DIABETIC NEUROPATHY

A
NEUROLOGY UNIT PRESENTATION
BY
DURU CHINONSO ELIZABETH
 CONTENTS
• Introduction References
• Relevant Anatomy
• Prevalence
• Predisposing factors
• Causes
• Pathophysiology
• Signs and Symptoms
• Complications
• Assessment
• Management
• Conclusion
 INTRODUCTION
• According to Zeng,Diabetic neuropathy is a type of nerve
damage that can occur if you have diabetes. High blood sugar
(glucose) can injure nerves throughout the body. Diabetic
neuropathy most often damages nerves in the legs and feet.
• Symptoms include pain and numbness in the legs, feet and
hands. It can also cause problems with the digestive system,
urinary tract, blood vessels and heart.
• Some people have mild symptoms. But for others, diabetic
neuropathy can be quite painful and disabling.
Zeng et al., 2020
 RELEVANT ANATOMY
• The peripheral nervous system refers to the components
of the nervous system outside of the brain and spinal
cord.
• The nerve roots exit the spinal cord and then branch out
into smaller peripheral nerves. The peripheral nerves
consist of motor and sensory fibers.
• In diabetic neuropathy, there is degeneration in the type,
severity, and distribution of these receptors, nerve
fibers, or neurons, with the degeneration beginning
distally and symmetrically, and spreading proximally.
 PREVALENCE
• A large American study estimated that 47% of
patients with diabetes have some peripheral
neuropathy.
• Neuropathy is estimated to be present in 7.5% of
patients at the time of diabetes diagnosis.
• It has been estimated that the prevalence of
diabetes neuropathy in Nigeria is 71.1%.

Bodman et al.,2021
 PREVALENCE
• DM affects men and women with equal frequency.
However, male patients with type 2 diabetes may
develop diabetic neuropathy earlier than female
patients, and neuropathic pain causes more morbidity in
females than in males.
• Diabetic neuropathy can occur at any age but is more
common with increasing age and severity and duration
of diabetes.
 PREDISPOSING FACTORS
• Anyone who has diabetes can develop neuropathy.
But these risk factors make nerve damage more
likely:
• Poor blood sugar control. Uncontrolled blood sugar
increases the risk of every diabetes complication,
including nerve damage.
• Diabetes history. The risk of diabetic neuropathy
increases the longer a person has diabetes,
especially if blood sugar isn't well controlled.
 PREDISPOSING FACTORS
* Kidney disease. Diabetes can damage the kidneys.
Kidney damage sends toxins into the blood, which can
lead to nerve damage.
* Being overweight. Having a body mass index (BMI) of
25 or more may increase the risk of diabetic neuropathy.
* Smoking. Smoking narrows and hardens the arteries,
reducing blood flow to the legs and feet. This makes it
more difficult for wounds to heal and damages the
peripheral nerves.
Mayo Clinic 2018
 SIGNS AND SYMPTOMS
• There are four main types of diabetic neuropathy. You
can have one type or more than one type of neuropathy.
• Peripheral neuropathy
• This type of neuropathy may also be called distal symmetric
peripheral neuropathy. It's the most common type of diabetic
neuropathy. It affects the feet and legs first, followed by the
hands and arms.
 SIGNS AND SYMPTOMS CONT’D
• Autonomic neuropathy
• The autonomic nervous system controls blood pressure,
heart rate, sweating, eyes, bladder, digestive system and
sex organs. Diabetes can affect nerves in any of these
areas, possibly causing signs and symptoms including:
• A lack of awareness that blood sugar levels are low
(hypoglycemia unawareness)
• Drops in blood pressure when rising from sitting or lying
down that may cause dizziness or fainting (orthostatic
hypotension)
 SIGNS AND SYMPTOMS CONT’D
•Proximal neuropathy
•This type of neuropathy often affects
nerves in the thighs, hips, buttocks or
legs. It can also affect the abdominal and
chest area. Symptoms are usually on one
side of the body, but may spread to the
other side.
 SIGNS AND SYMPTOMS CONT’D
•Mononeuropathy (focal neuropathy)
•Mononeuropathy refers to damage to a
single, specific nerve. The nerve may be in
the face, torso, arm or leg.
Mononeuropathy may lead to:
•Difficulty focusing or double vision
•Paralysis on one side of the face
 COMPLICATIONS
• Diabetic neuropathy can cause a number of serious
complications, including:
• Hypoglycemia unawareness.
• Loss of a toe, foot or leg.
• Urinary tract infections and urinary incontinence.
• Sharp drops in blood pressure.
• Digestive problems.
• Sexual dysfunction.
• Increased or decreased sweating.
 MANAGEMENT OF DIABETES
NEUROPATHY
• MEDICAL MANAGEMENT/INTERVENTIONS
•Management of diabetic neuropathy, involves
taking of anti-diabetic drugs like; Apidra, insulin, etc
•Life style and diet modifications alongside with
physical activity plays a vital role in diabetes
management.
•Moreover, multidisciplinary team management is
required for the prevention and management of
diabetic foot complications.
Physiotherapy Management and Exercise
• Research has shown that strength training can moderately
improve muscle function, reduce neuropathic pain and help
control blood sugar levels for people with diabetic
neuropathy. Therefore, exercise can help to improve quality of
life for this patient group. Diabetic clients must take
precautions, including monitoring their blood sugar levels
during exercise and snacking beforehand to prevent major
fluctuations.
• Specific exercise programs should include
• Flexibility (progressive stretching and self stretches).
Physiotherapy Management and Exercise
• Muscle strengthening (using a variety of modes as appropriate
eg isometric, graded weight progression, open and close
chain).
• Aerobic activity.
• Posture and balance training (for falls prevention and
stability).
• Gait (can improve proprioception and gait pattern in patients
with diabetic neuropathy).
• Splinting for mononeuropathies eg. carpal tunnel or for
muscle weakness e.g. ankle foot orthoses.
PHYSIOTHERAPY MANAGEMENT OF PAIN IN DIABETES
NEUROPATHY
•Evidence has been provided for:
•Transcutaneous Nerve Stimulation (TENS).
•Massage.
•Low-intensity laser therapy.
• infrared light.
•Acupuncture.
 CASE REPORT
• Name: S.A
• Age: 62 years
• Sex: Female
• Occupation: Retired Enterprenuer
• Address: Mcc Road owerri
• Religion: Christainity
• Nationality: Nigerian
• Phone number: 0803458******
 SUBJECTIVE EVALUATION
• Complaint: inability to walk properly, severe pain at both feet and
hands accompanied by tingling sensation, and general weakness.
• History(source; patient): patient has been a known diabetic since two
years ago and was apparently healthy until 15th of june 2023, when
patient slept and on waking up in the morning felt loss of sensation to
the lower limbs and on trying to get up from bed had a fall. Prior to this
incidence patient haven’t been taking her medications as her sugar
level has been normal for a while according to patient reports. Patient
was immediately rushed to FUTHO where it was confirmed her sugar
was high and was placed on medication immediately, and was later
referred to PT dept for further management.
 SUBJECTIVE EVALUATION
• PAST MEDICAL HISTORY: Diabetes, Hypertension,
Ulcer
• SURGICAL HISTORY: NIL
• DRUG HISTORY: Anti-hypertensives, Anti-diabetics
• FAMILY & SOCIAL HISTORY: Patient is married with 9
children, a retired entrepreneur, lives in a
bungalow, uses wc, drinks satchet water, neither
drinks alcohol nor smoke.
OBSERVATION AND EVALUATION
•GENERAL OBSERVATION:A 62years old
woman was met in supine lying in the
ward, afebrile, anicteric, acyanosed,
without any notable respiratory distress,
in pains and well oriented.
•SEGMENTAL ASSESSMENT:
•Head and Neck: NAD
OBSERVATION AND EVALUATION
Thorax and Abdomen: NAD
Back and Spine: NAD
Upper Limbs: Tingling sensation on both hands
Muscle power, ROM, and other parameters are
intact in the upper limb.
LOWER LIMB
RIGHT;
Range of motion; Limited and painful across all
•Gross muscle power; 2
•Muscle tone; hypotonia
•Atrophy; present
•Sensitivity; intact
•Nil oedema
•LEFT;
•Range of motion; Full but painful across all
joints
•Gross muscle power; 2
•Muscle tone; hypotonia
•Atrophy; present
•Sensitivity; intact
•Nil oedema
FUNCTIONAL ABILITIES AND INABILITIES
•Patient can feed self
•Patient can’t stand or walk
•Patient can’t dress self properly

•IMPRESSION: Paraparesis secondary to

diabetes neuropathy
MEANS
•EMS to the both Lower limbs
•STM using zet gel on the upper & lower limbs
•Passive mobilization and stretching on the
lower limbs
•Strengthening exercises
•Standing and walking reeducation using the
zimmer frame
MEANS
•TREATMENT PROGRESS:
•Prior to discharge from the ward Pt was able to
gain some improvements on muscle power
from 2-3 as patient was able to stand for longer
duration
•Increase in muscle power
•Pain reduced
RECOMMENDATION
• In addition to medication, exercise should be part of your
treatment plan for most diabetic patients.
• Reduced sugar intake, dietary modification and increase in
physical activity should be advised amongst the general
population.
• Early knowledge about sugar level status, should be advised.
• It is also important to note that although there’s for type 2
diabetes, studies shows it’s possible to reverse it through diet
changes and weight loss, there by reducing the effect of
diabetes neuropathy.
REFERENCES
• Zeng L, Alongkronrusmee D, van Rijn RM. An integrated perspective on diabetic,
alcoholic, and drug-induced neuropathy, etiology, and treatment in the US. J Pain
Res. 2017 Jan 20. 10:219-228. [QxMD MEDLINE Link]. [Full Text].
• Bodman MA, Varacallo M. Peripheral Diabetic Neuropathy. StatPearls. 2021 Jan. [
QxMD MEDLINE Link]. [Full Text].
• Carmichael J, Fadavi H, Ishibashi F, Shore AC, Tavakoli M. Advances in Screening,
Early Diagnosis and Accurate Staging of Diabetic Neuropathy. Front Endocrinol
(Lausanne). 2021. 12:671257. [QxMD MEDLINE Link]. [Full Text].
• Mayo clinic
• Physiopedia
• Skyler JS. Diabetic complications. The importance of glucose control. Endocrinol
Metab Clin North Am. 1996 Jun. 25(2):243-54. [QxMD MEDLINE Link].
•THANK YOU FOR
YOUR TIME.