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Diabetic Polyneuropathy and Physical Therapy

According to the Centers for Disease Control, there were nearly 19 million people with a diagnosis of diabetes in 2011. Diabetes is a chronic disease in which the body’s glucose levels are higher than normal, resulting from the body’s inability to produce and/or use insulin properly.  There are several different types of Diabetes, including Type I Diabetes, Type II Diabetes, and Gestational Diabetes.

Complications of Diabetes include heart disease, stroke, high blood pressure, polyneuropathy, impaired sensation, blindness, kidney dysfunction, periodontal disease, Diabetic ulcers and other chronic wounds, charcot deformity, lower limb amputations, coma and death.

What is Diabetic Polyneuropathy?

Neuropathy is a pathological change of the nerves.  Diabetic polyneuropathy is a type of neuropathy that is associated with diabetes mellitus.  It is thought to occur as the result of vascular changes experienced by those with diabetes.  There are many types of diabetic polyneuropathy, but general signs and symptoms of diabetic polyneuropathy include:

•    A burning sensation in the hands and/or feet
•    Numbness and/or tingling in the extremities
•    Abnormal sensation
•    Muscle weakness
•    Erectile dysfunction
•    Urinary incontinence
•    Dizziness
•    Vision changes

Sensorimotor polyneuropathy affects the body’s sensory and motor apparatuses.  It is marked by a “sock and glove” pattern of sensory changes that affects the toes first, then advances proximally up the foot and leg.  Symptoms include numbness, tingling, abnormal sensation, decreased sensation, and/or pain.  The pain, which often occurs at night, is described as dull, achy, burning, or prickly.  As a result of the decreased sensation caused by neuropathy, people with diabetes are at increased risk for developing ulcers on their feet, as they are unable to feel when they step on sharp objects, develop blisters from ill-fitting shoes, or experience any type of injury to the skin on the bottom of the foot.  Proprioception, or the awareness of one’s body position in space, is also affected by neuropathy, which may lead to decreased balance and resulting falls.  Charcot foot, a degenerative condition that causes fractures to the foot bones and an eventual rocker-bottom deformity, is also common among those with diabetic neuropathy.

Autonomic neuropathy causes dysfunction of the body’s autonomic functions.  Common signs and symptoms include dizziness upon standing (orthostatic hypotension), arrhythmia, bloating, nausea, diarrhea, and urinary retention, frequency, or incontinence.

Cranial neuropathy affects the cranial nerves, primarily those responsible for eye movements.

Treatment of Diabetic Polyneuropathy

There are many treatment options for patients with diabetic polyneuropathy.  While the neuropathy itself is a progressive condition, the symptoms and their resulting functional impairments can be treated.

Drugs are primarily prescribed to relieve the pain caused by neuropathy.  These drugs include tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, anti-epileptic drugs, and analgesics.

Physical therapy helps to maintain or regain the functional status of those with diabetic polyneuropathy, as it helps with pain control, maintaining strength and balance, and prevention and treatment of diabetic foot ulcers.  Modalities used in Physical Therapy, primarily electrical stimulation, can assist in pain relief, edema control, and treatment of ulcers.  Physical Therapists can also prescribe individualized exercise programs to strengthen weak muscles, regain postural control, and help maintain balance in those with neuropathy.  If a patient has a diabetic foot ulcer, a Physical Therapist can perform the wound care, instruct the patient in proper foot care, and recommend appropriate footwear.  In the case of a charcot foot or amputation, Physical Therapists perform transfer and gait training to help patients to be able to move themselves within the community as independently as possible.  Again, a PT would recommend appropriate footwear, as well as any needed assistive devices such as canes or walkers.

While diabetic polyneuropathy cannot be reversed, those with Diabetes can take steps to prevent or slow its development.  Preventative measures include maintaining control of one’s blood glucose levels, attending regular check-ups with an orthopedic or foot surgeon, performing daily foot inspections, wearing proper footwear, and using caution to prevent injury.  If someone with Diabetes develops any symptoms of polyneuropathy, he or she should consult a physician as soon as possible.