Diabetic Neuropathy: Symptoms, Treatment, and Management

Diabetic neuropathy?

Dear Li,
Question 1: Recently, my grandmother has experienced a loss of sensation in the tips of her fingers, particularly in her index, middle, and ring fingers, which has become more severe.
In addition to the numbness in her fingers, she also experiences numbness in her feet, which has persisted for several years.
The numbness in her hands started a few months ago.
She has a history of approximately 20 years of hypertension, diabetes, and heart disease, and she has been on medication for a long time, visiting the doctor once a month.
I suspect that the recent loss of sensation in her fingers may be due to diabetic neuropathy.
Among the medications she takes are Cobamamide 250 mcg, 1 tablet four times a day; Hydrochlorothiazide 50 mg, 1 tablet once daily; Atenolol 100 mg, 1 tablet once daily; Nobar 5 mg, 1 tablet once daily; Metformin 500 mg, 1 tablet once daily; and Liquid Brown Mixture 5 cc, four times a day.
I would like to know if there are any other methods to improve my grandmother's condition.
Question 2: As mentioned above, she has been on long-term medication under general internal medicine.
Recently, her blood pressure has been unstable, with measurements ranging from 160-190/90-60 mmHg.
She has reported experiencing headaches and dizziness, especially with the recent changes in weather.
She previously asked her doctor if it was possible to prescribe PRN (as needed) antihypertensive medication, but the doctor responded that she is already on too many medications and cannot prescribe more unless she consults a different specialty.
Is there a regulation that limits the number of medications a single specialty can prescribe? Should I consider consulting another specialty? Additionally, does your hospital have a consultation phone number or other contact methods?
Thank you for your valuable response.

Li Tianling, 20~29 year old female. Ask Date: 2012/10/29

Dr. Cai Zonglin reply Internal Medicine

Diabetic neuropathy commonly presents with numbness, tingling, or a sensation of wearing gloves in the extremities.
If a diabetes educator is available at the hospital, a monofilament test can be performed initially.
For further evaluation, a referral to a neurologist may be necessary for nerve conduction studies.
Currently, there is no effective treatment for diabetic neuropathy; however, topical analgesics containing capsaicin may be used for localized pain relief, along with analgesics or tricyclic antidepressants to alleviate discomfort.
Patients may also seek evaluation in a neurology or pain management clinic.
Regarding blood pressure, since the patient is already on three antihypertensive medications, it is advisable to consult a cardiologist for further assessment or medication adjustment.

Reply Date: 2012/10/29

More Info

Diabetic neuropathy is a common complication of diabetes that can lead to various symptoms, including numbness, tingling, and pain in the extremities. It is essential to understand the underlying mechanisms, symptoms, and management strategies for diabetic neuropathy, especially in the context of your grandmother's health issues.

Understanding Diabetic Neuropathy
Diabetic neuropathy occurs due to prolonged high blood sugar levels, which can damage the nerves over time. This condition can manifest in several forms, including peripheral neuropathy, which primarily affects the feet and hands. Symptoms may include:
1. Numbness or Tingling: As you mentioned, your grandmother is experiencing numbness in her fingers and toes, particularly in the index, middle, and ring fingers. This is a classic symptom of peripheral neuropathy.

2. Pain: Some individuals may experience sharp, burning pain or sensitivity to touch, which can be debilitating.

3. Loss of Coordination: Nerve damage can affect balance and coordination, increasing the risk of falls.

4. Autonomic Symptoms: In some cases, diabetic neuropathy can affect the autonomic nervous system, leading to issues such as gastrointestinal problems, bladder dysfunction, or changes in heart rate.

Treatment and Management Strategies
1. Blood Sugar Control: The cornerstone of managing diabetic neuropathy is maintaining stable blood glucose levels. Your grandmother's current medications, including Uformin (metformin), are essential for controlling her diabetes. Regular monitoring of blood sugar levels and adjusting medications as necessary can help prevent further nerve damage.

2. Pain Management: For neuropathic pain, medications such as gabapentin or pregabalin may be prescribed. These medications can help alleviate pain and improve quality of life. It’s crucial to discuss any concerns about medication effectiveness with her healthcare provider.

3. Physical Therapy: Engaging in physical therapy can help improve strength, balance, and coordination. A physical therapist can design a tailored exercise program that accommodates her limitations and enhances mobility.

4. Nutritional Support: A balanced diet rich in vitamins, particularly B vitamins, can support nerve health. Consulting a nutritionist may provide additional insights into dietary adjustments that could benefit her condition.

5. Regular Check-ups: Given her history of hypertension and heart disease, regular follow-ups with her healthcare provider are essential. This allows for ongoing assessment of her medications and overall health status.

Addressing Blood Pressure Concerns
Regarding your grandmother's fluctuating blood pressure readings, it’s crucial to address this with her healthcare provider. High blood pressure can exacerbate complications related to diabetes and increase the risk of cardiovascular events. If her current physician is unable to prescribe additional medications due to her existing regimen, it may be beneficial to seek a consultation with a cardiologist or an endocrinologist. These specialists can provide a comprehensive evaluation and may suggest alternative treatment options or adjustments to her current medications.

Conclusion
In summary, managing diabetic neuropathy involves a multifaceted approach that includes strict blood sugar control, pain management, physical therapy, and regular medical evaluations. Given your grandmother's complex medical history, it may be beneficial to consult with specialists who can provide targeted care for her diabetes, hypertension, and neuropathy. If you have further questions or need assistance, consider reaching out to her healthcare provider for guidance or to inquire about additional resources available at your local hospital.

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