Diabetic neuropathy diagnosis -
Some drugs affect bladder function, so your health care provider may recommend stopping or changing medications. A strict urination schedule or urinating every few hours timed urination while applying gentle pressure to the bladder area below your bellybutton can help some bladder problems.
Other methods, including self-catheterization, may be needed to remove urine from a nerve-damaged bladder. Digestive problems. To relieve mild signs and symptoms of gastroparesis — indigestion, belching, nausea or vomiting — eating smaller, more frequent meals may help.
Diet changes and medications may help relieve gastroparesis, diarrhea, constipation and nausea. Sexual dysfunction. Medications taken by mouth or injection may improve sexual function in some men, but they aren't safe and effective for everyone.
Mechanical vacuum devices may increase blood flow to the penis. Women may benefit from vaginal lubricants. Request an appointment. These measures can help you feel better overall and reduce your risk of diabetic neuropathy: Keep your blood pressure under control. If you have high blood pressure and diabetes, you have an even greater risk of complications.
Try to keep your blood pressure in the range your health care provider recommends, and be sure to have it checked at every office visit. Make healthy food choices. Eat a balanced diet that includes a variety of healthy foods — especially vegetables, fruits and whole grains.
Limit portion sizes to help achieve or maintain a healthy weight. Stop smoking. Using tobacco in any form makes you more likely to develop poor circulation in your feet, which can cause problems with healing.
If you use tobacco, talk to your health care provider about finding ways to quit. For diabetic neuropathy, you may want to try: Capsaicin. Capsaicin cream, applied to the skin, can reduce pain sensations in some people. Side effects may include a burning feeling and skin irritation.
Alpha-lipoic acid. This powerful antioxidant is found in some foods and may help relieve nerve pain symptoms in some people. This nutrient is naturally made in the body and is available as a supplement. It may ease nerve pain in some people. Transcutaneous electrical nerve stimulation TENS.
This prescription therapy may help prevent pain signals from reaching the brain. transcutaneous electrical nerve stimulation TENS delivers tiny electrical impulses to specific nerve pathways through small electrodes placed on the skin. Although safe and painless, doesn't work for everyone or for all types of pain.
Acupuncture may help relieve the pain of neuropathy, and generally doesn't have any side effects. Keep in mind that you may not get immediate relief with acupuncture and might require more than one session. Diabetic neuropathy and dietary supplements. To prepare for your appointment, you may want to: Be aware of any pre-appointment restrictions.
When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet. Make a list of any symptoms you're having, including any that may seem unrelated to the reason for the appointment.
Make a list of key personal information, including any major stresses or recent life changes. Make a list of all medications, vitamins, herbs and supplements you're taking and the doses.
Bring a record of your recent blood sugar levels if you check them at home. Ask a family member or friend to come with you. It can be difficult to remember everything your health care provider tells you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
Make a list of questions to ask your health care provider. Some basic questions to ask may include: Is diabetic neuropathy the most likely cause of my symptoms? Do I need tests to confirm the cause of my symptoms? How do I prepare for these tests? Is this condition temporary or long lasting? If I manage my blood sugar, will these symptoms improve or go away?
Are there treatments available, and which do you recommend? What types of side effects can I expect from treatment? I have other health conditions. How can I best manage them together? Are there brochures or other printed material I can take with me?
What websites do you recommend? Do I need to see a certified diabetes care and education specialist, a registered dietitian, or other specialists? What to expect from your doctor Your health care provider is likely to ask you a number of questions, such as: How effective is your diabetes management?
When did you start having symptoms? Do you always have symptoms or do they come and go? How severe are your symptoms? Does anything seem to improve your symptoms? What, if anything, appears to make your symptoms worse? What's challenging about managing your diabetes?
What might help you manage your diabetes better? By Mayo Clinic Staff. Apr 29, Show References. Ferri FF. Diabetic polyneuropathy. In: Ferri's Clinical Advisor Elsevier; Accessed Dec.
Diabetic neuropathy. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed Jan. American Diabetes Association. Standards of medical care in diabetes — Diabetes Care. Accessed Nov. Peripheral neuropathy adult.
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Disorders of peripheral nerves. In: Bradley and Daroff's Neurology in Clinical Practice. Baute V, et al. Complementary and alternative medicine for painful peripheral neuropathy.
Current Treatment Options in Neurology. Nature Reviews — Disease Primers. Cutsforth-Gregory expert opinion. Mayo Clinic. Castro MR expert opinion. Types of diabetic neuropathy. Associated Procedures. A Book: The Essential Diabetes Book.
Show the heart some love! Give Today. Help us advance cardiovascular medicine. Find a doctor. Explore careers. Lesions of the peripheral nerve roots are typically asymmetric, follow a dermatomal pattern of sensory symptoms, and may have associated neck and low back pain. Lesions of the plexus are asymmetric with sensorimotor involvement of multiple nerves in one extremity.
A Hz tuning fork should be used to test the vibratory sensations in extremities. Loss of sensation including vibration, proprioception, temperature, and pinprick sensations in distal extremities suggests peripheral neuropathy, as does a distal-to-proximal gradient of reflex elicitation.
Once the lesion has been localized to peripheral nerves, the next step is to find the etiology and exclude potentially treatable causes, such as acquired toxic, nutritional, inflammatory, or immune-mediated demyelinating disorders.
The neuropathies must be further characterized by onset and chronicity of symptoms, the pattern and extent of involvement, and the type of nerve fibers involved i. Over time, the numbness may extend proximally, and mild distal muscle weakness and atrophy may occur.
In disorders that cause acute peripheral neuropathy, such as those produced by toxic exposures, patients may present with similar but more fulminant symptoms, and pain predominates; symptoms also typically have a faster progression.
In other disorders, such as acute inflammatory demyelinating disorder i. The presence of neuropathic symptoms, decreased ankle reflexes, and decreased distal sensations, regardless of distal muscle weakness and atrophy, makes the diagnosis of peripheral neuropathy likely.
Some causes of peripheral neuropathy are characterized by mononeuropathy, some involve multiple nerves, and others have autonomic dysfunction or pain prominence Table 2. The evaluation of a patient with peripheral neuropathy starts with simple blood tests, including a complete blood count, comprehensive metabolic profile, and measurement of erythrocyte sedimentation rate and fasting blood glucose, vitamin B 12 , and thyroid-stimulating hormone levels 5 Figure 1.
Additional tests, if clinically indicated, may include a paraneoplastic panel to evaluate for occult malignancy; antimyelin-associated glycoprotein antibodies to evaluate for sensorimotor neuropathies; antiganglioside antibodies; cryoglobulins; cerebrospinal fluid CSF analysis to evaluate for chronic inflammatory demyelinating neuropathy; antisulfatide antibodies to evaluate for auto-immune polyneuropathy; and genetic testing if hereditary peripheral neuropathy is suspected Table 3.
Lumbar puncture and CSF analysis may be helpful in diagnosing Guillain-Barré syndrome and chronic inflammatory demyelinating neuropathy; CSF protein levels may be elevated in patients with these conditions.
Electrodiagnostic studies are recommended if the diagnosis remains unclear after initial diagnostic testing and a careful history and physical examination.
Nerve conduction studies assess the shape, amplitude, latency, and conduction velocity of an electrical signal conducted over the tested nerve. Axonal loss leads to lower amplitudes, and demyelination causes prolonged latency and slow conduction velocity.
EMG can detect active axonal damage, as evidenced by the presence of spontaneous muscle fiber activity at rest resulting from the absence of neuro-regulation denervation. The motor unit action potential on voluntary muscle contraction also is assessed.
In neuropathic conditions, reinnervation changes are recorded, the details of which are beyond the scope of this article. Electrodiagnostic studies can help determine whether the neuropathy is the result of damage to the axons axonal neuropathy or the myelin demyelinating neuropathy , or both mixed.
Normal nerve conduction studies and needle EMG significantly decrease the likelihood of peripheral neuropathy, whereas abnormal nerve conduction findings confirm the diagnosis.
A potential limitation of electrodiagnostic studies is that they are able to test only the large, myelinated nerve fibers.
This limits their sensitivity in detecting neuropathies of the small nerve fibers i. In these cases, a specialized test directed at autonomic functions, and other non-electrodiagnostic tests e.
Nerve biopsy should be considered when the diagnosis remains uncertain after laboratory and electrodiagnostic testing, or when confirmation of the diagnosis is needed before initiating aggressive treatment e.
Sural and superficial peroneal nerves are preferred for biopsy. When all investigations fail to identify a cause and electrodiagnostic studies show axonal-type symmetric peripheral neuropathy, idiopathic peripheral neuropathy is the presumptive diagnosis.
Epidermal skin biopsy can be performed in patients with burning, numbness, and pain, and in whom small, unmyelinated nerve fibers are suspected to be the cause. Small nerve fiber damage may constitute the earliest stages of some peripheral neuropathies and cannot be detected by electrodiagnostic studies.
Treatment of peripheral neuropathy has two goals: controlling the underlying disease process and treating troublesome symptoms. The former is usually achieved by eliminating offending agents, such as toxins or medications; correcting a nutritional deficiency; or treating the underlying disease e.
Acute inflammatory neuropathies require more urgent and aggressive management with intravenous immunoglobulin 9 or plasmaphereis. Mechanical ventilation should be considered in patients whose forced vital capacity is less than 20 mL per kg or is reduced by more than 30 percent of baseline, or if maximal inspiratory pressure is less than 30 cm of water.
It is important to help patients control troublesome symptoms of peripheral neuropathy, such as severe numbness and pain, as well as to alleviate disability resulting from weakness.
A second opinion regarding the patient's diagnosis and management also should be considered before initiating long-term opioid therapy.
Martyn CN, Hughes RA. Epidemiology of peripheral neuropathy. J Neurol Neurosurg Psychiatry. Davies M, Brophy S, Williams R, Taylor A. The prevalence, severity, and impact of painful diabetic peripheral neuropathy in type 2 diabetes. Diabetes Care.
England JD, Gronseth GS, Franklin G, et al. Distal symmetric polyneuropathy: a definition for clinical research. Willison HJ, Winer JB. Clinical evaluation and investigation of neuropathy. Dyck PJ, Lais AC, Ohta M, Bastron JA, Okazaki H, Groover RV. Chronic inflammatory polyradiculoneuropathy.
Mayo Clin Proc. Lewis RA. Chronic inflammatory demyelinating polyneuropathy. Neurol Clin. Hughes RA, Raphaël JC, Swan AV, van Doorn PA.
Intravenous immunoglobulin for Guillain-Barré syndrome. Cochrane Database Syst Rev. Raphaël JC, Chevret S, Hughes RA, Annane D. Plasma exchange for Guillain-Barré syndrome.
Lawn ND, Fletcher DD, Henderson RD, Wolter TD, Wijdicks EF. Anticipating mechanical ventilation in Guillain-Barré syndrome.
Diabetic neuropathy is Intermittent fasting for weight loss diabetes causes damage Nduropathy your nerves. Body recomposition transformation can affect different neuropath Body recomposition transformation nerves in your body, including in your feet, Diabetci and muscles. Nerves Body recomposition transformation messages neuropathh the brain and every part of our bodies so that we can see, hear, feel and move. They also carry signals to parts of the body such as the heart, making it beat at different speeds, and the lungs, so we can breathe. Damage to the nerves can therefore cause serious problems in various parts of the body for people with type 1, type 2 or other types of diabetes.
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