
Suggest Treatment For Mobility Impairment In A Type 2 Diabetic

My dad is insulin dependent type II diabetic and had it for 20 years.
Can dad get any mobility back and if so how? He has seen Neurologist but I think I am better getting in touch with Endocrinology Team Dad was under as I think they may be able to help more do you agree?
Dad needs to lose a bit of weight and blood sugar is now under control averaging around 6.2
This isn't classed as a terminal illness like motor neurone disease is it?
Can dad gain any kind of mobility back and if so how? Will Physio or acupuncture or anything like that help?
Please upload the reports/What is the functional disability status?
Detailed Answer:
Hi XXXXXXX
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
I have gone through the clinical details of your father,as you have mentioned and I shall offer my best help in this regard.
Prognosis of diabetic neuropathy depends on the stage of severity.Proper control of diabetes is of paramount importance to stop the disease progression. The damage which has already occurred is not usually reversible.However,with medicines and physical rehabilitation-symptoms and functional status of the patient can improve to some extent.
Please let me know that what is the current neurological deficit of your father?Can he do his routine activities independently?Can he walk,stand from the sitting position,use his hands for routine tasks?In other words- what are his symptoms due to neuropathy?
Further,if possible,please upload his 'nerve conduction studies' as scanned jpg image,so that I can review it and interpret the severity of his neuropathy.
Of course! the prognosis of the disease is not as bad, as of motor neuron disease.
I shall be glad to have you in follow-up with further details.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)


Appears to be advanced neuropathy.
Detailed Answer:
Hi XXXXXXX
Thanks for being in follow-up and providing further details.
It appears that he is having advanced stage of neuropathy. Since when he walks with a zimmer frame?I mean for how much duration now-he has been in similar functional status?
Further,Did the treating neurologist consider the diagnosis of radiculoplexopathy?I am asking the same as proximal weakness and quadriceps wasting is not usually seen in classical sensori-motor neuropathy.
Exact prognosis depends on the diagnosis.However,if we consider it as the advanced stage of neuropathy,physiotherapy and medicines may help to some extent,however,chances of recovery will be less as prognosis worsens with the disease progression.
If you can somehow manage to get the documents,please upload them so that I can make a better interpretation and advise accordingly.
Hope that helps.If you have some further questions,I shall be glad to have you in follow-up.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)


Physical rehabilitation will help.
Detailed Answer:
Hi XXXXXXX
Thanks for being in follow-up.
2 months is not a long duration.In this case,I am hopeful that medicines coupled with physical rehabilitation/physiotherapy may help to improve the strength.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)


Take him to a neurological emergency facility.
Detailed Answer:
Hi XXXXXXX
Thanks for being in follow-up.
If the numbness in lower limbs has occurred suddenly,then it must not be a part of neuropathy.You should immediately take him to a neurological emergency facility.He probably needs urgent examination and intervention.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)


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
This is not like,he can't improve at all.
Detailed Answer:
Hi XXXXXXX
Thanks for being in follow-up.
This letter gives the impression that nothing can be done for a patient of diabetic neuropathy. I agree that this disease can't be cured but it does not mean that he can't improve at all.Medicines and physical rehabilitation can help to gain some recovery in a patient of diabetic neuropathy.
Please get back to me after Nerve conduction studies and MRI of spine is done, so that exact diagnosis gets settled,and I get to know the severity of disease.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)


Not sure about how much will he improve.
Detailed Answer:
Hi XXXXXXX
Thanks for being in follow-up.
Though there is hope that he may improve with medicines and physical rehabilitation,but it can't be predicted at the moment that how much he will improve.No one can predict it.Its just wait and watch,for the time to come.
Hope that helps.If you have some further questions,I shall be glad to answer them.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)


Is there any hope we can get dad walking to even using just a zimmer without falling I do realise he will never walk independently again, though this would be great and if so how can we achieve this please?
No harm in trying acupuncture.
Detailed Answer:
Hi XXXXXXX
Thanks for being in follow-up.
No,absolutely there is no harm in trying acupuncture and further,dear friend-I have all my sympathies with you and can feel like the situation you must be in,however,it is just vague to say anything about the future course,unless the investigations arrive.Let the diagnosis and severity of the disease be defined.Have faith in God.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)

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