabetes after other causes have been excluded. It has a prevalence of 5-100% and is the most common neuropathy in developed countries.
- Risk factors include poor glycemic control, hypertension, smoking, alcohol, and longer duration of diabetes. Clinical presentations include distal symmetrical polyneuropathy, proximal diabetic neuropathy, truncal neuropathy, and mononeuropathies.
- Investigations include blood tests to assess glucose levels, vitamin deficiencies and organ function. Types include chronic sensorimotor neuropathy, autonomic neuropathy
Peripheral neuropathy is a condition that results from damage to the peripheral nerves outside of the brain and spinal cord. It can cause numbness, tingling, pain or weakness in the hands, feet or other areas. There are several types including peripheral, autonomic and focal neuropathies. The most common cause is diabetes, through mechanisms such as increased aldose reductase activity and oxidative stress damaging nerves over time. Diagnosis involves physical exams, nerve conduction tests and ruling out other potential causes. Treatment focuses on managing pain, slowing progression, and preventing complications through good glucose control, medications, physical therapy and foot care.
Parkinson's disease is a common neurodegenerative disorder characterized by motor and non-motor symptoms. It affects approximately 1 million people in the US and 5 million worldwide. The mainstays of treatment are pharmacological therapies aimed at replacing dopamine like levodopa, dopamine agonists, MAO-B inhibitors, and COMT inhibitors. For later stage patients with motor complications, additional treatments include modified levodopa preparations and deep brain stimulation surgery. While no treatment can stop the progression of Parkinson's, available options provide effective symptomatic relief.
Diabetic neuropathy is a serious and common complication of type 1 and type 2 diabetes.
Ocurres over 90% of diabetes people.
Presence of symptoms and or signs of nerve dysfunction in people with diabetes after all other causes have been excluded.
It’s a type of nerve damage caused by long-term high blood sugar levels.
The condition usually develops slowly, sometimes over the course of several decades.
Distal Symmetrical Neuropathy(DSN) most common form of DN.
DSN affects the toes and distal foot, but slowly progresses proximally to involve the feet and legs in a stocking distribution.
It is also characterized by a progressive loss of nerve fibers affecting both the autonomic and somatic divisions, thereby diabetic retinopathy and nephropathy can occur.
Foot ulceration and painful neuropathy are the main clinical consequences of DSPN, linked with higher morbidity and mortality
Final Presentation for Block 6
Objectives:
Describe the mechanism of action, side-effects and counseling points for GLP-1 RA
Compare and contrast GLP-1 RA studies
Discuss the PIONEER-6 study and its implications to clinical practice
The presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes after exclusion of other causes is called diabetic peripheral neuropathy.
The diagnosis is principally a clinical one. Patients with type 1 diabetes for 5 or more years and all patients with type 2 diabetes should be assessed annually.Treatment goals include
good glycemic control,symptomatic treatment and halt progressive nerve damage.
This document discusses diabetic neuropathy, its types, risk factors, pathogenesis, and treatment. Diabetic neuropathies are chronic complications of diabetes that manifest in diverse clinical ways. The most common types are distal symmetric polyneuropathy and diabetic autonomic neuropathies. Tight control of blood sugar levels is the primary treatment approach, though additional therapies show some benefits for neuropathic pain relief and prevention of progression. Overall management of this condition remains challenging as existing nerve damage is largely irreversible.
Painful diabetic peripheral neuropathy diagnosis and managementNaveen Kumar
Diabetic peripheral neuropathy, also known as painful diabetic neuropathy (PDN), is a complication of diabetes that often goes undertreated. It occurs when high blood sugar levels damage nerves, especially small nerve fibers that transmit pain and temperature sensations. PDN causes chronic pain symptoms and can significantly reduce patients' quality of life by interfering with sleep, exercise, and mood. While up to 70% of diabetes patients may develop some nerve damage, 10-20% experience the painful form of neuropathy. Early treatment of PDN and glycemic control can help prevent further nerve damage and progression of pain.
This document discusses diabetic neuropathy, including its definition, prevalence, risk factors, clinical presentations, investigations, and types. Some key points:
- Diabetic neuropathy is nerve dysfunction in people with diabetes after other causes have been excluded. It has a prevalence of 5-100% and is the most common neuropathy in developed countries.
- Risk factors include poor glycemic control, hypertension, smoking, alcohol, and longer duration of diabetes. Clinical presentations include distal symmetrical polyneuropathy, proximal diabetic neuropathy, truncal neuropathy, and mononeuropathies.
- Investigations include blood tests to assess glucose levels, vitamin deficiencies and organ function. Types include chronic sensorimotor neuropathy, autonomic neuropathy
Peripheral neuropathy is a condition that results from damage to the peripheral nerves outside of the brain and spinal cord. It can cause numbness, tingling, pain or weakness in the hands, feet or other areas. There are several types including peripheral, autonomic and focal neuropathies. The most common cause is diabetes, through mechanisms such as increased aldose reductase activity and oxidative stress damaging nerves over time. Diagnosis involves physical exams, nerve conduction tests and ruling out other potential causes. Treatment focuses on managing pain, slowing progression, and preventing complications through good glucose control, medications, physical therapy and foot care.
Parkinson's disease is a common neurodegenerative disorder characterized by motor and non-motor symptoms. It affects approximately 1 million people in the US and 5 million worldwide. The mainstays of treatment are pharmacological therapies aimed at replacing dopamine like levodopa, dopamine agonists, MAO-B inhibitors, and COMT inhibitors. For later stage patients with motor complications, additional treatments include modified levodopa preparations and deep brain stimulation surgery. While no treatment can stop the progression of Parkinson's, available options provide effective symptomatic relief.
Diabetic neuropathy is a serious and common complication of type 1 and type 2 diabetes.
Ocurres over 90% of diabetes people.
Presence of symptoms and or signs of nerve dysfunction in people with diabetes after all other causes have been excluded.
It’s a type of nerve damage caused by long-term high blood sugar levels.
The condition usually develops slowly, sometimes over the course of several decades.
Distal Symmetrical Neuropathy(DSN) most common form of DN.
DSN affects the toes and distal foot, but slowly progresses proximally to involve the feet and legs in a stocking distribution.
It is also characterized by a progressive loss of nerve fibers affecting both the autonomic and somatic divisions, thereby diabetic retinopathy and nephropathy can occur.
Foot ulceration and painful neuropathy are the main clinical consequences of DSPN, linked with higher morbidity and mortality
Final Presentation for Block 6
Objectives:
Describe the mechanism of action, side-effects and counseling points for GLP-1 RA
Compare and contrast GLP-1 RA studies
Discuss the PIONEER-6 study and its implications to clinical practice
The presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes after exclusion of other causes is called diabetic peripheral neuropathy.
The diagnosis is principally a clinical one. Patients with type 1 diabetes for 5 or more years and all patients with type 2 diabetes should be assessed annually.Treatment goals include
good glycemic control,symptomatic treatment and halt progressive nerve damage.
The document discusses autonomic dysfunction and various treatments. It defines autonomic dysfunction as a problem with the autonomic nervous system, which regulates unconscious body functions. Common types include orthostatic hypotension and multiple system atrophy. Symptoms vary but can include changes in blood pressure, heart rate when standing, and other issues. Treatment aims to manage symptoms and may include medications, lifestyle changes, and other therapies like yoga which can help balance the body and reduce stress.
1) Diabetic neuropathy is a syndrome comprising separate clinical disorders that affect the peripheral nervous system, with a prevalence of 66% for type 1 diabetes and 59% for type 2 diabetes.
2) Risk factors include hyperglycemia, longer duration of diabetes, age, hypertension, and smoking.
3) The most common form is distal symmetrical sensorimotor polyneuropathy, which involves small and large fiber sensory, autonomic, and motor nerves in various combinations.
Diabetic neuropathy- a Precise Insight , by RxVichuZ!! ;) ;)RxVichuZ
Hello members....this is my 40th powerpoint...published in GOOGLE SLIDESHARE!! :) :)
I wish to thank each and everyone who have supported me all the way...!!!
This presentation deals with DIABETIC NEUROPATHY ...the causes, epidemiological statistics, pathogenesis.
A deeper insight into manifestations, complications, management & natural remedies have been provided....!!
Do go through this...and let me know you reviews!!!
When you THINK DIFFERENTLY, it becomes an INNOVATION,
When u infuse DEDICATION into that INNOVATION, it becomes an INVENTION..!!
HAPPY READING!!
#RxVichuZ-alwz4uh!! :)
1) Gliptins like vildagliptin have less risk of hypoglycemia and weight gain compared to sulfonylureas.
2) Vildagliptin has shown beneficial effects on blood pressure and lipid levels.
3) Meta-analyses of clinical trials show that gliptins like vildagliptin have no increased cardiovascular risk compared to other antidiabetic drugs, and may have cardio-protective effects.
This slide is for the educational purpose.Prepared by medical student during their medical presentation. Please comment if any changes are required in this slides. i will be happy to make changes in knowledge.
Neuropathic pain strategies to improve clinical outcomewebzforu
This document discusses strategies for improving outcomes for patients with neuropathic pain. It begins by describing common conditions associated with neuropathic pain such as diabetes and shingles. It then discusses diagnostic approaches and distinguishing characteristics of neuropathic pain. Key points covered include the pathogenesis of neuropathic pain and new treatment options that modulate underlying mechanisms. Major forms of neuropathic pain like post-herpetic neuralgia and diabetic neuropathy are examined in depth. The document concludes by outlining a stepwise approach to managing neuropathic pain.
Diabetic neuropathy is nerve damage caused by diabetes. It has many forms including distal symmetrical polyneuropathy (most common), proximal motor neuropathy, and autonomic neuropathy. The pathogenesis involves multiple mechanisms from hyperglycemia like increased polyol pathway flux, oxidative stress, and vascular dysfunction. Risk factors include poor glycemic control, obesity, older age, male sex, and family history. Symptoms vary by type but may include pain, numbness, weakness, gastrointestinal issues, and cardiovascular problems. Diagnosis involves clinical exam and electrodiagnostic testing.
This document discusses diabetic polyneuropathy. It begins with an agenda outlining the topics to be covered: epidemiology, clinical presentation, pathogenic mechanisms, diagnosis, and treatment. Some key points include:
- Up to 50% of diabetics may develop symptomatic neuropathy 20 years after diagnosis. The risk increases the longer a person has diabetes.
- Neuropathic pain symptoms can include burning, tingling sensations, allodynia, and hyperalgesia. The pain is usually chronic.
- Pathogenic mechanisms include metabolic and vascular factors that damage nerve fibers over time, such as hyperglycemia, oxidative stress, impaired blood flow. This can lead to endoneurial hypoxia, ATP depletion and nerve damage.
This document discusses glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and compares them to other diabetes medications. It provides an overview of GLP-1 RAs, noting they are more effective at lowering A1C than other classes but also carry a lower risk of hypoglycemia. The document compares specific GLP-1 RAs such as liraglutide, exenatide, and lixisenatide, noting they differ in terms of amino acid homology to human GLP-1 and risk of antibody formation. DPP-4 inhibitors are also discussed and shown to result in lower GLP-1 levels than exogenous GLP-1 analog administration.
The document discusses Parkinson's disease (PD), including its classification, signs and symptoms, diagnosis, epidemiology, and management. PD is the most common form of parkinsonism, characterized by motor symptoms like tremors and rigidity. Diagnosis is clinical based on symptoms. Management includes non-pharmacological therapies as well as drugs to increase dopamine like levodopa, dopamine agonists, MAO-B inhibitors, COMT inhibitors, and anticholinergics. The goal of treatment is to manage motor symptoms and other non-motor issues.
The UK Prospective Diabetes Study was a 20-year multicenter randomized controlled trial that investigated the effects of intensive glucose control and tight blood pressure control on diabetes complications. Over 5,000 patients with newly diagnosed type 2 diabetes were recruited between 1977-1991 and followed for a median of 10 years. The study found that intensive glucose control reduced the risk of diabetes complications, particularly microvascular complications, by 10-25%. The blood pressure control study found that tight blood pressure control reduced the risk of diabetes-related endpoints by 24% and strokes by 44% compared to less tight control.
This document discusses the challenges of managing diabetes in patients with chronic kidney disease (CKD). It notes that diabetes is a leading cause of CKD progression and that CKD increases mortality risk in diabetes patients. Managing glucose levels in CKD patients is difficult due to risks of hypoglycemia from insulin clearance issues and need to adjust oral medications for kidney function. The CARMELINA trial demonstrated the renal safety of the DPP-4 inhibitor linagliptin in high cardio-renal risk patients, showing no increase in sustained decrease in eGFR or other renal outcomes compared to placebo over 2 years.
Empagliflozin and Cardiovascular OutcomesUyen Nguyen
1) The EMPA-REG OUTCOME trial evaluated the cardiovascular outcomes of empagliflozin compared to placebo in over 7000 patients with type 2 diabetes at high risk of cardiovascular events.
2) Empagliflozin was found to significantly reduce the risk of the primary composite outcome of cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke compared to placebo.
3) Additional benefits observed with empagliflozin included a significant reduction in all-cause mortality, cardiovascular mortality, and hospitalization for heart failure.
Motor neurone disease (MND) involves the progressive degeneration of motor neurons in the spinal cord, brainstem, and motor cortex. It is usually sporadic with an unknown cause, though genetics and oxidative damage may play a role. There is no sensory involvement and it has a prevalence of 5 per 100,000 people per year. Common patterns include progressive muscular atrophy starting in hands, amyotrophic lateral sclerosis with mixed upper and lower motor signs, and primary lateral sclerosis confined to upper motor neurons. MND is diagnosed clinically and has no cure, but treatments can help with symptoms and slow progression. The disease gradually spreads and most patients die within 3-5 years due to respiratory complications.
Teneligliptin the next generation gliptinAKSHATA RAO
Teneligliptin , one of the emerging gliptins have established its prowess among the gliptin giants like Sitagliptin Vildagliptin and Linagliptin. Proven to be safe in renally compromised patients, this one is to watch out for.
The document provides an overview of the Standards of Care in Diabetes - 2023 guidelines. It includes 17 sections that cover various aspects of diabetes care, treatment goals, and quality evaluation tools. The sections include classification and diagnosis of diabetes, prevention or delay of type 2 diabetes, medical evaluation and assessment of comorbidities, facilitating positive health behaviors, glycemic targets, pharmacologic treatment approaches, management of cardiovascular disease and other complications, and more. The guidelines are intended to provide clinicians, patients, and other stakeholders with an evidence-based framework for diabetes care and management.
Peripheral neuropathy and Hereditary NeuropathiesAnand Nambirajan
This document provides an overview of approaching peripheral nerve disease. It discusses obtaining a thorough history and examination. Key signs that implicate peripheral nerve involvement include distal numbness, tingling, neuropathic pain and gait imbalance. Electrodiagnostic studies can help with diagnosis and classification. The document then covers the temporal evolution, distribution, underlying pathology and findings that help localize the level and type of nerve fiber involved in different neuropathies.
The document summarizes clinical trials evaluating SGLT2 inhibitors:
1) The EMPA-REG trial found that empagliflozin reduced the risk of cardiovascular death, hospitalization for heart failure, and all-cause mortality compared to placebo in patients with type 2 diabetes at high cardiovascular risk.
2) The CANVAS trial found that canagliflozin reduced the risk of major adverse cardiovascular events and hospitalization for heart failure compared to placebo in patients with type 2 diabetes at high cardiovascular risk.
3) The DECLARE-TIMI 58 trial found that dapagliflozin did not increase the risk of major adverse cardiovascular events compared to placebo in patients with type 2 diabetes
Ueda 2016 7-diabetic complications - adel el sayedueda2015
This document discusses nephropathy (kidney damage) in patients with type 2 diabetes. It recommends screening all patients with type 2 diabetes for kidney damage at diagnosis and annually thereafter. For those found to have microalbuminuria, the document recommends repeating a urine test several times to confirm and then monitoring regularly. It provides referral criteria to specialists for patients with more advanced kidney disease. Treatment recommendations include ACE inhibitors or ARBs for micro- or macroalbuminuria and intensive control of blood pressure and blood glucose to protect kidney function.
This document discusses diabetic neuropathy, which is the most common neuropathy in the Western world. It affects different parts of the nervous system and presents with diverse clinical manifestations. Approximately 50% of patients with diabetes will eventually develop neuropathy. Distal symmetric polyneuropathy is the most common form, affecting the feet first and progressing proximally, with predominantly sensory symptoms like tingling and numbness. Complications include foot ulcers and infections that can lead to amputation. Treatment involves controlling blood glucose levels through lifestyle changes and medications to help prevent and possibly reverse neuropathy.
The document discusses autonomic dysfunction and various treatments. It defines autonomic dysfunction as a problem with the autonomic nervous system, which regulates unconscious body functions. Common types include orthostatic hypotension and multiple system atrophy. Symptoms vary but can include changes in blood pressure, heart rate when standing, and other issues. Treatment aims to manage symptoms and may include medications, lifestyle changes, and other therapies like yoga which can help balance the body and reduce stress.
1) Diabetic neuropathy is a syndrome comprising separate clinical disorders that affect the peripheral nervous system, with a prevalence of 66% for type 1 diabetes and 59% for type 2 diabetes.
2) Risk factors include hyperglycemia, longer duration of diabetes, age, hypertension, and smoking.
3) The most common form is distal symmetrical sensorimotor polyneuropathy, which involves small and large fiber sensory, autonomic, and motor nerves in various combinations.
Diabetic neuropathy- a Precise Insight , by RxVichuZ!! ;) ;)RxVichuZ
Hello members....this is my 40th powerpoint...published in GOOGLE SLIDESHARE!! :) :)
I wish to thank each and everyone who have supported me all the way...!!!
This presentation deals with DIABETIC NEUROPATHY ...the causes, epidemiological statistics, pathogenesis.
A deeper insight into manifestations, complications, management & natural remedies have been provided....!!
Do go through this...and let me know you reviews!!!
When you THINK DIFFERENTLY, it becomes an INNOVATION,
When u infuse DEDICATION into that INNOVATION, it becomes an INVENTION..!!
HAPPY READING!!
#RxVichuZ-alwz4uh!! :)
1) Gliptins like vildagliptin have less risk of hypoglycemia and weight gain compared to sulfonylureas.
2) Vildagliptin has shown beneficial effects on blood pressure and lipid levels.
3) Meta-analyses of clinical trials show that gliptins like vildagliptin have no increased cardiovascular risk compared to other antidiabetic drugs, and may have cardio-protective effects.
This slide is for the educational purpose.Prepared by medical student during their medical presentation. Please comment if any changes are required in this slides. i will be happy to make changes in knowledge.
Neuropathic pain strategies to improve clinical outcomewebzforu
This document discusses strategies for improving outcomes for patients with neuropathic pain. It begins by describing common conditions associated with neuropathic pain such as diabetes and shingles. It then discusses diagnostic approaches and distinguishing characteristics of neuropathic pain. Key points covered include the pathogenesis of neuropathic pain and new treatment options that modulate underlying mechanisms. Major forms of neuropathic pain like post-herpetic neuralgia and diabetic neuropathy are examined in depth. The document concludes by outlining a stepwise approach to managing neuropathic pain.
Diabetic neuropathy is nerve damage caused by diabetes. It has many forms including distal symmetrical polyneuropathy (most common), proximal motor neuropathy, and autonomic neuropathy. The pathogenesis involves multiple mechanisms from hyperglycemia like increased polyol pathway flux, oxidative stress, and vascular dysfunction. Risk factors include poor glycemic control, obesity, older age, male sex, and family history. Symptoms vary by type but may include pain, numbness, weakness, gastrointestinal issues, and cardiovascular problems. Diagnosis involves clinical exam and electrodiagnostic testing.
This document discusses diabetic polyneuropathy. It begins with an agenda outlining the topics to be covered: epidemiology, clinical presentation, pathogenic mechanisms, diagnosis, and treatment. Some key points include:
- Up to 50% of diabetics may develop symptomatic neuropathy 20 years after diagnosis. The risk increases the longer a person has diabetes.
- Neuropathic pain symptoms can include burning, tingling sensations, allodynia, and hyperalgesia. The pain is usually chronic.
- Pathogenic mechanisms include metabolic and vascular factors that damage nerve fibers over time, such as hyperglycemia, oxidative stress, impaired blood flow. This can lead to endoneurial hypoxia, ATP depletion and nerve damage.
This document discusses glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and compares them to other diabetes medications. It provides an overview of GLP-1 RAs, noting they are more effective at lowering A1C than other classes but also carry a lower risk of hypoglycemia. The document compares specific GLP-1 RAs such as liraglutide, exenatide, and lixisenatide, noting they differ in terms of amino acid homology to human GLP-1 and risk of antibody formation. DPP-4 inhibitors are also discussed and shown to result in lower GLP-1 levels than exogenous GLP-1 analog administration.
The document discusses Parkinson's disease (PD), including its classification, signs and symptoms, diagnosis, epidemiology, and management. PD is the most common form of parkinsonism, characterized by motor symptoms like tremors and rigidity. Diagnosis is clinical based on symptoms. Management includes non-pharmacological therapies as well as drugs to increase dopamine like levodopa, dopamine agonists, MAO-B inhibitors, COMT inhibitors, and anticholinergics. The goal of treatment is to manage motor symptoms and other non-motor issues.
The UK Prospective Diabetes Study was a 20-year multicenter randomized controlled trial that investigated the effects of intensive glucose control and tight blood pressure control on diabetes complications. Over 5,000 patients with newly diagnosed type 2 diabetes were recruited between 1977-1991 and followed for a median of 10 years. The study found that intensive glucose control reduced the risk of diabetes complications, particularly microvascular complications, by 10-25%. The blood pressure control study found that tight blood pressure control reduced the risk of diabetes-related endpoints by 24% and strokes by 44% compared to less tight control.
This document discusses the challenges of managing diabetes in patients with chronic kidney disease (CKD). It notes that diabetes is a leading cause of CKD progression and that CKD increases mortality risk in diabetes patients. Managing glucose levels in CKD patients is difficult due to risks of hypoglycemia from insulin clearance issues and need to adjust oral medications for kidney function. The CARMELINA trial demonstrated the renal safety of the DPP-4 inhibitor linagliptin in high cardio-renal risk patients, showing no increase in sustained decrease in eGFR or other renal outcomes compared to placebo over 2 years.
Empagliflozin and Cardiovascular OutcomesUyen Nguyen
1) The EMPA-REG OUTCOME trial evaluated the cardiovascular outcomes of empagliflozin compared to placebo in over 7000 patients with type 2 diabetes at high risk of cardiovascular events.
2) Empagliflozin was found to significantly reduce the risk of the primary composite outcome of cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke compared to placebo.
3) Additional benefits observed with empagliflozin included a significant reduction in all-cause mortality, cardiovascular mortality, and hospitalization for heart failure.
Motor neurone disease (MND) involves the progressive degeneration of motor neurons in the spinal cord, brainstem, and motor cortex. It is usually sporadic with an unknown cause, though genetics and oxidative damage may play a role. There is no sensory involvement and it has a prevalence of 5 per 100,000 people per year. Common patterns include progressive muscular atrophy starting in hands, amyotrophic lateral sclerosis with mixed upper and lower motor signs, and primary lateral sclerosis confined to upper motor neurons. MND is diagnosed clinically and has no cure, but treatments can help with symptoms and slow progression. The disease gradually spreads and most patients die within 3-5 years due to respiratory complications.
Teneligliptin the next generation gliptinAKSHATA RAO
Teneligliptin , one of the emerging gliptins have established its prowess among the gliptin giants like Sitagliptin Vildagliptin and Linagliptin. Proven to be safe in renally compromised patients, this one is to watch out for.
The document provides an overview of the Standards of Care in Diabetes - 2023 guidelines. It includes 17 sections that cover various aspects of diabetes care, treatment goals, and quality evaluation tools. The sections include classification and diagnosis of diabetes, prevention or delay of type 2 diabetes, medical evaluation and assessment of comorbidities, facilitating positive health behaviors, glycemic targets, pharmacologic treatment approaches, management of cardiovascular disease and other complications, and more. The guidelines are intended to provide clinicians, patients, and other stakeholders with an evidence-based framework for diabetes care and management.
Peripheral neuropathy and Hereditary NeuropathiesAnand Nambirajan
This document provides an overview of approaching peripheral nerve disease. It discusses obtaining a thorough history and examination. Key signs that implicate peripheral nerve involvement include distal numbness, tingling, neuropathic pain and gait imbalance. Electrodiagnostic studies can help with diagnosis and classification. The document then covers the temporal evolution, distribution, underlying pathology and findings that help localize the level and type of nerve fiber involved in different neuropathies.
The document summarizes clinical trials evaluating SGLT2 inhibitors:
1) The EMPA-REG trial found that empagliflozin reduced the risk of cardiovascular death, hospitalization for heart failure, and all-cause mortality compared to placebo in patients with type 2 diabetes at high cardiovascular risk.
2) The CANVAS trial found that canagliflozin reduced the risk of major adverse cardiovascular events and hospitalization for heart failure compared to placebo in patients with type 2 diabetes at high cardiovascular risk.
3) The DECLARE-TIMI 58 trial found that dapagliflozin did not increase the risk of major adverse cardiovascular events compared to placebo in patients with type 2 diabetes
Ueda 2016 7-diabetic complications - adel el sayedueda2015
This document discusses nephropathy (kidney damage) in patients with type 2 diabetes. It recommends screening all patients with type 2 diabetes for kidney damage at diagnosis and annually thereafter. For those found to have microalbuminuria, the document recommends repeating a urine test several times to confirm and then monitoring regularly. It provides referral criteria to specialists for patients with more advanced kidney disease. Treatment recommendations include ACE inhibitors or ARBs for micro- or macroalbuminuria and intensive control of blood pressure and blood glucose to protect kidney function.
This document discusses diabetic neuropathy, which is the most common neuropathy in the Western world. It affects different parts of the nervous system and presents with diverse clinical manifestations. Approximately 50% of patients with diabetes will eventually develop neuropathy. Distal symmetric polyneuropathy is the most common form, affecting the feet first and progressing proximally, with predominantly sensory symptoms like tingling and numbness. Complications include foot ulcers and infections that can lead to amputation. Treatment involves controlling blood glucose levels through lifestyle changes and medications to help prevent and possibly reverse neuropathy.
The document discusses diabetes, providing statistics on its prevalence and discussing advances in treatment. While medical advances have improved diabetes management, better control has not been achieved for all as it requires a team approach and access to care. The elimination of diabetes listings may lead to a more stringent disability standard given impairments from conditions like neuropathy and retinopathy. Proper management of diabetes is challenging and requires ongoing medical care and self-care.
Ueda2015 dn standards of medical care dr.mamdouh el-nahasueda2015
This document discusses diabetic peripheral neuropathy (DPN) and cardiovascular autonomic neuropathy (CAN), which are common complications of diabetes that can cause substantial morbidity. DPN affects up to 50% of patients with diabetes and causes numbness, pain, and increased risk of foot ulcers and amputation. CAN prevalence is about 20% in asymptomatic patients with diabetes and can impact multiple body systems. Tight glycemic control through diet and medication is recommended to prevent or delay the progression of DPN and CAN, especially in type 1 diabetes patients. Pharmacological and nonpharmacological therapies can help treat pain and symptoms from DPN and autonomic neuropathy. Regular screening for DPN and CAN is important for early detection and management
- Diabetic kidney disease is a major cause of mortality and morbidity in patients with diabetes. It can progress from microalbuminuria to macroalbuminuria and decreased kidney function over many years.
- Risk factors include uncontrolled hypertension and hyperglycemia, genetics, obesity, and smoking. The pathogenesis involves hemodynamic changes, activation of metabolic pathways, growth factors, the renin-angiotensin system, and oxidative stress.
- Management involves tight glycemic and blood pressure control, lifestyle modifications like diet and exercise, and medications targeting glucose, blood pressure, lipids, and proteinuria. Dialysis and kidney transplantation are treatment options for end-stage kidney disease.
Diabetic nephropathy is a major cause of end-stage renal disease. It occurs in about 30% of patients with type 1 diabetes and risks include poor glycemic control, long diabetes duration, hypertension, and family history. The stages progress from initial hyperfiltration to microalbuminuria and later macroalbuminuria as kidney function declines. Screening for microalbuminuria helps early detection. Treatment focuses on optimizing glucose and blood pressure control.
This document discusses the management of diabetic nephropathy. It begins with defining diabetic nephropathy as a clinical syndrome characterized by persistent albuminuria, progressive decline in glomerular filtration rate, elevated blood pressure, worse glycemic control, hypertension, and genetic predisposition. It then outlines the typical progression of diabetic kidney disease and reviews risk factors. Current treatment strategies are aimed at strict glycemic control, blood pressure control, reducing proteinuria, and preserving renal function through ACE inhibitors, ARBs, and lifestyle modifications like weight loss and smoking cessation. Newer treatments continue to be explored, but therapeutic intervention works best when begun early and glycemia, blood pressure, and proteinuria are well controlled.
Hypertension is very common in patients with type 2 diabetes, affecting around half of patients at diagnosis. Strict control of blood pressure, with a target of below 130/80 mmHg, is important for reducing cardiovascular risks in diabetic patients. Several classes of antihypertensive drugs can be used effectively for this purpose, including diuretics, beta-blockers, calcium channel blockers, ACE inhibitors, and angiotensin receptor blockers. Aggressive treatment of hypertension is recommended for diabetic patients, especially those with kidney disease, in order to prevent complications and disease progression.
diabetes mellitus by Tushar 202345.pptxTushar Mankar
This document provides information on diabetes mellitus and considerations for anesthesia. It begins with an introduction to diabetes and classifications of type 1 and type 2 diabetes. It then discusses anesthetic considerations including preoperative evaluation of diabetes control and complications, intraoperative glucose management goals, and techniques for perioperative insulin administration. The goals are to avoid hypoglycemia while maintaining blood glucose under 180 mg/dL. Tight control below 150 mg/dL is not recommended. Frequent glucose monitoring is important. The document outlines various insulin regimens that can be used during surgery including Alberti-Thomas and tight control protocols.
This document provides an overview of diabetic kidney disease (DKD). It discusses the epidemiology, pathophysiology, clinical presentation, diagnosis, treatment, and evidence related to DKD. Some key points include: DKD is the leading cause of kidney failure worldwide; hyperglycemia is the primary factor in its development; it can present with or without albuminuria; treatment involves glycemic control, blood pressure control, and RAAS inhibitors; landmark trials such as RENAAL and IDNT showed renoprotective effects of ACEIs and ARBs; and recent trials demonstrate kidney and cardiovascular benefits of SGLT2 inhibitors in DKD patients.
Hypertension, or high blood pressure, is one of the most common diseases worldwide. It is a major risk factor for heart disease and stroke. The document discusses the definition, classification, evaluation, causes, treatment, and prevention of hypertension. Prevention strategies recommended by WHO include reducing salt intake, maintaining a healthy weight, regular exercise, stress reduction, not smoking, and modifying lifestyle behaviors. Treatment aims to lower blood pressure below 140/90 mmHg through lifestyle changes and lifelong medication if needed.
Chapter 6 Endocrine disorders by Dr. DerejepdfRebiraWorkineh
Chronic kidney disease (CKD) is common in patients with diabetes and is diagnosed through elevated albuminuria and reduced estimated glomerular filtration rate (eGFR). CKD attributed to diabetes occurs in 20-40% of patients and can progress to end-stage renal disease requiring dialysis. Diabetic retinopathy, caused by chronic hyperglycemia, is the most common cause of blindness and is assessed through eye exams. Neuropathy is assessed through history and examination of sensation, with annual 10-g monofilament testing to check for high-risk feet. Foot care includes inspection, assessment of deformities and pulses, and referral for ongoing surveillance in high-risk patients to prevent ulcers and amputations.
DM is a metabolic disorder with an increasing global incidence and prevalence. Poor peri-operative glycaemic control increases the risk of adverse outcomes. Through careful glycemic management in perioperative period, we may reduce morbidity and mortality and improve surgical outcomes.
This document discusses diabetic nephropathy and chronic kidney disease in patients with diabetes. It notes that diabetic nephropathy is a leading cause of end-stage renal disease in the United States. It recommends annual screening for albuminuria and measuring creatinine to monitor kidney function. Intensive glucose control can help reduce risk of kidney complications. Medications like ACE inhibitors and ARBs may preserve kidney function for patients with modestly elevated albumin levels. Lifestyle changes like reducing protein intake and controlling blood pressure and cholesterol are also important aspects of management.
This document provides information on periodontal treatment considerations for patients with medical complications. It discusses cardiovascular diseases like hypertension, ischemic heart disease, and congestive heart failure. It also covers respiratory diseases like asthma and chronic obstructive pulmonary disease. Other topics include endocrine diseases like diabetes mellitus and adrenal insufficiency. The document discusses hemorrhagic disorders and evaluates bleeding risk. It provides guidance on treatment modifications for various medical conditions.
diabetes Orientation Talk The dealing with diabetic complications pptxGovindRankawat1
When and how to screen Diabetic Kidney Disease (DKD) And what is the role of Urine Albumin Creatinine Ratio (UACR)
All patients with type 2 diabetes must be screened for diabetic nephropathy at the time of diagnosis.
Patients with type 1 diabetes should be screened five years after diagnosis and at puberty. If the initial test reveals negative result then the test has to be repeated annually for both type 1 and type 2 diabetes.
Early Diabetic kidney disease expressed as Microalbuminuria (if urinary albumin excretion is 30 - 300 mg/24 h.
Random urine samples should be used and the results of albumin measurement in spot collection may be expressed as urinary albumin concentration (mg/dL) or as urinary albumin to creatinine ratio (mg/g or mg/mmol).
This method is often found to be the easiest to carry out in an office setting, generally provides accurate information, and is therefore preferred;
Anaesthetic considerations in diabetes mellitus (1)hassam2
The document discusses anaesthetic considerations for patients with diabetes mellitus. It notes that the preanesthesia evaluation should include assessing the patient's type of diabetes, level of blood glucose control, and medication regimen. It also discusses implications for different types of diabetes, implications of regional anesthesia, diabetic complications like nephropathy and implications for airway management. The document provides guidance on adjustments to insulin regimens prior to surgery depending on the patient's usual insulin doses and risk of hypoglycemia.
Complications of Diabetes Mellitus can be serious and affect many parts of the body. Consistently high blood glucose can lead to cardiovascular disease, kidney failure, nerve damage, eye disease, and lower limb amputations. Maintaining near-normal blood glucose, blood pressure, and cholesterol levels can help prevent or delay complications. People with diabetes need regular monitoring and treatment to manage their condition and reduce risks.
This document discusses hypertension (high blood pressure) including its causes, effects on the heart, treatment targets, and drug treatment options. It notes that primary hypertension accounts for 90-95% of cases and outlines trial findings showing benefits of tight blood pressure control, especially in patients with diabetes. Treatment involves lifestyle changes and medications, typically starting with diuretics, with the goal of controlling blood pressure to under 140/85 mmHg.
Similar to New diabetic neuropathy american diabetes association, jan 2017 (20)
Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
"Learn about all the ways Walmart supports nonprofit organizations.
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The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
The event will cover the following::
Walmart Business + (https://business.walmart.com/plus) is a new shopping experience for nonprofits, schools, and local business customers that connects an exclusive online shopping experience to stores. Benefits include free delivery and shipping, a 'Spend Analytics” feature, special discounts, deals and tax-exempt shopping.
Special TechSoup offer for a free 180 days membership, and up to $150 in discounts on eligible orders.
Spark Good (walmart.com/sparkgood) is a charitable platform that enables nonprofits to receive donations directly from customers and associates.
Answers about how you can do more with Walmart!"
Beyond Degrees - Empowering the Workforce in the Context of Skills-First.pptxEduSkills OECD
Iván Bornacelly, Policy Analyst at the OECD Centre for Skills, OECD, presents at the webinar 'Tackling job market gaps with a skills-first approach' on 12 June 2024
3. Introduction
Diabetic neuropathies are the most prevalent chronic complications of
diabetes.
There are several typical &atypical forms.
Patients with prediabetes may also develop neuropathies that are similar
to diabetic neuropathies
4. The early recognition and appropriate management of neuropathy in the
patient with diabetes is important for a number of reasons:
o Diabetic neuropathy is a diagnosis of exclusion. Nondiabetic neuropathies may be
present in patients with diabetes and may be treatable by specific measures.
o A number of treatment options exist for symptomatic diabetic neuropathy.
o Up to 50% of diabetic peripheral neuropathies may be asymptomatic. If not
recognized and if preventive foot care is not implemented, patients are at risk for
injuries to their insensate feet.
o Recognition and treatment of autonomic neuropathy may improve symptoms,
reduce sequelae, and improve quality of life.
5.
6. Prevention
It focuses on glucose control and lifestyle modifications.
o Optimize glucose control as early as possible to prevent or delay the
development of distal symmetric polyneuropathy and cardiovascular
autonomic neuropathy in people with type 1 diabetes.
o Optimize glucose control to prevent or slow the progression of distal
symmetric polyneuropathy in people with type 2 diabetes.
o Consider a multifactorial approach targeting glycemia among other risk factors
to prevent cardiovascular autonomic neuropathy in people with type 2
diabetes.
7. A recent study reported nerve fiber regeneration in patients with type 2
diabetes engaged in an exercise program compared with loss of nerve
fibers in those who only followed standard of care.
8. Distal Symmetric Polyneuropathy
(DSPN)
Most common -75%.
It is the presence of symptoms and/or signs of peripheral nerve
dysfunction in people with diabetes after the exclusion of other causes.
DSPN occurs in at least 20% of people with type 1 diabetes after 20 years
of disease duration.
It is present in at least 10%–15% of newly diagnosed patients with type 2
diabetes with rates increasing to 50% after 10 years of disease duration.
9. Most important cause of foot ulceration, and it is also a prerequisite in the
development of Charcot neuroarthropathy (CN).
These late complications drive amputation risk and are also predictors of
mortality.
DSPN is also a major contributor to falls and fractures.
Small and large fiber dysfunction, with loss of sensory, proprioception,
temperature discrimination, and pain, all ultimately leading to
unsteadiness, recurrent minor injuries, and an increased risk of falls.
10. An acute case of Charcot foot arthropathy presents with pain and swelling.
If left untreated, leads to a "rocker bottom" deformity and ulceration.
The early radiologic changes show joint subluxation and periarticular fractures
11.
12. Screening and Diagnosis
All patients should be assessed for DSPN starting at diagnosis of type 2 diabetes and 5
years after the diagnosis of type 1 diabetes and at least annually thereafter.
Consider screening patients with prediabetes who have symptoms of peripheral
neuropathy.
Assessment should include a careful history and either temperature or pinprick
sensation (small-fiber function) and vibration sensation using a 128-Hz tuning fork
(large-fiber function). All patients should have an annual 10-g monofilament testing to
assess for feet at risk for ulceration and amputation.
Electrophysiological testing or referral to a neurologist is rarely needed for screening,
except in situations where the clinical features are atypical
- Atypical features include motor greater than sensory neuropathy, rapid onset, or
asymmetrical presentation.
13.
14. Foot Complication
A comprehensive clinical exam is principally designed to identify those at
risk for the late complications who need education on preventative foot
self-care and regular podiatric foot care.
Recently an even simpler foot exam, the “3-minute diabetic foot exam,”
has been proposed that requires no equipment and provides simple advice
on education on preventative foot self-care.
15. 3 min Foot Examination
History
Physical examination
Patients education
16.
17.
18.
19.
20.
21. Treatment of Foot Complications
Effective off-loading that prevents patients with plantar neuropathic ulcers
to walk on the lesions.
Off-loading, usually with casting, and careful follow-up and repeated
investigations are also key components for the management of CN.
Ongoing education and regular podiatry follow-up can reduce the
incidence of foot complications in those found to be at “high risk.”
Tests assessing gait and balance may be considered in people with distal
symmetric polyneuropathy to evaluate the risk of falls.
22. Tight glucose control targeting near-normal glycemia in patients with type 1
diabetes dramatically reduces the incidence of distal symmetric polyneuropathy.
In patients with type 2 diabetes with more advanced disease and multiple risk
factors and comorbidities, intensive glucose control alone is modestly effective in
preventing DSPN.
Lifestyle interventions are recommended for distal symmetric polyneuropathy
prevention in patients with prediabetes/metabolic syndrome and type 2 diabetes
23. Any infection should be treated with debridement and appropriate antibiotics.
Healing duration of 8 - 1 0 weeks is typical.
When healing appears refractory, plateletderived growth factor (becaplermin
[Regranex] ) should be considered for local application.
24.
25.
26. Pain Management
Consider either pregabalin or duloxetine as the initial approach in the
symptomatic treatment for neuropathic pain in diabetes.
Gabapentin may also be used as an effective initial approach, taking into
account patients’ socioeconomic status, comorbidities, and potential drug
interactions.
Tricyclic antidepressants are also effective for neuropathic pain in diabetes
but should be used with caution given the higher risk of serious side effects.
27. Because of high risks of addiction and other complications, the use of opioids,
including tapentadol or tramadol, is not recommended as first- or second-line
agents.
Capsaicin, a topical irritant, found to be effective in reducing local nerve pain.
(zostrix, 2-4 times daily )
28.
29.
30.
31. Diabetic Autonomic Neuropathies
Autonomic neuropathies affect the autonomic neurons (parasympathetic,
sympathetic, or both).
Manifestations of diabetic autonomic neuropathy include hypoglycemia
unawareness, resting tachycardia, orthostatic hypotension, gastroparesis,
constipation, diarrhea, fecal incontinence, erectile dysfunction, neurogenic
bladder, and sudomotor dysfunction with either increased or decreased
sweating.
CAN is the most studied and clinically relevant of the diabetic autonomic
neuropathies.
32. Cardiovascular Autonomic Neuropathy
CAN prevalence increases substantially with diabetes duration.
In type 1 DM at least 30% were observed after 20 years of diabetes duration
while up to 60% of patients with type 2 diabetes after 15 years.
CAN is present in patients with impaired glucose tolerance, insulin resistance,
or metabolic syndrome.
CAN is an independent risk factor for cardiovascular mortality, arrhythmia,
silent ischemia, any major cardiovascular event, and myocardial dysfunction.
33. Screening & Diagnosis
Symptoms and signs of autonomic neuropathy should be assessed in
patients with microvascular and neuropathic complications.
In the presence of symptoms or signs of cardiovascular autonomic
neuropathy, tests excluding other comorbidities or drug effects/interactions
that could mimic cardiovascular autonomic neuropathy should be performed.
Consider assessing symptoms and signs of cardiovascular autonomic
neuropathy in patients with hypoglycemia unawareness.
35. CAN may be completely asymptomatic and detected only by decreased
heart rate variability (HRV) with deep breathing.
Testing HRV may be done in the office by either
o 1) taking an electrocardiogram recording as a patient begins to rise from a
seated position or
o 2) taking an electrocardiogram recording during 1–2 min of deep breathing
with calculation of HRV.
In more advanced cases, patients may present with resting tachycardia
(>100 bpm) and exercise intolerance
36. Advanced disease associated with orthostatic hypotension (a fall in systolic or
diastolic blood pressure by >20 mmHg or >10 mmHg, respectively, upon
standing without an appropriate increase in heart rate).
The diagnosis includes documentation of symptoms & signs of CAN, which
include impaired HRV, higher resting heart rate, and presence of orthostatic
hypotension.
37. Treatment
Optimize glucose control as early as possible to prevent or delay the
development of cardiovascular autonomic neuropathy in people with type 1
diabetes.
Consider a multifactorial approach targeting glycemia among other risk
factors to prevent cardiovascular autonomic neuropathy in people with type 2
diabetes.
Lifestyle modifications to improve CAN in patients with prediabetes.
Physical activity and exercise should be encouraged to avoid deconditioning,
which is known to exacerbate orthostatic intolerance.
38. Volume repletion with fluids and salt is central to the management of
orthostatic hypotension.
Low-dose fludrocortisone(0.1-0.2mg orally daily ) may be beneficial in
supplementing volume repletion in some patients.
The administration of sympathomimetic medications is central to the care of
patients whose symptoms are not controlled with other measures.
39. Midodrine, a peripheral, selective, direct α1-adrenoreceptor agonist, is an
FDA-approved drug for the treatment of orthostatic hypotension(10MG
orally 3times ).
Recently, droxidopa was approved by the FDA for the treatment of
neurogenic orthostatic hypotension but not specifically for patients with
orthostatic hypotension due to diabetes.
40. Gastrointestinal Neuropathies
Gastrointestinal neuropathies may involve any portion of the gastrointestinal
tract with manifestations including esophageal dysmotility, gastroparesis
(delayed gastric emptying), constipation, diarrhea, and fecal incontinence.
Incidence of gastroparesis over 10 years was higher in type 1 diabetes (5%)
than in type 2 diabetes (1%).
Gastroparesis may directly affect glycemic management.
41. Screening & Diagnosis
Evaluate for gastroparesis in people with diabetic neuropathy, retinopathy,
and/or nephropathy by assessing for symptoms of unexpected glycemic
variability, early satiety, bloating, nausea, and vomiting.
Exclusion of other causes documented to alter gastric emptying, such as use
of opioids or glucagon-like peptide 1 receptor agonists and organic gastric
outlet obstruction, is needed before performing specialized testing for
gastroparesis.
To test for gastroparesis, either measure gastric emptying with scintigraphy of
digestible solids at 15-min intervals for 4 h after food intake or use a 13C-
octanoic acid breath test.
42. Treatment
Only metoclopramide, a prokinetic agent, is approved by the FDA for the
treatment of gastroparesis.
Dietary changes may be useful, such as eating multiple small meals and
decreasing dietary fat and fiber intake.
Withdrawing drugs with effects on gastrointestinal motility, such as opioids,
anticholinergics etc.
43. Erectile Dysfunction
ED may be a consequence of autonomic neuropathy, as autonomic
neurotransmission controls the cavernosal and detrusor smooth muscle tone and
function.
The etiology is multifactorial, and clinicians should also evaluate other vascular
risk factors such as hypertension, hyperlipidemia, obesity, endothelial
dysfunction, smoking, CVD, concomitant medication, and psychogenic factors.
Glucose control was associated with a lower incidence of erectile dysfunction.
Pharmacological treatment includes phosphodiesterase type 5 inhibitors as first-
line therapy and transurethral prostaglandins, intracavernosal injections, vacuum
devices, and penile prosthesis in more advanced cases.
44. Lower Urinary Tract Symptoms and Female Sexual
Dysfunction
Manifest as urinary incontinence and bladder dysfunction (nocturia,
frequent urination, urgency,weak urinary stream).
Female sexual dysfunction occurs more frequently in women with
diabetes.
Bladder dysfunction presents as recurrent urinary tract infections,
pyelonephritis, incontinence, or a palpable bladder.
45. Atypical Neuropathies
Mononeuropathies
It can occur as a result of involvement of the median, ulnar, radial, and
common peroneal nerves.
Cranial neuropathies present acutely and are rare; primarily involve cranial
nerves III, IV, VI, and VII; and usually resolve spontaneously over several
months.
Electrophysiological studies are helpful.
Nerve entrapments may require surgical decompression.
46. Diabetic Radiculoplexus Neuropathy
Diabetic radiculoplexus neuropathy, a.k.a. diabetic amyotrophy or diabetic
polyradiculoneuropathy, typically involves the lumbosacral plexus.
Occurs mostly in men with type 2 diabetes.
People with the condition routinely present with extreme unilateral thigh pain and
weight loss, followed by motor weakness.
Electrophysiological assessment is required to document the extent of disease
and alternative etiologies.
Usually self-limiting, and patients improve over time with medical management
and physical therapy.
47. Treatment-Induced Neuropathy
Treatment-induced neuropathy in diabetes (also referred to as insulin
neuritis) is considered a rare iatrogenic small-fiber neuropathy caused by an
abrupt improvement in glycemic control in the setting of chronic
hyperglycemia, especially in patients with very poor glucose control.
The prevalence and risk factors of this disorder are not known but are
currently under study.
48. Questions
1. Prevention of diabetes neuropathy can be done by :
a. Glucose control only
b. Lifestyle modification only
c. Both
Ans . c
49. 2 . Patients with type2 diabetes should be screened for neuropathy at
a. 5 years
b. 10 years
c. Annually
d. At the time of diagnosis
Ans . d
50. 3 . Site of monofilament testing
a. 2,3,4 metatarasals
b. 1,3,5 metatarsals
c. 4,5,6 metatarsals
d. 1,2, 3 metatarsals
Ans . b
51. 4. Treatment of choice for pain management in diabetic neuropathy
a. SSRI
b. Tricyclic antidepressants
c. Opioids
d. Voltage gated a2 ligand
Ans . d
52. 5 . Most common diabetic autonomic neuropathy is
a. Gastroparesis
b. ED
c. CAN
Ans . c
53. 6. FDA approved drug for the treatment of orthostatic hypotension in diabetes
a. Fludrocortisone
b. Midodrine
c. Droxidopa
Ans. b
54. Take Home Message
DSPN is a very prevalent complication of diabetes.
Tight glucose control & life style modification will help in prevention.
All patients should be screened.
Foot care should be explained.
Pregabalin or duloxetine useful for DSPN.
Metoclopramide used for the treatment of gastroparesis.