There are several nomenclatures which can be confusing. In practice they are not always clearly definable. From the patient's point of view it is important to know if any sensory modality is missing so as to be careful to avoid injury; if it hurts or feels peculiar; or if a muscle is weak or does not work.
The commonest form of neuropathy is loss or blunting of sensation in a 'sock' or sometimes 'glove' distribution. Different modalities may be differently affected.
Problems that arise are numbness so that rubbing or injury is not noticed, loss of temperature discrimination with a risk of burning, loss of position sense which, if severe, can make walking and balance difficult. Loss of vibration sense is an early sign of neuropathy but has no major clinical impact. This peripheral neuropathy may be accompanied by tingling or actual pain.
Single nerve lesions, with or without entrapment, are quite common. They include median and ulnar nerves and those serving eye movement (see p. 126).
Muscle weakness may be secondary to an individual nerve lesion (as above) or more diffuse. It can affect the thighs with marked wasting, weakness, and pain, or rarely be more extensive.
Many patients are unaware of the extent of their neuropathy until they are affected by one of its consequences such as a foot ulcer at the site of an unnoticed injury. A few are severely disabled by pain. Such patients should be referred to a diabetologist. The pain is sometimes relieved by minor analgesics, but if not, tricyclic antidepressants, carbamazepine, or phenytoin may help.
Obviously the most likely reason for neuropathy in someone with diabetes is diabetic tissue damage. However, it is important not to miss other treatable causes such as vitamin B12 deficiency, vitamin B6 deficiency, alcohol excess, drugs, uraemia, collagen-vascular disease, and other conditions.
Warning for neuropathic patients
♦ Never walk barefoot
♦ Check shoes and socks for foreign bodies every time you put them on
♦ Never use a hot water bottle
♦ Check the bath-water temperature with a bath thermometer
♦ Always use an oven glove
♦ Inspect your feet every day.
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This guide will help millions of people understand this condition so that they can take control of their lives and make informed decisions. The ebook covers information on a vast number of different types of neuropathy. In addition, it will be a useful resource for their families, caregivers, and health care providers.