i bc27f85be50b71b1 (213 page)

ENDOCRINE SYSTEM

683

Management of diabetic neuropathy may include"

•

Strict glycemic control (primary method)

•

Pain relief with:

Tricyclic antidepressants, such as amitriptyline, nortriptyline, and desipramine

Anticonvulsants, such as carbamazepine, phenytoin, gabapenrtn, and c10nazepam

Topical agems, such as capsaicin cream (0.025-0.075%)

or lidocaine ointment

Opioids used as a last resort

Transcutaneous electrical nerve stimulation

Table II- I I. Signs and SymplOms of Diabetic Neuropathy

Classification of

Diabenc Neurop.lthy

SymptOms

Signs

Symmetric polyneuropathies

Peripheral sensory

Paresrhcslas, numbness,

Absent ankle jerk

polrneuroparh),

coldness, tinglmg pins

Impairmem of vibration

and needles (mainly in

sense in feet

feet)

Foar ulcers (often over

Pam, often disabling,

metatarsal heads)

worse at night

rcriphcTal motor

\Veakness

Bilateral imerosseous

neuropathy

muscle atrophy, claw

or hammer roes,

decreased gri p

strength, decreased

manual muscle test

grades

Autonomic neu

Constipation or diarrhea,

Incontinence, orthoroparhy

nausea or vomiting,

static hypotension,

tremulousness, Impotachycardia, periphtence, dysphagia

eral edema, gustatory

sweating

684

ACUTE CARE HANDROOK .. OR PHYSICAL THERAI)ISTS

Table 11-"1"1. Conti11ued

Classification of

Diabetic Neuropathy

Symproms

Signs

Focal and multifocal

neuropathies

Cranial neuropathy

Pain behind or above the

Palpebral prosis

eye, headaches, facial or

Inward deviation of

forehead pain

one eye

Trunk and limb

Abrupt onset of cramping

Peripheral nervc-specific

mononeuroor lancinating pain

motor loss

pathy

Constricting band-like pain

Abdominal wall weaknc5.!

in trunk or abdomen

Cutaneous hyperesthesia

of the trunk

Proximal moror

Pain in lower back, hips,

Asymmetric proximal

neuropathy or

and thighs that is worse

weakness

diabetic amyoat night; loss of appetite,

Atrophy in lower limbs

trophy

depression

Absent or diminished

knee jerk

Sources: Data from JS Boissonault, D Madlon-Kay. Screening for Endocrine Syslem DISease. In we Boissonauh (ed), Examination 111 Physical Therapy: Screening for Medical Disease. New York: Churchill LivingstOne, 1991; 159; PA Melvin-Sater" Diabetic neurop"

:lthy. Physician Assistant 2000j24(7):63; and CO Saudek. Diabetes r..tellitus. In JO SlOoo.

DB Hellmann, PW L1.denson, Ct al. (cds), The PrinCiples and Practice of Medicine (23rd

cd). Stamford Cf: Appleton & L1.nge, 1996; 330.

•

Aldose reductase inhibitors aimed at slowing the progression of

nerve damage

•

Exogenous nerve growth facrors

•

Immunotherapy

•

Pancreatic transplant

Coronary Artery Disease

See Myocardial Ischemia and Infarction in hapter I for a discussion

of coronary artery disease.

Stroke

See Cerebrovascular Accident in Chapter 4 for a discussion of stroke.

Peripheral Vascular Disease

See Atherosclerosis in Chapter 6 for a discussion of peripheral vascular disease.

ENDOCRINE SYSTEM

685

Nephropathy

See Chapter 9 for a discussion of nephropathy.

Hypoglycemia (Hyperinsulinism)

Hypoglycemia is a state of decreased BS levels. Excess serum insulin

results in decreased BS levels, which leads to symptoms of hypoglycemia. Causes for this imbalance of insulin and sugar levels can be grouped as (1) fasting, (2) postprandial, or (3) induced.