Diabetic Neuropathy: Concerns and Management Strategies

Diabetic neuropathy issues?

Hello Dr.
Shi: My mother is a diabetic and she is 65 years old.
Last year, she underwent surgery for cervical spondylosis (she initially went for surgery due to numbness in her left hand), but unexpectedly, after the surgery, she experienced weakness in her right hand and both legs.
Sometimes she even says that she feels her neck is too weak to support her.
She has previously received insulin injections at the hospital, and she reported that her numbness and discomfort improved at that time.
However, later the doctor said she could manage with oral medication, so she returned home to take the medication.
Is this type of neuropathy irreversible? Will it progressively worsen in the future? Currently, she can stand with assistance, but her independence is very limited.
Additionally, since I do not live in the same county and I am usually at work, she sees a different doctor each day (hoping for a miracle cure in one visit), but I would like to communicate with her physician.
How can I get in touch with her outpatient doctor? If I call to ask, will it be a bother to the doctor? How can I find out the opinions of doctors at larger institutions, such as teaching hospitals, regarding my mother's condition? (Whenever I ask her what the doctor said, she responds with vague statements like, "They said I won't die or be buried," which is quite frustrating.
I am genuinely concerned about the true state of my mother's health.) Furthermore, she fell and sat on the ground the day before yesterday, and she has osteoporosis.
How should a diabetic patient manage this condition? Thank you very much!

mei, 40~49 year old female. Ask Date: 2008/05/14

Dr. Shi Guangzhong reply Internal Medicine

From your letter, it is evident that your mother has been struggling with weakness in her limbs for quite some time.
There are many potential causes for limb weakness, including blood sugar control issues and cervical spondylosis.
It appears that your mother's weakness has significantly impacted her daily life, so I recommend that you take her to follow up with her neurosurgeon to assess the condition of her cervical spondylosis and determine if her nerves are still being compressed by the intervertebral discs, which could be contributing to her weakness.
Additionally, poor blood sugar control can lead to neuropathy, so it is crucial for your mother to maintain good blood sugar levels.
Whether through insulin injections or oral medications, stabilizing her blood sugar can help alleviate her symptoms of numbness in her hands.
According to the American Diabetes Association, fasting blood sugar should be kept below 120 mg/dL, and blood sugar levels should be below 140 mg/dL two hours after meals.
Therefore, your mother needs to pay attention to her diet and engage in regular physical activity to keep her blood sugar within a healthy range.
Furthermore, you expressed a desire to understand your mother's condition better.
Since you do not live with her, I am unsure how often you visit home.
If you do not visit frequently, I suggest you make an effort to see her more often, as she may be feeling helpless about her health and might be looking forward to your company.
You are also very concerned about her well-being and wish to communicate with her doctor.
I recommend that when your mother has an appointment, you arrange to accompany her so that you can discuss her condition in detail with her physician.
Regarding the issue of osteoporosis, it is crucial for older adults to prevent falls.
From your letter, it seems that your mother needs assistance to stand, so her primary caregiver must pay close attention to her mobility to avoid falls.
It is also advisable for her to take calcium supplements to help counteract bone loss.

Reply Date: 2008/05/14

More Info

Diabetic neuropathy is a common complication of diabetes that can significantly impact a patient's quality of life. It occurs when high blood sugar levels damage the nerves, particularly in the extremities. Your mother's situation, involving both diabetes and recent cervical spine surgery, adds complexity to her neurological symptoms.
Firstly, it is essential to understand that diabetic neuropathy can manifest in various forms, including peripheral neuropathy, which affects the feet and hands, and autonomic neuropathy, which can impact involuntary bodily functions. The symptoms can range from numbness and tingling to severe pain and weakness. In your mother's case, her symptoms of weakness in her arms and legs, as well as her neck feeling weak, could be attributed to a combination of diabetic neuropathy and potential complications from her cervical spine surgery.

Regarding the management of her condition, controlling blood sugar levels is paramount. Even if she is currently on oral medications, it is crucial to ensure that her blood sugar is well-managed. The American Diabetes Association recommends maintaining fasting blood glucose levels below 130 mg/dL and postprandial levels below 180 mg/dL. Regular monitoring and adjustments to her medication regimen may be necessary to achieve these targets.

Physical therapy and rehabilitation are also vital components of her care. Since she has difficulty standing and requires assistance, a tailored physical therapy program can help improve her strength and mobility. Occupational therapy may also be beneficial to assist her in performing daily activities more independently.
In terms of communication with her healthcare providers, it is understandable that you want to be more involved in her care, especially since you do not live in the same city. It is perfectly acceptable to call her doctor's office to ask questions about her treatment plan or to express your concerns. Most healthcare providers appreciate family involvement, as it can lead to better patient outcomes. If you are unable to attend appointments, consider asking your mother to take notes during her visits or to record the conversations (with the doctor's permission) so you can better understand her condition.

If you are looking for specialists, teaching hospitals often have more resources and may provide a multidisciplinary approach to care. You can check their websites for information on their neurology departments or diabetes clinics. Many hospitals also have patient navigators who can assist you in finding the right specialists and scheduling appointments.

Regarding her osteoporosis, it is crucial to address this condition to prevent fractures, especially since she has already experienced a fall. Ensuring she receives adequate calcium and vitamin D, along with weight-bearing exercises (as tolerated), can help strengthen her bones. Additionally, her healthcare provider may consider medications that can help improve bone density.

In summary, managing diabetic neuropathy involves a comprehensive approach that includes strict blood sugar control, physical and occupational therapy, effective communication with healthcare providers, and addressing any coexisting conditions like osteoporosis. Regular follow-ups with her healthcare team will be essential in monitoring her progress and adjusting her treatment plan as needed. Your involvement and support will be invaluable in her journey toward better health.

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