Diabetic Peripheral Neuropathy Flashcards
(50 cards)
A1C, fasting blood sugar test, and glucose tolerance test results for diabetes
6.5% or greater
126 mg/dL or above
200 mg/dL or above
A1C, fasting blood sugar test, and glucose tolerance test results for prediabetes
5.7-6.4%
100-125 mg/dL
140-199 mg/dL
A1C, fasting blood sugar test, and glucose tolerance test results that are considered normal
below 5.7%
99 mg/dL or below
140 mg/dL or below
what does subclinical mean
not detectable or producing effects that are not detectable by the usual clinical tests
- clinical tests may be positive, but does the patient have sx???
what structures does DPN affect
damage to the nerve and also the blood vessel
does DPN affect CNS or PNS
PNS
autonomic nervous system
described as the visceral nervous system or visceral motor system; motor fibers that stimulate smooth involuntary muscles, cardiac muscle, stomach and intestines
- sympathetic (fight or flight) and parasympathetic (rest and digest)
somatic nervous system
provides sensory and motor innervation to all body parts; sensations of touch, pain, temperature and position of sensory receptors; innervates skeletal muscle (both voluntary and reflexive movement)
does DPN affect autonomic or somatic NS
affects both and can be focal or diffuse
what type of neuropathy is DPN
metabolic –> can affect the body in many ways
what aspect of diabetes can injure nerves throughout the body
high blood sugar/glucose
what aspects of PNS does DPN affect (what cells)
nerve cells and Schwann cells (myelination to PNS)
what nerves does DPN most commonly affect
feet and legs first, then hands and arms (less common)
describe the systemic effects chronic hyperglycemia can have on the body
- increase sorbitol and fructose levels which affect sodium/potassium and APT within peripheral nerves
- causes microcirculatory ischemia to afferent peripheral nerves
- excess sorbitol damages schwann cells
- alterations in insulin levels alters gene expression of neurotrophic factors
- promotes loss of myelinated and unmyelinated axons
- nodes of ranvier are affected which slows nerve conduction velocity
does DPN affect prox to distal or distal to prox
distal to proximal
what is sorbitol
sugar
what are some s/s of DPN
- numbness/reduced ability to feel pain/temp
- tingling/burning
- sharp pains/cramps
- mm weakness
- extreme sensitivity to touch (bed sheets can become painful)
- foot problems - ulcerations, infections, bone and joint damage
what type of DPN is rapidly reversible
hyperglycemic neuropathy
NCV
nerve conduction velocity
describe hyperglycemic neuropathy
occurs in newly diagnosed or poorly controlled DM; distal symmetric sensory changes causes burning, tingling, numbness; sx resolved when blood sugar is controlled; NCV issues can still exist
what types of DPN are generalized symmetric polyneuropathies
acute sensory
chronic sensorimotor
autonomic
describe acute sensory DPN
- rapid onset of severe burning/sharp pain
- hypersensitivity worse at night
- can improve if blood glucose is stabilized long term
describe chronic sensorimotor DPN
- most common (50%)
- sensory loss
- small fibers = pain
- large fibers = painless paresthesia with loss of proprioception/vibration
- mild motor weakness
- “walking on clouds”
describe autonomic DPN – when is sympathetic and parasympathetic systems most affected with type 1 and 2
- sympathetic and parasympathetic affected with type 1 and 2
- parasympathetic more affected with type 2
