बुधवार, 18 मई 2011

suspect diabetes

dr satyajit sahu explaning to patient
suspect the diagnosis of diabetes at an early stage :-

  1) the classical triad of polydipsia ,polyuria ,andpolyphagia
  2) weight loss and weakness in spite of excessive appetite
 3) secondary enuresis
 4) recurrent or resistant vaginal candiadiasis
  5 a history of anta collecting around the urine.

मंगलवार, 3 मई 2011

What is diabetes neuropathy?

What is diabetes neuropathy?
This is a very common complication for those people who suffer from diabetes. Diabetes neuropathy refers to the damage to the nerves which causes a person to be unable to feel any sensations such as the feeling of pain. Diabetes damage can attack certain nerves in the nerve system. They affect the nerves in a number of different ways but all seem to be somehow related to blood sugar levels which remain too high for too long a period of time.
Although nerve damage related to diabetes may be painful, in most cases it is not severe pain.
There are 4 known types of diabetic 
·                                                            Proximal
·                                                            Focal

Diabetic Autonomic Neuropathy

Diabetic autonomic neuropathy affects most often the digestive tract, as well as the urinary system, blood vessels, and sex organs. To prevent this type of neuropathy, a diabetic should continuously keep the blood sugar levels well managed.
·                               Lack of awareness that blood sugar is low (hypoglycemia unawareness).
·                               Problems with bladder including frequent urinary infections or urinary incontinence.
·                              Uncontrolled diarrhea or constipation or a combination of both.
·                               Stomach emptying slowly (gastroparesis), which leads to vomiting, nausea and loss of appetite.
·                                With men erectile dysfunction
·                                 Sexual difficulties and vaginal dryness in women.
·                                  Decreased or increased sweating
·                                   Problems with the body adjusting to blood pressure and heart rate, which can lead to sharp drops in blood pressure when rising from sitting or lying down (orthostatic hypotension) which may cause lightheadedness or fainting.
·                                                            Changes in the eyes adjusting from light to dark.
·                                                            Problems regulating body temperature.
·                                                            Difficulty exercising
·                                                            Increased heart rate when at rest.
Autonomic neuropathy is more likely to occur in diabetics who have been poorly managing their diabetes for several years. Some of the symptoms of autonomic neuropathy can be hard to manage but others do respond well to treatment:

Mild constipation

Eat small  frequent meals which are high in fiber while being low in fat may help.

Frequent diarrhea

Eat foods which are high in fiber. It may be necessary to use medications that slow the rate of digesting of food and the waste traveling through the intestines or antibiotics such as amoxicillin, tetracycline and ormetronidazole.

Mild gastroparesis

This is a condition that causes the stomach to empty too slowly. It can get better by eating small, frequent meals that are low in fiber and fat. There are medicines that help the stomach empty more quickly that can be used as needed. Controlling blood sugar levels can also reduce symptoms of gastroparesis.

Abnomal sweating

If there is a lot of sweating, the diabetic should try to avoid extreme humidity or heat. There are also certain foods which cause severe sweating, anticholinergic medication can help. But, these medications do have side effects which may often be more bothersome than the abnormal sweating. Botox injections can also help. If the opposite is true – not sweating enough – moisturizers can help with dry or cracked skin. Also drinking more water can prevent overheating.

Lack of awareness of low blood sugar level

This is called hypoglycemia unawareness. Diabetics can adjust their insulin and allow the blood sugar levels to be a bit higher than normal range although usually it is recommended that the A1C should be at near normal levels.

Urinary problems

These can be treated with antibiotics for urinary tract infections and medication to improve bladder control.

Sexual problems

The doctor may suggest using medications or devices to improve this function. There are also several nonprescription lubricants as well as estrogen cream for vaginal dryness.

Blood pressure problems

This can be treated with medication as well as wearing support stockings.

Diabetic Peripheral Neuropathy

This is the form of neuropathy which is most common for diabetics. It seems to affect the nerve ending first and usually starts with the nerves that are longest. This means that legs and feet are where the beginning of this neuropathy usually starts. Rarely, other areas of the body such as the abdomen, arms and back may be affected.
The possible symptoms and signs of this form of neuropathy:
·                                                            Tingling or burning feelings.
·                                                            Reduced ability to feel any changes in the temperature or pain as well as numbness. This is common in the toes and feet.
·                                                            When walking there is pain
·                                                            Sensitivity is very extreme to touches that are very light – for some, a bed sheet weight can be unbearable.
·                                                            Weakness of muscles and walking difficulties.
·                                                            Foot problems which are serious including infections, ulcers, deformities, joint and bone pain.
Many diabetics who have peripheral neuropathy will have some mild to severe pain within areas of their bodies. These people should talk with their doctor about treatment which can reduce the pain as well as improving physical functioning, mental well-being as well as mood. These treatments can include:

Over the counter (OTC) medications

OTC medications such as pain medication or creams which relieve pain. There are prescription medications which also often reduce pain including medications which treat depression, and medications which control seizures. These medications can be tried to reduce the pain even though the diabetic does not have any signs of depression or seizures.

Alternative therapies such as acupuncture

This has not been studied well as a treatment for diabetic neuropathy. But there are some studies which show that it can help with pain.

Physical therapies

Physical therapies such as stretching, exercises, and massage. If the diabetic is told to use ice or heat it should be done with care. Neuropathy will make it difficult to feel the temperature changes on the skin.

Transcutaneous electrical nerve stimulation (TENS)

This is a therapy which attempts to relieve pain by applying brief pulses of electricity to the endings of the nerve in the skin.

Diabetic Proximal Neuropathy

Diabetic proximal neuropathy causes pain usually on only one side. This usually happens in the hips, thighs, or buttocks. It can even sometimes lead to leg weaknesses. Treatment for the weakness or the pain is normally needed and can include medications and also sessions of physical therapy. The recovery of this type of neuropathy varies and depends on the types of nerves which suffered damage. Prevention of this type of nerve problems can be with the daily maintaining blood sugar at normal levels.
Rather than affect the nerve endings proximal neuropathy affects the nerves nearest to the shoulders or hips. This is most common in those with Type-2 diabetes as well as older adults. Affected most often or the legs but this kind of neuropathy can also affect the nerves in the arms and even in the abdomen. Most diabetics improve somewhat over time, although the symptoms can worsen before getting better. These symptoms are:
·                                                            Severe sudden pain in hip, buttock or thigh.
·                                                            Atrophied and weak thigh muscles happens eventually.
·                                                            Rising from a sitting position can become a problem.
·                                                            Weight loss is unintentional.
·                                                            If there is an affected abdomen, there can be abdominal swelling.

Diabetic Focal Neuropathy

Diabetic focal neuropathy can very often appear suddenly and effects very specific nerves, most often those in the torso, head, or leg. This causes muscle weakness or pain.
Mostly affects older adults. And even though the pain can be severe, it usually does not cause any problems which are long term. Signs or symptoms usually disappear or diminish over months or a few weeks all on their own. Symptoms and signs depend on the nerve involved and can include:
·                                                            Problems with focusing eyes, aching sensation behind an eye as well as double vision.
·                                                            Pain in shin or foot.
·                                                            Paralysis on only 1 side of the face (Bell’s Palsy).
·                                                            Pain in front of thigh.
·                                                            Abdominal or chest pain.
Often focal neuropathy happens with a squeezed nerve. Carpal tunnel syndrome is one of the more common types of neuropathy compression in diabetics. Symptoms and signs of carpal tunnel include:
·                                                            Tingling and numbness in hand or fingers, especially the thumb, middle, ring, and index finger.
·                                                            In the hand there is a feeling of weakness together with inclination to drop items.
·                                                            Symptoms seem to be worse on awakening or when gripping something
Currently there is no treatment which can cure diabetic neuropathy. When a person has it, treatment can be done to keep the disease from becoming worse. The key to treating neuropathy is good management or control of diabetes. Also, getting to and remaining at a healthy weight is an excellent start.
In order to control diabetes, you must eat foods which are good for diabetes and also exercise. Controlling diabetes is probably the best and only way to control the complications of diabetes. And if you do have diabetic neuropathy controlling your diabetes is the only way to prevent it from getting worse.
But, most important is to learn and manage proper care of the feet as diabetic neuropathy causes a loss of feeling in the feet. This means that a sore or another problem can go totally unnoticed. This means that an unnoticed sore on the foot can easily lead to a severe infection which can possibly mean amputation.
It is also important to maintain other healthy habits such as regular doctor visits, controlling blood pressure, eating a balanced diet, regularly exercising, not smoking and avoiding or limiting alcohol.

When to see a medical professional ?

Seek attention from a medical professional if you notice:
·                                                            Sore or cut on the foot which isn’t healing, seems to be infected or is becoming worse.
·                                                            Unusual tingling, burning, pain and weakness in feet or hands which interferes with normal routine as well as sleep.
·                                                            Dizziness
·                                                            Modifications in sexual function, urination, or digestion.
These symptoms do not always indicate damage to a nerve but they can be a sign of other problems which need medical care. Either way, early treatment and diagnosis usually offers the better chance for managing signs and symptoms and preventing more severe problems from developing.


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