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Suggest Treatment For Diabetic Peripheral Neuropathy
Question: my dad is in hospital and has been diagnosed with diabetic type 2 peripheral neuropathy. Dad has lost complete mobility. Can my dad ever walk again and if so what can we do. the hospital have basically said this is dads life now so we need adaptations at home. i am sure something can help to gain a bit of mobility. dad cant stand from a sitting position and then when he does his legs collpase underneath him. please help
Brief Answer:
Supportive therapy and physiotherapy may help
Detailed Answer:
Hi! Welcome to Health care magic! Thanks for sharing your concerns with us. We will try to help you in best way possible.
First of all, it is sad to hear about his health. At this verge, few measures can be of some help as thorough disappointment from his or yours end will only aggravate the issue, instead of bringing any improvement in his quality of life.
Proper consultation, review and follow up with regular exercises by a physiotherapist are of much help and can improve some mobility. Other measures like weight control and diabetic control will help with further progression and little reversibility in the symptoms. Meanwhile supplementation with micronutrients after checking the levels along with keeping up the compulsory protein energy requirement will help with generalized outcome.
In short, even if their is a little hope, you need to maximize it to get as much benefit for him as possible instead of getting disappointed and giving up. Meanwhile proper bed care, posture changes to avoid nursing care and thrombus prophylaxis should be ensured after geriatric specialist from time to time follow ups.
Wishing him good health. If you have any more questions, feel free to ask.
Regards
Supportive therapy and physiotherapy may help
Detailed Answer:
Hi! Welcome to Health care magic! Thanks for sharing your concerns with us. We will try to help you in best way possible.
First of all, it is sad to hear about his health. At this verge, few measures can be of some help as thorough disappointment from his or yours end will only aggravate the issue, instead of bringing any improvement in his quality of life.
Proper consultation, review and follow up with regular exercises by a physiotherapist are of much help and can improve some mobility. Other measures like weight control and diabetic control will help with further progression and little reversibility in the symptoms. Meanwhile supplementation with micronutrients after checking the levels along with keeping up the compulsory protein energy requirement will help with generalized outcome.
In short, even if their is a little hope, you need to maximize it to get as much benefit for him as possible instead of getting disappointed and giving up. Meanwhile proper bed care, posture changes to avoid nursing care and thrombus prophylaxis should be ensured after geriatric specialist from time to time follow ups.
Wishing him good health. If you have any more questions, feel free to ask.
Regards
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
let me start from the beginning.
Dad approximately 2 months tried to get up and simply couldnât. Dad has always been an independent man with no mobility problems. We took Dad to the hospital who thought Dad had had a TIA. After assessment TIA was ruled out.
Dads main symptoms were severe pain in left thigh and leg and when he tried to stand up his legs would just collapse underneath him. Dad does have some numbness in his leg. This all started in his left leg but has now developed to the right leg (right leg is now much worse than the left with exactly the same symptoms, numbness, pain and legs collapse underneath him. Numbness in left leg has now resolved but still has it in his right leg. Dads feet are always stone cold and he says he cant tell himself without touch whether both feet are hot or cold. Dad has no upper limb symptoms.
At the moment Dad canât get from a sitting to standing position yet his left leg now has full power and can leg raise with full range of movement. The right leg however he can hardly lift it up, Dads left leg was like this at first but now the leg seems to be resolving though Dad can still not walk or stand.
We have had a follow up appointment with the Stroke Team who have now discharged Dad as they say his condition is not stroke related.
We have seen a Neurologist and are awaiting EMG studies plus MRI scan and Occupational Therapy input. Neurologist gave us no hope what so ever and said there is no treatment and reversing what is wrong with Dad. I am sure medicine these days there must be something.
Please find below the letter we got from the Neurologist:
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 previously 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 (18 months of antibiotics). He now describes a 2 month history of progressive weakness of both legs. 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 fasciculationâs 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 exclude any more treatable condition but we need to do some further investigations to exclude anymore treatable causes. I am arranging 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.
Questions:
1. Do you have any idea what is wrong with my Dads legs?
2. How can we get Dad XXXXXXX even with a Zimmer (Dad still falls with a frame)
3. Do you think this condition can resolve or get better?
4. If Dad can move legs freely whilst sat down why can he not stand up without legs collapsing or him falling?
5. What is axonal motor sensory neuropathy and do you agree this is what is wrong? Can it get any better?
6. What treatable causes are there?
Hospital are give dad vitamin drips. They have also said mri scan shows disc bulge can this cause dads problems of not be able to stand up also they now say it could be dads hip thats the problem. And they are think of moving dad to rehab unit will this help my dad. All i want is for him to be able to stand is this possible please
Dad approximately 2 months tried to get up and simply couldnât. Dad has always been an independent man with no mobility problems. We took Dad to the hospital who thought Dad had had a TIA. After assessment TIA was ruled out.
Dads main symptoms were severe pain in left thigh and leg and when he tried to stand up his legs would just collapse underneath him. Dad does have some numbness in his leg. This all started in his left leg but has now developed to the right leg (right leg is now much worse than the left with exactly the same symptoms, numbness, pain and legs collapse underneath him. Numbness in left leg has now resolved but still has it in his right leg. Dads feet are always stone cold and he says he cant tell himself without touch whether both feet are hot or cold. Dad has no upper limb symptoms.
At the moment Dad canât get from a sitting to standing position yet his left leg now has full power and can leg raise with full range of movement. The right leg however he can hardly lift it up, Dads left leg was like this at first but now the leg seems to be resolving though Dad can still not walk or stand.
We have had a follow up appointment with the Stroke Team who have now discharged Dad as they say his condition is not stroke related.
We have seen a Neurologist and are awaiting EMG studies plus MRI scan and Occupational Therapy input. Neurologist gave us no hope what so ever and said there is no treatment and reversing what is wrong with Dad. I am sure medicine these days there must be something.
Please find below the letter we got from the Neurologist:
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 previously 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 (18 months of antibiotics). He now describes a 2 month history of progressive weakness of both legs. 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 fasciculationâs 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 exclude any more treatable condition but we need to do some further investigations to exclude anymore treatable causes. I am arranging 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.
Questions:
1. Do you have any idea what is wrong with my Dads legs?
2. How can we get Dad XXXXXXX even with a Zimmer (Dad still falls with a frame)
3. Do you think this condition can resolve or get better?
4. If Dad can move legs freely whilst sat down why can he not stand up without legs collapsing or him falling?
5. What is axonal motor sensory neuropathy and do you agree this is what is wrong? Can it get any better?
6. What treatable causes are there?
Hospital are give dad vitamin drips. They have also said mri scan shows disc bulge can this cause dads problems of not be able to stand up also they now say it could be dads hip thats the problem. And they are think of moving dad to rehab unit will this help my dad. All i want is for him to be able to stand is this possible please
Brief Answer:
Further work up will reveal the prognosis
Detailed Answer:
Hi! Thanks for sharing the details in such comprehensive yet informative way. It is sad what you all had gone through. Based on the history you have shared, it is likely to be diabetic neuropathy but other causes like spine issues leading to compression of nerves supplying muscles of lower limbs can be additional cause to his immobility. A neurosurgeon review with films of MRI and reports of NCS can be suggestive that whether any surgical intervention can be of any benefit as described on report of MRI as bulge pressing at nerves. Rehab centres offering physiotherapy have shown to be of some benefit in such patients and even if their is slightest of the chances I would suggest you to take it. Meanwhile other reversible causes may have included B12, D3 or B6 defficiencies. Such causes may be reversed with replacements of these micronutrients. Wishing him good health and better recovery. In case of any more questions, feel free to ask. Regards.
Further work up will reveal the prognosis
Detailed Answer:
Hi! Thanks for sharing the details in such comprehensive yet informative way. It is sad what you all had gone through. Based on the history you have shared, it is likely to be diabetic neuropathy but other causes like spine issues leading to compression of nerves supplying muscles of lower limbs can be additional cause to his immobility. A neurosurgeon review with films of MRI and reports of NCS can be suggestive that whether any surgical intervention can be of any benefit as described on report of MRI as bulge pressing at nerves. Rehab centres offering physiotherapy have shown to be of some benefit in such patients and even if their is slightest of the chances I would suggest you to take it. Meanwhile other reversible causes may have included B12, D3 or B6 defficiencies. Such causes may be reversed with replacements of these micronutrients. Wishing him good health and better recovery. In case of any more questions, feel free to ask. Regards.
Above answer was peer-reviewed by :
Dr. Naveen Kumar
Nerve conduction studies have revealed inflammation of dads nerves in thighs and says it is diabetic inflammation peripheral neuropathy. Does that make sense he is hopeful dad can recover what are your thoughts please?
Brief Answer:
Recovery depends upon presence of any other treatable entity
Detailed Answer:
Hi! Thanks for staying in the loop. Will the recovery be possible, whether complete or partial? will depend upon presence of any other treatable entity like I mentioned, for example any cord compression or by correcting metabolic abnormalities. Diabetic neuropathy itself is difficult to be reversed completely. And here the role of rehab comes into play. They can help him with the rehabilitation phase and can help to lift the functional capacity. Meanwhile close liason with neurological surgeon for that disc bulge and with a second opinion with another neurologist should be sought. Meanwhile good control of diabetes should be ensured for progression of complications. Regards.
Recovery depends upon presence of any other treatable entity
Detailed Answer:
Hi! Thanks for staying in the loop. Will the recovery be possible, whether complete or partial? will depend upon presence of any other treatable entity like I mentioned, for example any cord compression or by correcting metabolic abnormalities. Diabetic neuropathy itself is difficult to be reversed completely. And here the role of rehab comes into play. They can help him with the rehabilitation phase and can help to lift the functional capacity. Meanwhile close liason with neurological surgeon for that disc bulge and with a second opinion with another neurologist should be sought. Meanwhile good control of diabetes should be ensured for progression of complications. Regards.
Above answer was peer-reviewed by :
Dr. Naveen Kumar
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