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Suggest Treatment For Diabetic Neuropathy
Question: Please find below the letter received from hospital. Is there really nothing we can do I would like your opinion please as I feel my Dad has been written off;
Diagnosis: likely diabetic motor sensory neuropathy
Thank you for referring this 68 year old right handed gentleman to the Neurology clinic. He has had diabetes since 2000. His control was previosuly poor though has improved in the last 9 months. Mr Bridge has a previous history of osteomyelitis for which he was treated long term antibiotics. He now describes a 3 month history of progressive weakness of both legs. Although he can stand he feels unsteady and his legs quite often give way. He also described numbness in the legs. His arms bowel bladder speech and swallowing is unaffected.
On examination today his cranial nerves were unremarkable. Examination of limbs revealed normal tone. Power was normal in both arms and legs. Hip flexion was reduced to 3/5 bilaterally. Reflexes were absent in the legs but present in the arms. Sensation to pinprick was reduced distally in the legs but was present in the arms. Vibration sense was absent up to the hips. There were no fasiculations visible.
I suspect this gentleman has quite a severe axonal motor sensory neuropathy secondary to his diabetes. I have explained that this is not a treatable condition but we need to do some further investigations to exclude any more treatable causes. I am areanging MRI scan of lumbar spine to make sure there is no cord pathology or nerve root compression and some nerve conduction studies to quantify the extent of his nerve damage. I will write with the results once they are available.
Please help me there must be something I can do to help my dad I am really upset
Diagnosis: likely diabetic motor sensory neuropathy
Thank you for referring this 68 year old right handed gentleman to the Neurology clinic. He has had diabetes since 2000. His control was previosuly poor though has improved in the last 9 months. Mr Bridge has a previous history of osteomyelitis for which he was treated long term antibiotics. He now describes a 3 month history of progressive weakness of both legs. Although he can stand he feels unsteady and his legs quite often give way. He also described numbness in the legs. His arms bowel bladder speech and swallowing is unaffected.
On examination today his cranial nerves were unremarkable. Examination of limbs revealed normal tone. Power was normal in both arms and legs. Hip flexion was reduced to 3/5 bilaterally. Reflexes were absent in the legs but present in the arms. Sensation to pinprick was reduced distally in the legs but was present in the arms. Vibration sense was absent up to the hips. There were no fasiculations visible.
I suspect this gentleman has quite a severe axonal motor sensory neuropathy secondary to his diabetes. I have explained that this is not a treatable condition but we need to do some further investigations to exclude any more treatable causes. I am areanging MRI scan of lumbar spine to make sure there is no cord pathology or nerve root compression and some nerve conduction studies to quantify the extent of his nerve damage. I will write with the results once they are available.
Please help me there must be something I can do to help my dad I am really upset
Brief Answer:
unfortunatley diabetic neuropathy not treatable but doc ruling out others
Detailed Answer:
HI, thanks for using healthcare magic
It is understandable to be upset about the diagnosis.
The doctor mentioned in the last paragraph about doing further investigations to exclude treatable causes and also suggesting an MRI to take a look at the spine.
The other investigations may be to look for causes such as vitamin b12 and folate levels, checking liver and kidney function, ruling out possible hormonal or autoimmune causes (rheumatoid, lupus, guillain barre).
Infection may also be ruled out. If there is another treatable cause found then this can be managed
From this paragraph, the impression is that they plan to make sure that there are no other causes that they can find and treat.
Uncontrolled diabetes unfortunately can cause nerve damage and if this is the only cause found, then unfortunately it is not reversible. It can be treated with medications to try and relieve any abnormal sensations that may be experienced.
unfortunatley diabetic neuropathy not treatable but doc ruling out others
Detailed Answer:
HI, thanks for using healthcare magic
It is understandable to be upset about the diagnosis.
The doctor mentioned in the last paragraph about doing further investigations to exclude treatable causes and also suggesting an MRI to take a look at the spine.
The other investigations may be to look for causes such as vitamin b12 and folate levels, checking liver and kidney function, ruling out possible hormonal or autoimmune causes (rheumatoid, lupus, guillain barre).
Infection may also be ruled out. If there is another treatable cause found then this can be managed
From this paragraph, the impression is that they plan to make sure that there are no other causes that they can find and treat.
Uncontrolled diabetes unfortunately can cause nerve damage and if this is the only cause found, then unfortunately it is not reversible. It can be treated with medications to try and relieve any abnormal sensations that may be experienced.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dad keeps falling and has lost all mobility can we improve it?
Brief Answer:
treatable causes, change in physical house structure
Detailed Answer:
HI
If another cause is found, then treatment of this cause can improve it.
His doctors may also want to consider physiotherapy to see if this would improve his balance.
Changes to the living environment such as rails along walkways , bathroom, may also be needed.
He may need a walker as well to help maintain balance
Please feel free to ask any other questions
treatable causes, change in physical house structure
Detailed Answer:
HI
If another cause is found, then treatment of this cause can improve it.
His doctors may also want to consider physiotherapy to see if this would improve his balance.
Changes to the living environment such as rails along walkways , bathroom, may also be needed.
He may need a walker as well to help maintain balance
Please feel free to ask any other questions
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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