January 18, 2012

Diabetic Neuropathy – Part 3

Seeing a doctor is very difficult for many people. They do not like to admit something is wrong that they cannot handle. Others just will not see a doctor until they have to. Neuropathy is not something to take lightly and does need to be seen by a doctor. It is better to see a doctor sooner than later with neuropathy. I hate to say this, but if you can manage your diabetes, neuropathy may be managed as well. Neuropathy is still possible whether we like it or not.

If you have a cut or sore on your foot or lower legs that does not seem to be healing, is infected or is getting worse, seek medical care. If you have a burning sensation, a tingling, weakness, or pain in your hands or feet that bothers you doing your daily tasks, be sure to see a doctor. If you have dizziness, or changes in your digestion, urination, or sexual function, seek medical care quickly.

These symptoms do not always mean nerve damage, as they may indicate other problems needing medical care. Regardless of the symptoms, record them and get an appointment with your doctor, as this is your best opportunity to prevent more serious complications. If fact, any problems with your feet should be seen by a doctor. This is the best method to prevent any problems from becoming severe enough to cause amputation.

Anyone can develop neuropathy, but people with diabetes are more susceptible if they have these risk factors. Number one is poor blood glucose management as this is the greatest risk factor for every complication of diabetes. Keeping your blood glucose levels consistently within goals is the best way to protect the health of your nerves and blood vessels.

Another factor is just the length of time you have had diabetes. This is especially true if your blood glucose levels are poorly managed. Peripheral neuropathy is most common in people who have had diabetes for 25 years. Others who are successful in their management of their diabetes may never develop peripheral neuropathy.

Kidney disease is another factor that can be caused by poor management of diabetes and can increase the toxin in your blood and contribute to nerve damage. Finally, smoking causes your arteries to narrow and harden, reducing the blood flow to your legs and feet. This makes it more difficult for cuts and wounds to heal.

People with type 2 diabetes should prepare for their appointments by being prepared. Your preparation will depend on the doctor you are seeing. Unless your doctor is very knowledgeable about diabetes, expect to be referred to an endocrinologist as they specialize in treating metabolic disorders, such as diabetes. You may also be referred to a doctor who specializes in treating the nervous system (neurologist). Here are some tips to help make the best use of the time you have to spend with the doctor.

When you make the appointment, be sure to ask about special preparations necessary, such as fasting or diet restrictions. Next write down any symptoms you are experiencing. Be sure to include any symptoms even if they seem unrelated to the reason for seeing this doctor. Make a list of all (this is important) medications you are taking and include all vitamins and supplements you are taking. While this may seem unimportant, record any major stresses or recent life changes that have happen, such as illnesses, family deaths, major accidents, etc.. Depending on what you can find out, it may be wise to take your blood glucose meter with you as well as your daily log of blood glucose readings.

If possible, ask a family member or a friend to come with you. Instruct them to record potential important information to assist you in remembering everything all the information you will receive during the appointment. Also write down the questions for your doctor. List the most important one first in case time expires before all are asked. Some doctors will accept a list of questions and send a follow-up letter with answers, but this is not to be expected.

If you cannot get a referral to a neurologist, check with your medical insurance company to see what they will allow or suggest. Some will offer a list of two or three that are in proximity to you. A neurologist will give you an examination to check your muscle strength and tone, tendon reflexes, and sensitivity to touch, temperature and vibration.

Other tests may include a filament test using a monofilament and electromyography (EMG) which measures the electrical discharges produced in your muscles. Other tests may be a quantitative sensory testing to assess how your nerves respond to vibration and temperature changes and a nerve conduction studies that measures how quickly the nerves in your arms and legs conduct electrical signals. Finally autonomic testing may be done if you have symptoms of autonomic neuropathy to determine your blood pressure in different positions and assess your ability to sweat.

The American Diabetes Association recommends all people with diabetes have a comprehensive foot exam, either by a doctor or by a foot specialist (podiatrist), at least once a year. In addition, your feet should be checked for sores, cracked skin, calluses, blisters, and bone and joint abnormalities at every office visit. If you already have diabetic neuropathy, you will likely be referred to a podiatrist or other specialist for monitoring and treatment.

The next blog will be on treatment. Part 3 of 5.

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