Neuropathy

It is important for diabetes educators to understand the extent to which neuropathy can affect many areas of the body and quality of life. 

 

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1. What is Diabetic Neuropathy?

  • Numerous types of diabetic neuropathies have the potential to affect both sensory and autonomic nervous systems in varied capacities.
  • Educators are not expected to know or recognize the categories of neuropathy. It is important for educators to recognize the extent to which neuropathy can affect sensation, pain, gait, autonomic functions (cardiovascular, gastrointestinal, urogenital), skin disorders and  quality of life.
  • The role of the educator is to advise clients to discuss symptoms with physicians to allow for investigations, diagnoses and treatments if possible.
  • Diabetes may not be a causal factor in many neuropathies.
  • An optional and detailed summary of diabetic neuropathy can be found here: Diabetic Neuropathies: Update on Definitions, Diagnostic Criteria, Estimation of Severity, and Treatments Diabetes Care. Oct 2010; 33(10): 2285–2293. 
  • Of all the different types of neuropathies, most educators find helping patients manage gastroparesis along with diabetes to be the most challenging. 

Gastroparesis 

  • Gastroparesis is a common form of autonomic neuropathy seen in patients with type 1 or type 2 diabetes meaning delayed or slowed gastric (stomach) emptying in the absence of any mechanical obstructions. It is part of a larger group of neuromuscular dysfunctions termed “gastropathy.”
  • Acute hyperglycemia can affect gastric motor action even in the absence of gastroparesis. Studies have shown that the time in which half of solid food contents are emptied from the stomach is 15 minutes longer in people whose blood glucose is >10 mmol/L as compared to those with normal glucose levels (Camilleri, 2007).
  • Signs and symptoms of gastroparesis may include: 
    • often complaints of anorexia, early satiety, a sense of fullness, bloating and/or nausea after meals
    • hypoglycemia 1-2 hours post-meal 
    • poor glucose control can occur because of unpredictable food intake and poor absorption of nutrients
    • may result in nutritional deficits 
  • Some management strategies include:
    • Medications that increase gut mobility
    • Improvement in glycemic control.
    • Post-prandial delivery of bolus insulin to better match the delayed carbohydrate absorption.
    • Dietary changes with a referral to a registered dietitian. The goals of treatment would be to minimize symptoms and maintain adequate fluid and nutrient intake. Strategies may include small and frequent meals, lower fat and potentially lower fibre diets as well as liquid meal supplements depending on the severity.

2. How is Diabetic Neuropathy Prevented, Screened for and Treated? 

 

Prevention

Diabetic neuropathy can be prevented by maintaining optimal glycemic control in both type 1 and type 2 diabetes. See A1c page for more details. 

 

Screening 

  • Diabetes Canada, Clinical Practice Guidelines includes a chapter on Neuropathy and the various types along with potential tests to screen and/or diagnose. 
  • See Topics Cataloge: Foot Care for resources on screening for periperhal neuropathy. 

 

Treatment

  • See notes above for strategies to manage gastroparesis. 
  • There is currently no cure for diabetic neuropathy. Patients are encouraged to manage symptoms and avoid complications by: 
    • Maintaining optimal blood sugar control
    • Daily foot checks and foot care
    • Talking to their family physician or diabetes specialist about medications to help manage pain 

3. Resources