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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
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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.