0930_Jacobs.pdf

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1、EXAMINATION AND TESTING FOR THE EVALUATION OF DIABETIC NEUROPATHYPOTENTIAL CONFLICTSI HAVE NO CONFLICTS OF INTEREST FOR THIS LECTURENEUROPATHY IN THE DIABETIC PATIENTCOMMON COMPLICATIONFREQUENTLY ASYMPTOMATICNEUROPATHY FREQUENTLY PREDATES DIAGNOSIS OF DIABETES SYMPTOMATIC PARASTHESIA ASYMPTOMATIC SE

2、NSORY DEFICIT SYMPTOMATIC MOTOR NEUROPATHY VASOMOTOR,SUDOMOTOR CHANGES NEUROPATHIC EDEMAFrom Vinik A,Casellini DC,Nakave A,et al.Chapter 35.Diabetic neuropathies.2007;http:/endotext.org/diabetes/diabetes35/diabetesframe35.htmSMALL FIBER DISEASESUPERFICIAL PAIN,ANESTHESIA,PARASTHESIA,DYSETHESIA(C-FIB

3、ER TYPE)DECREASED TEMPERATURE PERCEPTIONAUTONOMIC DYSFUNCTIONNORMAL STRENGTH AND REFLEXESNEGATIVE NCV/+ENFD/SGB TESTINGMAY LEAD TO DEATHLARGE FIBER DISEASE DEEP-SEATED PAIN PARASTHESIA,DYSETHESIA IMPAIRED VIBRATION WASTING AND WEAKNESS OF MUSCLE LOSS OF POSITION SENSE LOSS OF REFLEXES IMPAIRED GAIT,

4、RISK OF FALLING RISK OF FRACTURES RISK OF CHARCOTS JOINT DISEASE?IMPAIRED NCV,+EMGDIABETIC NEUROPATHYDIABETIC NEUROPATHY:ETIOLOGY MICROVASCULAR DISEASE HYPERGLYCEMIA/AGE SORBITOL CONCENTRATION MYOINOSITOL DEPLETION PROTEIN KINASE C OXIDATIVE STRESS NEUROTROPHIC FACTORS NEURAL DEVELOPMENT NEURAL MAIN

5、TENANCE NEURAL REGENERATIONDIABETIC NEUROPATHYGENERAL PHILOSOPHY YOU WILL NOT DIAGNOSE WHAT YOU DO NOT LOOK FOR OR ASK ABOUT THE FIRST VISIT IS CRITICAL:IT WILL SET THE TONE OF YOUR INTERACTIONS BETWEEN YOU AND THE PATIENT/FAMILY DISCUSS FINDINGS AND IMPLICATION OF FINDINGS WITH PATIENT AND CARETAKE

6、RS EDUCATION IS THE KEY IDENTIFY YOUR ROLE AS HEALTH CARE PROVIDER:INITIATE APPROPRIATE THERAPUTIC INTERVENTIONS RINSE AND REPEAT AT MOST IF NOT ALL VISITSGENERAL WISDOMSCREENING FOR DIABETIC SENSORY NEUROPATHY SHOULD BE PERFORMED ANNUALLY FOR ALL TYPE 2 DIABETIC PATIENTSSCREENING FOR DIABETIC NEURO