| Diabetic neuropathy is defined as nerve damage (neuropathy) resulting from decreased blood flow and elevated blood sugar levels secondary to diabetes and is a complication of this disease. There are two basic types of neuropathy, peripheral and autonomic, and are differentiated by the nerves affected.
Peripheral neuropathy affects the nerves of the head and spinal cord as well as the nerves that branch out from the spinal cord. This type of neuropathy tends to develop in stages. It begins with a tingling sensation that, over time, develops to pain and eventually to a loss of sensation entirely.
Autonomic neuropathy involves nerves that control the involuntary movement of vital organs such as the heart, the digestive system, and the glands. Autonomic neuropathy is characterized by low blood pressure (hypotension), diarrhea, constipation, sexual dysfunction, vision problems, eye pain, and other symptoms.
On average, diabetic neuropathy occurs 10 to 20 years after diabetes has been diagnosed, although some diabetics will never develop neuropathy, and others will develop this condition relatively early in the disease process.Risk: Patients at risk for diabetic neuropathy generally have problems controlling their blood glucose levels, serum lipid levels, blood pressure, or body weight. Diabetics over the age of 40 are also at risk for diabetic neuropathy. Incidence and Prevalence: Ten to sixty-five percent of all patients with diabetes have some sort of disease-related neuropathy, with the highest rates occurring in patients who have had the disease for over 25 years (Soliman). |
Source: Medical Disability Advisor
| History: The individual will have a history of diabetes mellitus, usually for more than 10 years. Symptoms will vary depending on the nerves affected, and will develop gradually over a period of years. Common complaints include tingling, pain, decreased sensation or loss of sensation, particularly in the feet or hands. Drooping of the eyelid, mouth, or face may also occur as nerves to the facial muscles are damaged. If the autonomic nerves are affected, diarrhea, constipation, loss of bladder control (urinary incontinence), sexual dysfunction, and difficulty swallowing may be reported. Additional symptoms include vision changes, dizziness (particularly with changes in body position), weakness, speech impairment, and involuntary muscle contractions. Pain may also cause difficulty sleeping. Physical exam: The exam may reveal a decreased skin temperature, a reddish-blue discoloration of the hands, lower legs, and feet with loss of skin color when the arm or leg is elevated (vascular insufficiency). There may be a decrease or absence of ankle reflexes, and the individual may not be able to distinguish sharp from dull or hot from cold when applied to the skin (2-point discrimination). The most subtle finding is the decrease of light touch and pain sensation in the toes. The physician may also find a decrease or absence of pulses or a drop in blood pressure with positional changes from lying or sitting to standing (postural hypotension). The individual's nails may be very thick and have ridges with dryness and cracks in the skin. Tests: A blood glucose test will confirm the presence of diabetes but nerve conduction studies may be necessary to determine the presence of diabetic neuropathy. Tests for delayed gastric emptying are sometimes useful. Anscore testing, which measures autonomic neuropathy of the heart, has recently been developed and is used to diagnose diabetic neuropathy. |
Source: Medical Disability Advisor
| Diabetic neuropathy is a progressive disease. Treatment is aimed at alleviating symptoms. Control of the underlying diabetes is vital. Medications may be prescribed (as needed) to control pain (analgesics, antidepressants and/or anticonvulsants), insomnia (sedatives, antidepressants), anxiety (sedatives, antidepressants), infection (antibiotics), and muscle cramps (muscle relaxants). |
Source: Medical Disability Advisor
| The process of diabetic neuropathy is not well understood. The disease is progressive. If untreated or poorly treated (those who do not adequately control their blood sugar), outcome is generally poor. If caught early and the underlying cause, diabetes mellitus, is treated aggressively, progression may be stopped or slowed, making for a better outcome. In some individuals, medication may restore some degree of nerve function; however, substantial reversal of nerve damage is rare. |
Source: Medical Disability Advisor
| Complications of diabetic neuropathy may include bladder infections or muscle wasting (diabetic amyotrophy). In addition, individuals with this condition are at increased risk of traumatic injury including burns, infection, or gangrene. Charcot joint disease is a complication resulting in fractures and collapsing bones in the feet, and occurs in individuals with good vascular supply and neuropathy. |
Source: Medical Disability Advisor
| Individuals should avoid extreme temperature variations or moist/wet areas. Extended/prolonged standing could increase complications, so reassignment to a more sedentary position may be required. The use of gloves and appropriate footwear (safety shoes) may be necessary. Individual should also avoid direct skin exposure to chemicals. Individuals who have lost sensation to a particular body part may need to be reassigned depending on their job requirements. For example, a chef who could not feel pain in the hand would be prone to burns. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- How long has individual had diabetes?
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Does individual have peripheral or autonomic neuropathy?
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Does individual complain of a tingling, pain, decreased sensation or loss of sensation, particularly in the feet or hands?
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Does individual have hypotension, drooping of the eyelid, mouth, or face?
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Does individual have diarrhea, constipation, urinary incontinence, sexual dysfunction, difficulty swallowing, vision changes, dizziness (particularly with position changes), weakness, speech impairment, and involuntary muscle contractions?
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Does pain cause difficulty sleeping?
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On exam does individual have decreased skin temperature, a reddish-blue discoloration of the hands, lower legs, and feet with vascular insufficiency? Is there a decrease or absence of ankle reflexes? Is individual able to distinguish sharp from dull or hot from cold? Is there an absence of pulses? Postural hypotension? Abnormal nails and skin?
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Have conditions with similar symptoms been ruled out?
Regarding treatment:
- Is individual receiving treatment that is aimed at alleviating symptoms?
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Does individual have control of the underlying diabetes?
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If needed, have medications been prescribed to control pain, insomnia, anxiety, and/or muscle cramps?
Regarding prognosis:
- Is individual's employer able to accommodate any necessary restrictions?
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Does individual have any conditions that may affect the ability to recover?
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Does individual have any complications such as bladder infections, diabetic amyotrophy, and traumatic injury including burns, infection, or gangrene?
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Source: Medical Disability Advisor
| Soliman, Emad, and Charles Gellido. "Diabetic Neuropathy." eMedicine. Eds. Milind J. Kothari, et al. 20 Sep. 2004. Medscape. 21 Dec. 2004 <http://emedicine.com/NEURO/topic88.htm>. |
Source: Medical Disability Advisor
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