What's New in Diabetic Neuropathy?

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MNSI - Ankle Reflexes • Sitting position, foot dependent, pt relaxed F Foot relaxed and slightly dorsiflexed Achilles percussed directly • Reflex present • Reflex present with Jendrassic maneuver • Reflex absent with Jendrassic reinforcement Presented by IHS Division of Diabetes 24
MNSI - Monofilament • Foot supported; eyes closed • Pre-stress 10 gm monofilament with 4-6 perpendicular applications to dorsum of finger • Apply perpendicular to point of bending for 1 sec, release • Apply to dorsum of great toe between nail fold and DIP for 1 sec, even pressure, 10 times: 8/10 normal; 1-7 reduced;0 absent • IHS/ADA: Apply to plantar great toe and 1,3,5 metatarsal heads • Even one site insensate is high risk foot • 2011 ADA recommends testing vibration, pinprick, or ankle jerks - (Diabetes Care 2011: 34 (supplement 1): S37.) Presented by IHS Division of Diabetes 25
Page 1 and 2: What’s New in Diabetic Neuropathy
Page 3 and 4: * Presented by IHS Division of Diab
Page 5 and 6: Case Presentation • PMH: HTN, hyp
Page 7 and 8: Thinking • Classic presentation f
Page 9 and 10: Diabetic Neuropathies Focal/Multifo
Page 11 and 12: Classic Symptoms • Pain worsens a
Page 13 and 14: Patient Education • A condition t
Page 15 and 16: Michigan Neuropathy Screening Instr
Page 17 and 18: MNSI - Physical TEN POINTS MAX 0 PO
Page 19 and 20: Charcot Presented by IHS Division o
Page 21 and 22: Skin Abnormalities Presented by IHS
Page 23: Tuning Fork for Your Entire Sensory
Page 27 and 28: Treatment • Glycemic control and
Page 29 and 30: Education 2 • Wear clean, dry, so
Page 31 and 32: IHS Guidelines 2010 • First Line
Page 33 and 34: AAN Recommendations Recommended, in
Page 35 and 36: Stepwise Management (IHS, JAMA) •
Page 37 and 38: Effect on Co-morbidities DULOX- ETI
Page 39 and 40: Amitriptyline • Check standing BP
Page 41 and 42: Pregabalin (Lyrica©) • Relative
Page 43 and 44: Topiramate (Topamax©) • AAN: ins
Page 45 and 46: Venlafaxine (Effexor ©) • 75-225
Page 47 and 48: Opioids • Dextromethorphan 400 mg
Page 49 and 50: Capsaicin, Isosorbide, Lidoderm©
Page 51 and 52: Autonomic Neuropathy • Orthostati

What's New in Diabetic Neuropathy?

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