Diabetic Neuropathy: The Latest Facts

How is diabetic neuropathy diagnosed?

The diagnosis is based on the examination taking into account the context (diabetes in development for more than 5 years and poorly controlled). During the examination, the doctor may look for certain signs such as a sudden drop in blood pressure while sitting or standing (orthostatic hypotension) by measuring the pressure while sitting or lying down and then while standing. The following tests can help diagnose diabetic neuropathy and guide treatment:

  • The monofilament test is the simplest sensation test. It involves touching the skin with a small thread: The device exerts constant pressure so that the doctor can compare the sensitivity of the skin in an affected area with the sensitivity in an area without neuropathy (stomach, thigh, etc.). This is often the only test that will be required.
  • Nerve conduction studies using electromyography (EMG) examine whether the electrical signal passes through a nerve and whether the muscles respond well to the nerve signal. In most cases, these tests are not necessary, but they can help to rule out other causes of nerve pain if necessary. It is important to note that in some cases electromyographic changes occur quite late.
  • Quantitative sensitivity analysis can be used in research to quantify changes in neurological impairment over time: sensitivity to light, touch, bite, pressure, vibration, and temperature.

When should diabetic neuropathy be considered?

Nerve damage can be painful at first, but it can also develop silently. It is therefore important to see a doctor regularly so that he or she can detect nerve pain associated with hyperglycemia at an early stage. This way it can be managed quickly to prevent the risk of worsening until it reaches a stage where nothing can be reversed.

Damage to the peripheral nerves can cause strange sensations such as burning, electrical shocks or tingling in the extremities of the hands and feet.

Damage to the autonomic nervous system should be considered in diabetics if blood pressure and heart rate change over time or if there is erectile dysfunction.

What can diabetic neuropathy be confused with?

A neuropathy that occurs in a diabetic can be confused with neuropathy that is related to another cause (10% of cases), which should therefore also be systematically investigated.

When should a doctor be consulted?

A doctor should be consulted if there are strange sensations in the extremities or if there are problems with blood pressure or heart rate, but also with digestive or sexual problems.

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