Duration of diabetic neuropathy
The starting point for the diagnosis is the feelings of the person concerned: His description of the symptoms can already give the doctor important clues as to whether the symptoms are most likely to be due to diabetic neuropathy or whether other causes are more obvious. Diabetes patients should visit their diabetologist or a neurologist once a year to have the condition of their nerves checked, even if they do not have the symptoms. The doctor will first perform a few simple functional tests to check the various sensitive sensations (pain, touch, vibration and temperature sensations) of the skin and reflexes.
This examination is usually started on the legs, as this is where diabetic neuropathy originates in most patients. If the physical examination provides evidence of the presence of diabetic neuropathy, further examinations can be performed to confirm the suspicion and determine the extent of the damage. These include in particular electromyography (EMG) and electroneurography (ENG) with measurement of nerve conduction velocity (NLG).
If diabetic autonomic neuropathy is suspected, other examination methods are used: cardiac arrhythmias can be examined, for example, by means of a 24-hour ECG, while suspected circulatory instability can be evaluated by a so-called Schellong test (repeated blood pressure measurements before and after getting up quickly from a lying position). The measurement of nerve conduction velocity within the scope of electroneurography (ENG) is probably the most common instrumental examination method for diagnosing and monitoring diabetic neuropathy. For this purpose, two electrodes are attached to areas of skin under which one and the same nerve runs.
An electrical impulse is then emitted via one of the electrodes and the time elapsed until the signal reaches the second electrode is measured. The comparison with standard values or with values from previous examinations then provides information as to whether there is nerve damage or how the condition of the nerve has developed compared to the previous examination. The nerve conduction velocity can also be determined by electromyography: For this purpose, the nerve to be examined is stimulated with an electrode and then the strength and time delay of the muscle response is measured with a muscle electrode.
The question of the degree of disability in diabetic polyneuropathy cannot be answered in general terms. The classification depends on various factors, including in particular the extent of the impairment caused by the polyneuropathy and the treatment effort for the underlying diabetes disease. In principle, it is irrelevant whether it is a type 1 or type 2 diabetes, but a type 1 diabetes is usually associated with a greater effort due to the mandatory insulin injections.
On the basis of these considerations, a type 1 diabetic without other serious diseases and without consequential damage (such as diabetic polyneuropathy) is currently classified as having a degree of disability of 40. A degree of disability of at least 50 corresponds to a severe disability and, according to the Versorgungsmedizin-Verordnung, requires more than three insulin injections per day, an independent adjustment of the insulin dose to the self-measured blood sugar level as well as serious lifestyle changes. The small word “as well as” is decisive here: even if patients argue that daily blood glucose measurement and insulin injections represent a considerable cut in their lifestyle, the legislator considers these procedures to be already checked off in the previous paragraph. Consequently, for a degree of disability of 50 additional incisions must exist, such as polyneuropathy or diabetic foot syndrome.
