How To Diagnose Diabetic Neuropathy?
Diabetic neuropathy occurs usually when a patient is suffering from poor glycaemic control for a long period of time. It occurs due to the accumulation of advanced glycated products in small vessels supplying distal nerves popularly known as microangiopathic changes. It occurs usually 10 to 15 years with slow onset after the diagnosis of diabetes has been made or in an undetected case of diabetes presenting with neuropathy as its first symptom.
The diagnosis of diabetic nephropathy is generally clinical because the physical examination is nearly a characteristic diagnostic feature of it; however various tests can be done for it. Usually, the testing is started from blood glucose levels and Hba1c levels of the blood. Routine blood screening tests are also done like complete blood count, complete metabolic panel, thyroid function tests, c- reactive protein, erythrocyte sedimentation rate, etc. These tests will determine the glycemic control of the patient and will rule out other systemic disorders presenting with similar features.
Nerve specific studies also are done to diagnose the neuropathy and its extent. Nerve conduction studies and electromyography are done specifically to check the functioning of the nerves. Needle electromyography and electrophysiologic studies have largely replaced conduction studies because of greater reliability and better results.
Magnetic resonance imaging and computed tomography can also be done to rule out the spinal causes of neuropathy. Color Doppler ultrasound is done to check the perfusion of the skin at the distal-most parts of the body. Electrocardiography and nuclear imaging studies are done to evaluate the functioning of the heart and its autonomic system. Lastly, the most diagnostic tests like skin and nerve biopsy, microdialysis can be done to confirm the diagnosis of diabetic neuropathy but these tests as these are invasive are done.
Best Medicine For Diabetic Neuropathy
The best approach of treatment for a patient of diabetic neuropathy is the control of diabetes mellitus itself. Usually, the cause is the long-standing poor control over glucose levels which when managed would not only slow the progression of nerve damage but also can remit some of the reversible damages occurred recently.
For controlling the pain and other symptoms of sensory diabetic neuropathy, antiepileptic group of drugs is the drug of choice. Pregabalin is the most commonly and efficiently used the drug for relieving neuropathic pain. Other drugs like sodium valproate and gabapentin can also be used with good results. Transdermal patches of local anesthetics like lignocaine are also used in some cases of severe pain.
For the treatment of autonomic diabetic neuropathy, antiemetic drugs like metoclopramide are used for gastrointestinal tract symptoms and phosphodiesterase inhibitors like sildenafil are used for erectile dysfunction. To treat the orthostatic hypertension salt and water intake is increased along with cardiac inotropes sometimes can be used. For sudomotor dysfunctioning glycopyrrolate is the drug of choice because it is an antimuscarinic agent. Spinal nerve electronic stimulation devices are used sometimes in cases of severe neuropathic pain. Surgical treatment can be suggested in extreme cases of neuropathic symptoms in diabetes.
The diagnosis of the diabetic nephropathy usually is evident from the history of the patient and investigational history itself. The clinical physical examination is very much likely to rule out the other causes of nerve damage found locally like trauma etc. Systemic causes for sensory neuropathy can be ruled out on laboratory investigations. Blood glucose levels and Hba1c levels pretty much are sufficient to make the diagnosis of diabetic neuropathy.
The treatment approach starts from the cause itself that is the high glucose levels persistent for long periods of time or the untreated cases of diabetes mellitus. For regulating the sensory symptoms of the neuropathy like pain, pregabalin is the drug of choice. distal-most the blood glucose levels with stronger anti-diabetic medications along with more frequent follow up of the patients to check for the adequacy of the treatment is suggested.
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