Working in various settings of physical therapy rehabilitation centers is one of the most challenging and complicated. Apart from the 40-hour workweek, it is physically strenuous as well. Physical therapists often have to the need to stoop, kneel, crouch, lift, and stand for extensive periods. Above and beyond, physical therapists move heavy equipment and lift patients or help them turn, stand, or walk.
Most of the patients that I have encountered are diagnosed with Diabetic Neuropathy (DN). Diabetic Neuropathy is a brought about by a complication of Type 1 and Type 2 Diabetes. In 2012, there are about 29.1 million Americans, or 9.3% of the population, had diabetes (American Diabetes Association [ADA], 2016). Due to its increase
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Acting in accordance with National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), diabetic neuropathies are family of nerve syndromes affected by diabetes (2009). People with diabetes can be asymptomatic overtime and some can have notable signs with radicular symptoms in the upper and lower extremities (NIDDK, 2009), Moreover, can affect even the digestive, cardiac, and reproductive system in serious conditions (NIDDK, 2009). In fact, based on academic literatures, about two thirds of patients with diabetes have medical or subclinical pathology of nerve (Bansal, Kalita, & Mistra, 2006). The occurrence of neuropathy amplified from approximately 7 percent to 50 percent on admittance at 25 years in consequence (Bansal, Kalita, & Mistra, 2006).
The threatening factors of diabetic neuropathy are as follows: decreased glycemic regulation, old age, high blood pressure, prolonged diabetic mellitus (DM), increased cholesterol, smoking, alcoholic, tall height, and HbA1c level (Quann, Lin, & Khardori , 2015). About close to 26 percent of seniors or above 65 years of age are impacted with DN (ADA, 2016).
Diabetes was the 7th primary cause of mortality in the United States in 2010 (ADA, 2016).
Pathogenesis of DN
Several assumptions were made due to unexplained pathological mechanism of DN
Explain, that diabetes is the most common cause of neuropathy. Peripheral neuropathy is the most common form of diabetic neuropathy. Your feet and legs are often affected first, followed by your hands and arms.
Diabetes is a disease where the body is unable to produce or use insulin effectively. Insulin is needed for proper storage and use of carbohydrates. Without it, blood sugar levels can become too high or too low, resulting in a diabetic emergency. It affects about 7.8% of the population. The incidence of diabetes is known to increase with age. It’s the leading cause of end-stage renal disease in the US, and is the primary cause of blindness and foot and leg amputation. It is known to cause neuropathy in up to 70% of diabetic patients. Individuals with diabetes are twice as likely to develop cardiovascular disease. There are two types of diabetes: Type 1 and Type 2.
Why are nerves often damaged in patients with diabetes mellitus, and what are some of the
The rate of diabetes in the United States is one of the highest compared to other developed countries. An estimate of 9.3% of the population have diabetes, of those with diabetes 27.8% have yet to be diagnosed (Centers for Disease Control and Prevention [CDC], 2014). This means that approximately 8.1 million people are currently living with diabetes, but are unaware of it. As of 2012, 12.3% of people with diabetes were 20 years old or older, the largest population diagnosed with diabetes were adults 65 years old or older. 25.9% of this population lives with diabetes (CDC, 2014). On a national level, the CDC have launched initiatives that focus on prevention and disease management. The National Diabetes Prevention Program is an example of one such initiative. This program focuses on lifestyle changes,
Diabetic neuropathy can occur with long-term diabetes, usually after several years of uncontrolled high blood glucose. Glucose proteins, called glycoproteins, form in the nerves primarily those in the legs and feet. When the nerves in the feet are damaged, the brain cannot recognize pain in that area. Nerve damage from diabetic neuropathy can lead to weakness in the muscles in the legs and feet. Since the muscles work as a system, neuropathy can lead to other foot problems, such as hammertoes, calluses, bunions, and other foot deformities. These deformities are dangerous because of the risk of infection. A simple blister from a tight shoe can spell disaster
7. Examine your feet. Diabetes-related nerve damage can mean that you might have minor injuries to your feet that you can’t feel. This can lead to infections and other complications. Check the soles of your feet daily. Put lotion on them at night to keep the skin in good condition. Wear comfortable shoes that fit correctly. Ask your doctor to examine your feet whenever you have an office visit.
The early diagnosis of neuropathy is crucial to stop progression to advanced stages, and further complications. (Toopchizadeh V., et al.2016) Early intervention can protect diabetic patients from a risk of foot ulcers and amputation, improve the quality of life (Vlckova-Moravcova E, et al 2008.Van Schie CH. 2008, Ismail K, et al 2007) and mitigate the socioeconomic consequences of diabetic foot disease. (Davis WA,et al 2006,Lavery LA,et al 2007,Gordois A,et al 2003 )
Diabetic neuropathy is a nerve disorders caused by diabetes. Symptoms include pain, tingling, or numbness, loss of feeling in hands, arms, feet, and legs. Nerve problems can occur in every organ system. Diabetic neuropathies appears more common in people who have problems controlling their blood glucose, those with high levels of blood fat, high blood pressure and obese (Porth, 2015). Metabolic factors include high blood glucose, abnormal blood fat levels, and low insulin levels. Neurovascular factors are associated to damage to the blood vessels that carry oxygen and nutrients to nerves (Porth, 2015). Autoimmune factors that cause inflammation in nerves. Mechanical injury to nerves, for example, carpal tunnel syndrome (Porth, 2015). Inherited
Physical Therapists help people who have suffered an injury and have suffered impairment. They help develop a plan that helps bring back mobility into the part of the body, help relieve pain, and they prevent the risk of permanent physical disability. In specifically they help people with problems that are a result from a back or neck injury which include: sprains, strains neurological disorders, sports related injuries and any other condition.
Diabetic neuropathy is defined as damage to nerves caused by diabetes. Nerve damage in the arms, legs, hands and feet caused by diabetes is referred to as diabetic peripheral neuropathy. While some patients may have extremely painful symptoms, others may be asymptomatic. If there is damage to the peripheral nerves, one might not be able to feel normally in their arms, hands, legs, and feet. In some cases, these parts may feel numb. Some may also have a needles and pins, or burning sensation. These symptoms are often worsened at night and can interfere with sleep. "Painful diabetic neuropathy symptoms exhibit a symmetrical 'stocking and gloves' distribution and are often associated with nocturnal exacerbation (Aslam, Singh, & Rajbhandari, 2014,
One of the most common long-term complications of diabetes mellitus is painful neuropathy. Diabetic neuropathy is estimated to affect about 60-70% of all diabetes patients and can lead to foot ulcers, amputations, and decreased quality of life. The most common form is chronic peripheral neuropathy which results in pain and numbness in the extremities, usually described as a burning, tingling, or steady aching pain.1 Patients may also feel increased sensitivity to pain or experience paresthesia, a sensation of tingling, tickling, or prickling of the skin.1 According to current guidelines, intensive glycemic control is very important for the prevention and reduction of peripheral neuropathy and other microvascular complications.1,2 Medications used to help relieve nerve pain include duloxetine and pregabalin (Lyrica®), which are both approved by the U.S. Food and Drug Administration for use in diabetic neuropathy. Other drug classes commonly used are antidepressants, anticonvulsants, and opioids.3 Although there are many medications used for this condition, pain relief is often insufficient for patients. Treatment is difficult due to the complicated pathophysiology of pain transmission and the wide range of mechanisms of action of drugs used to treat pain. Therefore, there is a continued need for additional medication options for this chronic painful condition. Lacosamide is an anticonvulsant approved for use as monotherapy or adjunctive therapy for partial-onset seizures.
First, we will talk about Peripheral neuropathy which is a medical term used to describe a whole series of disorders resulting from damage to the body's peripheral nervous system( Alexiadou and Doupis, 2012). According to research, Diabetic neuropathy is the common factor in almost 90% of diabetic foot ulcers ( Alexiadou and Doupis, 2012). Because even a slightly high blood sugar level can causes damage of some nerves. It will affected
Diabetic peripheral neuropathy is caused by prolonged elevated blood sugar, which affects the nerves, particularly in the extremities. According to research, diabetic peripheral neuropathy can affect other parts of the body which can also contribute to other critical conditions.
Diabetic foot ulcer (DFU) is a major complication of diabetes mellitus [2]. Non-healing ulceration usually progress to amputation in spite of standard care. DFUs result from interaction of ;neuropathy, peripheral vascular disease and foot deformity. 80% of diabetic persons with foot ulcers present with peripheral neuropathy which is the greatest risk of foot ulceration [3]. Neuropathy in DM shows variable degrees of autonomic, sensory, and motor functions changes[4]. Motor neuropathy causes atrophy of the foot muscles resulting in clawing of the toes, sensory neuropathy results in repetitive trauma to the foot, and autonomic neuropathy changes skin consistency so accelerating ulcer formation [5] .40 to 50% of all patients show ischemic manifestations with the most having neuroischemic ulcers, and only few of them has purely ischemic
The nervous system consists of a complex network of nerve cells and fibers which transmit impulses between the different parts of the body. Diabetic neuropathy is a nerve disorder caused by diabetes where high blood glucose levels cause chemical changes in nerves, impairing their ability to transmit signals. It also damages the blood vessels which carry oxygen and nutrients to nerves. This nerve damage can lead to problems with every other body system, resulting in numbness, tingling sensations, limb pain, indigestion, diarrhea, constipation, dizziness, bladder infections, impotence, weakness and depression. Approximately 60% of diabetics are diagnosed with some form of neuropathy (Diabetes United Kingdom,