Polyneuropathies: Therapy

General measures

• Nicotine restriction (refraining from tobacco use).
• Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day), as alcohol can lead to hypoglycemia (low blood sugar).
• Aim for normal weight!Determination of BMI (Body Mass Index, body mass index) or body composition by means of electrical impedance analysis and participation in a medically supervised weight loss program.
• Regular examinations of the feet and footwear (foot care; if necessary, see also under “Diabetic foot/other therapy“).
• Optimal adjustment of concomitant diseases (blood pressure; blood lipids).
• Review of permanent medication due topossible effect on the existing disease.
• Avoidance of psychosocial conflict situations:
  • Bullying
  • Mental conflicts
  • Stress
• Avoidance of environmental stress:
  • Acrylamide – formed during frying, grilling and baking; used in the production of polymers and dyes.
  • Arsenic
  • Hydrocarbons
  • Heavy metals such as lead, thallium, mercury
  • Carbon disulfide
  • Trichloroethylene
  • Triorthocresyl phosphate (TKP)
  • Bismuth (due tobismuth-containing dental material or in the case of long-term treatment with bismuth preparations).

Conventional non-surgical therapy methods

• Electrical spinal cord stimulation (stimulation of the posterior cord pathways by epidural electrical spinal cord stimulation with permanently implanted pulse generator); indication: diabetic patients with painful, refractory peripheral neuropathy; reduction of pain level by 58%; potential complications: Infection incidence 3%, electrode complications 8% (approximately 8% infections and 30% electrode complications).

Bariatric surgery/Bariatic surgery

In severely obese patients, gastric bypass (artificially reduced stomach) may be indicated in terms of metabolic surgery. According to a study by Schauer et al, 42 percent of diabetic patients have a normal HbA1c (laboratory parameter for determining blood glucose over the past days or weeks/HbA1c is the “blood glucose long-term memory,” so to speak) after surgery. In another study by Mingrone, as many as 75% of patients achieved remission of diabetes mellitus.

Vaccinations

The following vaccinations are advised because infection often leads to worsening of the diabetic metabolic situation:

• Pneumococcal vaccination
• Flu vaccination

Regular checkups

• Regular medical checkups

Nutritional medicine

Nowadays, the diet for a person suffering from diabetes is not as strict as it was a few years ago. It is also allowed to eat sugary foods.

• Nutritional counseling based on a nutritional analysis.
• The goal of the dietary change must be weight reduction to normal weight!
• Observance of the following nutritional medical recommendations:
  • Meals of diabetics should contain 15-20% protein (protein), 30% fats and > 50% carbohydrates.
  • Avoidance or reduction of monosaccharides (single sugars) and disaccharides (double sugars).
  • Diet rich in fruits and vegetables and marine fish (due toOmega-3 fatty acids).
• In diabetic gastroparesis (paralysis of gastric peristalsis), the symptoms can be improved by strained and pureed food; furthermore, the following recommendations should be considered:
  • Refrain from
    • Caffeine, peppermint, chocolate and fats because they reduce the pressure of the distal esophageal sphincter (lower sphincter in the transition area from the esophagus (food pipe) to the stomach)
    • Chewing gum, as they favor air swallowing.
  • Recommended are
    • Small meals low in fiber and low in fat
    • Chewing well and sitting upright for up to 30 minutes after a meal
    • Insulin-dependent diabetics should reduce the splash-eat interval.
• See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
• Detailed information on nutritional medicine you will receive from us.

Sports Medicine

• Endurance training (cardio training) and strength training (muscle training).
• Slow increase in endurance training: in the beginning, intervals can be trained until the breaks become shorter and shorter, so that training at a stretch for 30 minutes becomes possible.
• Through physical activity, blood glucose levels drop and insulin sensitivity is improved. However, since diabetics can experience blood glucose fluctuations during and after exercise, blood glucose monitoring before and after exercise is important.
• Preparation of a fitness or training plan with suitable sports disciplines based on a medical check (health check or athlete check).
• Detailed information on sports medicine you will receive from us.

Physical therapy (including physiotherapy)

• Occupational therapy (“work therapy” or “occupational therapy”) – indicated for hand function impairment.
• Cryotherapy (cold therapy)/cryocompression during chemotherapy – to prevent chemotherapy-induced peripheral neuropathy (CIPN) [unclear evidence].
• Physical therapy – exercises that improve stance and gait stability and train balance, coordination, and proprioception.
• If necessary, also balneological therapy measures

Psychotherapy

• Stress management – Participants in an eight-week anti-stress group therapy with weekly exercise program were less depressed and more physically fit after one year; they had lower blood pressure, for example. Their protein excretion was unchanged – it had deteriorated further in the untreated control group.
• Detailed information on psychosomatics (including stress management) is available from us.

Complementary treatment methods

• Sensorimotor training → stimulates neuronal adaptation responses, leading to long-term induction of neuronal plasticity of spinal and supraspinal structures in the central nervous system (CNS) . Training duration: 1-9 months; frequency 2 times per week; training session duration: 6-30 minutes; exercise duration: 20 seconds; pause between exercises: 20-40 seconds; number of repetitions: 3.
• Vibration training (frequency: >18 Hz; amplitude: 2-4 mm)Training duration: > 4 weeks; frequency 2-to 6 times per week; duration of the training session: 6-30 minutes; duration of the exercise: 20-60 seconds; pause between exercises: 20-60 seconds; number of series: 3-5; pauses between series: 1-4 minutes.

Training activities

• Every diabetic should attend special diabetic training courses that explain in detail the diagnosis and treatment of the disease, in order to live as independently and as safely as possible with diabetes.
• In a diabetic training is shown to those affected especially the correct use of insulin, the importance of blood glucose self-monitoring and the adapted diet.This includes in particular to recognize changes in the body in time to prevent damage, such as diabetic foot syndrome (DFS). It is therefore very important in this context to examine the feet daily for possible wounds (for more details, see “Diabetic foot“).
• Furthermore, in such groups, a mutual exchange of experience can take place.