Medical history (history of illness) represents an important component in the diagnosis of diabetic polyneuropathy. Family history Are there any diseases (diabetes mellitus, neurologic diseases) in your family that are common? Social history Current medical history/systemic history (somatic and psychological complaints). Have you noticed symptoms such as burning, tingling, or loss of sensation in arms … Diabetic Polyneuropathy: Medical History
Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99). Hereditary motor-sensitive neuropathy type I (HMSN I; from English, “hereditary neuropathy with liability to pressure palsies” (HNPP); synonyms: Charcot-Marie-Tooth disease (CMT), English Charcot-Marie-Tooth disease) – chronic neuropathy inherited in an autosomal dominant manner, resulting in motor and sensory deficits. Blood, blood-forming organs – immune system (D50-D90). Pernicious anemia … Diabetic Polyneuropathy: Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be contributed to by diabetic polyneuropathy: Endocrine, nutritional, and metabolic diseases (E00-E90). Severe hypoglycemia (hypoglycemia) due to lack of awareness of symptoms. Diabetic foot or diabetic foot syndrome (DFS) – ulcerations (ulcers) on the feet due to circulatory disturbances of the limb and/or the … Diabetic Polyneuropathy: Complications
To prevent diabetic polyneuropathy, attention must be paid to reducing individual risk factors. Behavioral risk factors Diet Micronutrient deficiency (vital substances) – see Prevention with micronutrients. Consumption of stimulants Alcohol (= alcohol-associated polyneuropathy) → sensitive symptoms, such as numbness, stinging, or gait unsteadiness. Tobacco (smoking); moderate association between smoking and diabetic peripheral neuropathy (DPN). Poor … Diabetic Polyneuropathy: Prevention
The following symptoms and complaints may indicate diabetic polyneuropathy: Sensory insensitivity Formication Burning Lack of sensation of heat or cold Tingling sensation Furry feeling Swelling sensation Stinging Numbness Motor symptoms Muscle spasms Muscle weakness Muscle twitching Pain Sensory and motor disturbances (= sensorimotor diabetic polyneuropathy) usually occur uniformly in both legs and/or hands, so they … Diabetic Polyneuropathy: Symptoms, Complaints, Signs
Pathogenesis (disease development) The pathophysiology of diabetic polyneuropathy is not yet fully understood. However, several factors that attack and damage the nerves are considered proven: Microangiopathy (disease of the small blood vessels) of the vasa nervorum (small blood vessels supplying the nerves). Direct metabolic-toxic damage to neurons by various substances (such as sorbitol and fructose) … Diabetic Polyneuropathy: Causes
General measures Aim for normal weight!Determine BMI (body mass index, body mass index) or body composition using electrical impedance analysis and participate in a medically supervised weight loss program. Nicotine restriction (refrain from tobacco use). Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day), as alcohol can … Diabetic Polyneuropathy: Therapy
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing). Skin and mucous membranes (skin temperature, skin tugor and perspiration). Gait Acquisition of muscle and joint function Foot [rhagades?, blistering?, subcutaneous hemorrhages?; hyperkeratosis (keratinization)?, signs of bacterial infection and/or … Diabetic Polyneuropathy: Examination
1st order laboratory parameters – obligatory laboratory tests. Small blood count Differential blood count [eosinophilia? Macrocytic anemia? MCV elevation in alcohol abuse/alcohol dependence?] Inflammatory parameters – CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate). Urine status (rapid test for: pH, leukocytes, nitrite, protein, glucose, ketone, blood), sediment, if necessary urine culture (pathogen detection and resistogram, … Diabetic Polyneuropathy: Test and Diagnosis
Therapy goals Normoglycemia (blood glucose levels within normal range) including control of cardiovascular risk factors. Improvement of the general quality of life Therapy recommendations Therapy of painful diabetic polyneuropathy is symptomatic. It should always be supported by nonpharmacologic measures. Therapy of painful diabetic polyneuropathy should begin as early as possible and thus lead to an … Diabetic Polyneuropathy: Drug Therapy
Obligatory medical device diagnostics. Electromyography (EMG; measurement of electrical muscle activity) of affected nerves – if proximal nerve damage is suspected. Electroneurography (ENG; method for measuring nerve conduction velocity) of affected muscles [impaired nerve conduction velocity without symptoms or clinical findings = subclinical diabetic polyneuropathy]. Optional medical device diagnostics – depending on the results of … Diabetic Polyneuropathy: Diagnostic Tests
An at-risk group indicates the possibility that the disease may be associated with the risk of vital nutrient deficiency. The complaint diabetic polyneuropathy indicates a vital nutrient deficiency for L-carnitine Within the framework of micronutrient medicine, the following vital substances (micronutrients) are used for prevention. Omega-6 fatty acid gamma-linolenic acid Within the framework of micronutrient … Diabetic Polyneuropathy: Micronutrient Therapy
