How to recognize diabetic neuropathy?

How to recognize diabetic neuropathy?   In the early stage of diabetic neuropathy, patients are often difficult to detect because there are no obvious clinical symptoms.

Diabetic neuropathy is a disorder of the nervous system caused by diabetes. Approximately 70% of diabetic patients have some form of neuropathy. The characteristics of these pathologies are that they can appear at any time during the course of diabetes and will also increase with the age of the patient. Growth and prolongation of the disease course increase the risk of neuropathy [1].

According to relevant clinical statistics, the prevalence of neuropathy is 30% to 40%, 60% to 70%, and more than 90% in patients with diabetes for 5 years, 10 years, and 20 years.

If not detected, diagnosed and treated in time, it will affect the quality of life such as appetite and sleep, and will significantly increase the risk of diabetic foot, cardiac autonomic neuropathy, painless myocardial infarction, and sudden cardiac death.

However, the tragedy is that in the early stages of diabetic neuropathy, patients are often difficult to detect because there are no obvious clinical symptoms.

Later, as the disease progresses, various clinical symptoms will appear, such as numbness, pain, insensitivity, orthostatic hypotension, resting tachycardia, etc., but the disease is often not early at this time.

So how to find out the murderer behind-diabetic neuropathy early?

Self-test

1 Temperature check

Pour cold water and warm water into the cup, and then touch the skin of the foot with the cup wall. If the patient does not feel the change in cold or heat, it means that the temperature sense is lost.

2 Position detection

Ask the patient to close their eyes, and then push up or down the toe (or finger). If the patient cannot distinguish the direction of movement of the toe, it may indicate abnormal nerve position.

3 Standing blood pressure test

Let the patient lie supine on the bed and rest for 15 minutes in a quiet environment. Fix the cuff on the patient’s right upper arm and measure the blood pressure. Do not untie the cuff after the measurement, and ask the patient to stand up immediately, raise the right arm to keep the cuff, sphygmomanometer and the heart at the same level, and measure blood pressure quickly. If the systolic blood pressure drops by more than 20mmHg or the diastolic blood pressure drops by more than 10mmHg in the standing position compared with the supine position, it can be judged as “Orthostatic hypotension”.

Hospital check

1 Pain test

Mainly by measuring the different responses of the foot to the pain caused by acupuncture, to initially assess the function of the peripheral sensory nerve.

2 Tactile inspection

A special 10g nylon wire is used to stimulate the palms of the hallux and metatarsal heads I and V. If the patient does not feel it, it means that the sense of touch is decreased.

3 Vibration inspection

A 128 Hz tuning fork is placed on the bony prominence on the back of the patient’s hallux. If the patient’s feeling of vibration caused by the tuning fork is weakened or disappears, it indicates abnormal nerve vibration.

4 Achilles tendon reflex detection on both feet

Tap the Achilles tendons on both sides of the patient with a percussion hammer. If the Achilles tendon reflex is weakened or disappeared, it may indicate peripheral neuropathy.

Patients with diabetic neuropathy are basically difficult to reverse. Therefore, prevention and early detection are particularly important.

General recommendations: patients with type 1 diabetes should be screened for diabetic neuropathy after 5 years of diagnosis; type 2 diabetes should be screened for diabetic neuropathy at the beginning of the diagnosis, and at least once a year after that.

At the same time, it is recommended that diabetic patients can take the aldose reductase inhibitor epalrestat, which has excellent performance in the treatment of DPN. Studies have confirmed that epalrestat has the effect of improving symptoms and delaying progression of DPN [2].

(source:internet, reference only)

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