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Diabetic Neuropathy

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physicians on the detection and evaluation of. Diabetic Neuropathy with ... Gangrene. Amputations. Sexual dysfunction. Sudden death from cardiac arrhythmias ... – PowerPoint PPT presentation

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Title: Diabetic Neuropathy


1
This educational program is presented by
Integrated Practice Resources, LLC 8081
Congress Ave 2nd Floor Suite B Boca Raton, FL
33487 Phone (888) 395-4007 Fax (888) 395-3941
2
Welcome to this program for physicians on the
detection and evaluation of Diabetic Neuropathy
with Loss of Protective Sensation.
3
  • First, you will be presented with a clinical
    overview of diabetic neuropathy.
  • Next, you will be introduced to a screening
    program for the detection of neuropathic loss of
    protective sensation and its confirmation using
    electrodiagnostic (EDX) testing.

4
THIS PRESENTATION INTRODUCES
AN ORGANIZED PROGRAM OF DIABETIC NEUROPATHY
DETECTION
5
Diabetic Neuropathy
  • Its Detection and Evaluation

6
An expression often heard from patients who have
foot pain. . .
When your feet hurt, you hurt all over.
7
But when feet should hurt when injured, yet they
do not. . .
  • Think Diabetic Neuropathy with Loss of Peripheral
    Sensation (LOPS)

8
Diabetic Neuropathy with Loss of Peripheral
Sensation (LOPS)
  • Persons with LOPS are not aware of minor foot
    injuries that can become major problems.
  • Even continuing to walk on a little pebble in the
    shoe that is not felt can result in skin injury,
    an open sore, ulcer formation, infection, and
    amputation.
  • The cause of LOPS is believed to be related to
    blockage of small arteries that supply blood to
    the affected nerves.

9
Diabetic ulcer in a patient with LOPS. This was
a complication of a small blister caused by
walking with a pebble in a shoe.
10
Diabetic Neuropathy Facts
  • Diabetes mellitus is believed to affect 15 to 16
    million Americans.
  • Diabetic neuropathy is one of the most common
    manifestations of diabetes and potentially its
    most debilitating.
  • Most studies agree that the overall prevalence of
    symptomatic diabetic neuropathy is approximately
    30 of all patients with diabetes.
  • Because many patients are asymptomatic, it
    quietly and insidiously places its victim at high
    risk for devastating complications.

11
Classification of Diabetic Neuropathy
  • A. Diffuse Neuropathy
  • 1. Distal symmetric sensorimotor neuropathy
  • 2. Autonomic neuropathy
  • a. Sudomotor
  • b. Cardiovascular
  • c. Gastrointestinal
  • d. Genitourinary
  • 3. Symmetrical proximal lower limb motor
    neuropathy (amyotrophy)
  • B. Focal Neuropathy
  • 1. Cranial neuropathy
  • 2. Radiculopathy and plexopathy
  • 3. Entrapment neuropathy

12
Complications of Diabetic Neuropathy
  • Foot ulceration
  • Gangrene
  • Amputations
  • Sexual dysfunction
  • Sudden death from cardiac arrhythmias

13
Complications of Diabetic Neuropathy
  • Those patients who are symptomatic complain of
    frequent or continuous pain, numbness, or other
    severe discomfort in the affected extremity or
    dermatome.
  • Despite the prevalence of diabetic neuropathy,
    many physicians fail to recognize it, and if they
    do recognize it, many fail to evaluate or treat
    these patients appropriately.
  • Medical science stands poised to take a very
    aggressive approach to diabetic neuropathy
    preventing it, diagnosing it, controlling its
    secondary complications and symptoms, and
    possibly even reversing it.

14
Preventing Complications of Diabetic Neuropathy
  • Physicians who screen for loss of protective
    sensation can play an important role in detecting
    and assessing diabetic neuropathy and preventing
    life threatening complications.
  • A four-step neuropathy detection and evaluation
    program can be easily implemented in physicians
    offices.

15
Four-Step Diabetic Neuropathy Detection/Evaluation
Program
  • STEP 1 Identify all patients who have diabetes
    when taking medical histories.
  • STEP 2 Screen all diabetic patients over age 40
    for neuropathy irrespective of their presenting
    symptoms.
  • STEP 3 Schedule patients who have positive
    screening results and are not under medical care
    for neuropathy for electrodiagnostic (EDX)
    confirmation and evaluation.
  • STEP 4 Appoint patients who have had neuropathy
    detected, confirmed, and evaluated for a
    follow-up visit to outline a program of
    prevention and treatment.

16
EDX Testing for Diabetic Neuropathy
  • Nerve conduction studies can demonstrate both
    demyelination and axonal degeneration.
  • Demyelination primarily affects the nerve
    conduction velocity, which is slowed.
  • Among the earliest detectable findings in
    diabetic neuropathy are distal slowing of nerve
    conduction velocity with axonal degeneration.
  • Reduced amplitudes are a later finding consistent
    with advanced neuropathy.

17
Screening for LOPS
  • Screen patients for loss of peripheral sensation
    (LOPS) with a 10, 5.07 Semmes-Weinstein
    monofilament.

18
  • TESTING FILAMENTS AND PRINTED SCREENING
    DIRECTIONS ARE AVAILABLE AT NO CHARGE FROM THE
    FEDERAL HEALTH AND HUMAN SERVICES (HHS)
    DEPARTMENT
  • Lower Extremity Amputation Prevention
  • (LEAP) Program
  • General Information Website
  • And To Order Monofilaments
  • www.hrsa.gov/leap

19
LOPS Monofilament Screening
  • The 10 monofilament correlates with protective
    sensation.
  • Protective sensation may be lost when the
    filament cannot be felt.
  • The sensory exam should be done in a quiet and
    relaxed setting. The patient must not watch while
    you apply the filament.
  • Test the monofilament on the patient's hand so
    he/she knows what to anticipate.
  • Test at least 5 sites on each foot. Apply the
    monofilament perpendicular to the skin's surface.
  • Apply just enough pressure to bend the
    monofilament.

20
Press until the filament bends.
21
Locations To Test
22
LOPS Monofilament Screening
  • The total duration of the approach, skin contact,
    and departure of the filament should be
    approximately 1-1/2 seconds.
  • Apply the filament along the perimeter and NOT ON
    an ulcer site, callus, scar or necrotic tissue.
    Do not allow the filament to slide across the
    skin or make repetitive contact at the test site.
  • Press the filament to the skin so that it buckles
    at one of two times as you say "time one" or
    "time two." Have patients identify at which time
    they were touched. Randomize the sequence of
    applying the filament throughout the examination.
  • Diabetic neuropathy is suggested when the patient
    cannot feel four or more sites.

23
  • FOR INFORMATION ABOUT
  • ELECTRODIAGNOSTIC TESTING FOR
  • DIABETIC NEUROPATHY AND COMPLIMENTARY SCREENING
    MATERIALS
  • contact a
  • Integrated Practice Resources, LLC
  • Physician Representative
  • 1- (888) 395-4007
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