Coping Methods For Diabetic Neuropathy

Diabetes mellitus is known as a modern epidemic because of a widespread increase in a number of cases in the 21st century with the advent of non-communicable diseases. It is a common disease but can produce fatal complications. Triad of complications of diabetes mellitus due to the microangiopathic changes encountered in it consists of diabetic retinopathy, diabetic neuropathy and diabetic nephropathy.^[1]

Patients of diabetic neuropathy are likely to suffer from diabetic foot ulcers and other complications related to the healing capacity of the body. In patients of diabetic neuropathy, the rehabilitation process is very essential in coping with the disabilities and complications suffered or else the quality of life would be very poor.

Neuropathic pain and muscular weakness are the common symptoms of sensory neuropathy of diabetes. To cope with these symptoms, physical activity is the best way. It helps in regaining muscular strength and prevents muscular atrophy. The blood supply of the affected area also improves which can provide a scope for the regeneration of the damaged nerves to some extent. It also helps in maintaining balance and gait during the involvement of autonomic system in the disease.^[2]

Vigorous exercise and the extremes of temperature should be avoided in autonomic diabetic neuropathy because these can precipitate or initiate dangerous events which can even cause sudden death. Making an exercise program would not only regularize the discipline of exercising but also will help to prevent the development of muscle contractures and spasms. Gait retraining with the help of prosthetics and supportive devices should be taught to cope with the disability that has already occurred. Sitting and standing methods should be changed to reduce the events of syncope and hypotension.

Pain management and monitoring are taught by physical therapists as part of the coping skills of diabetic nephropathy. Transcutaneous electrical nerve stimulation can be an effective method to control neuropathic pain in severe cases. In patients suffering from diabetic foot ulcers, it is very much necessary to explain foot care and prevent further damage. The patients who had already undergone amputation should be taught to cope with the prosthetics and orthotic devices.

Comorbid conditions like depression can be associated with diabetes either due to diabetic complications like the stress occurring in its suffering or can become isolated. should be prevented by the introduction of community activities and playful environment among the elderly. These would help to teach better coping skills for the disease.^[3]

As much as the current status of the patient is needed to be improved as is the necessity of long term monitoring to cope with the complications of diabetes mellitus in the long run. Regular visits to the physician after every one month for or as directed by the physician should be done and glycaemic control of the body should be maintained adequately. Glucometers could be kept at home for regular checking of the blood glucose levels and noting it down in a notebook which should be shown to the physician at every visit.

Since diabetes is a dangerous disease with many burdening complications, it is absolutely necessary for the patient to learn various coping skills and apply them; otherwise, it will have a high negative impact on the mental status of the patient. Regular daily physical activities with active involvement should be done to cope with symptoms of diabetic neuropathy. Mental conditioning and behavioral modification may be needed in the development of coping skills for neuropathic pain. Active participation in public activities will not only boost the confidence of the patient but also will prevent the comorbid conditions like depression.

These patients also are needed to be taught for wound care and ulcer management in the diabetic foot. Patients should be educated about the autonomic symptoms of diabetic neuropathy so that they can timely recognize them and report them to the physician as soon as possible.

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