What's New in Diabetic Neuropathy?

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Case Presentation: Exam • BP lying 120/80 sitting 110/80 standing 80/64. • P 100 R 12 T 98.4 W 295 lb. • Heart, lungs, neck, normal. Extremities hairless with dry, callused skin of feet, pulses intact. • MS – normal. • CN II-XII - normal aside from miotic pupils. • Motor – 4+/5 dorsiflexion of great toe . • Sense – decreased PP and cold sensation to knees. Absent vibration perception to mid-shin. • CBM – tandem poor, casual normal, cannot walk on heels . • DTRs – BRJ 1/1 BJ 1/1 TJ 1/1 KJ tr/tr AJ 0/0. Presented by IHS Division of Diabetes 6
Thinking • Classic presentation for chronic, long standing diabetic neuropathy with sensorimotor involvement, one of the microvascular complications. • People associate numbness, but not pain, with neuropathy, think “bad circulation.” This is chronic already. • He likely has autonomic neuropathy. Presented by IHS Division of Diabetes 7
Page 1 and 2: What’s New in Diabetic Neuropathy
Page 3 and 4: * Presented by IHS Division of Diab
Page 5: Case Presentation • PMH: HTN, hyp
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 and 24: Tuning Fork for Your Entire Sensory
Page 25 and 26: MNSI - Monofilament • Foot suppor
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

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