Physiotherapy in diabetic neuropathy

What is diabetic neuropathy?

Diabetic neuropathy is a type of nerve damage that occurs as a complication of type 1 and type 2 diabetes. The condition usually develops slowly and is caused by a prolonged high blood sugar level. Diabetic neuropathy damage is often noticed in the legs and feet. Diabetic neuropathy is a serious and common complication of diabetes that affects as many as 50% of the people with diabetes. Diabetes increases the risk of foot ulceration and amputation more than 23-fold and neuropathy is the major contributory factor to this increased risk. Neuropathy presents as painful neuropathy in 20% of patients and it independently predicts all-cause and diabetes-related mortality. Diabetic neuropathy can be prevented, or the progression be slowed down with a consistent blood sugar management and a healthy lifestyle.
Types of diabetic neuropathy
• Peripheral neuropathy-This type of neuropathy may also be called distal symmetric peripheral neuropathy. It’s the most common type of diabetic neuropathy. It affects the feet and legs first, followed by the hands and arms.
• Autonomic neuropathy-The autonomic nervous system controls your heart, bladder, stomach, intestines, sex organs and eyes. Diabetes can affect nerves in any of these areas.
• Proximal neuropathy (diabetic polyradiculopathy)-This type of neuropathy is also called diabetic amyotrophy. It often affects nerves in the thighs, hips, buttocks or legs. It can also affect the abdominal and chest area. Symptoms are usually on one side of the body but may spread to the other side.
• Mononeuropathy (focal neuropathy)-There are two types of mononeuropathy — cranial and peripheral. Mononeuropathy refers to damage to a specific nerve.

Signs and symptoms

The symptoms of neuropathy appear gradually and the first type of damage to occur involves the nerves of the feet. Symptoms vary depending on the area affected. Common signs and symptoms of different types of diabetic neuropathy includes:
• Sensitivity to touch/loss of sense of touch
• Difficulty with coordination when walking
• Numbness or pain in your hands or feet/burning sensation in feet, especially at night
• Muscle weakness or wasting
• Bloating or fullness, nausea, indigestion, or vomiting, diarrhea or constipation
• Excessive or decreased sweating
• Bladder problems, such as incomplete bladder emptying
• Vaginal dryness/erectile dysfunction
• Inability to sense low blood glucose
• Vision trouble, such as double vision, dizziness when you stand up.
• Increased heart rate.
Risk factors
Risk factors are associated with more severe symptoms, and they include:
• Smoking
• Poor glycemic control
• Ageing
• Long duration of Diabetes disease
• Heavy alcohol intake

Physiotherapy intervention

Research has shown that strength training can moderately improve muscle functions in people with peripheral neuropathy (PN). Regular exercise can also help reduce neuropathic pain and help control blood sugar levels. Diabetic clients must tightly monitor their blood sugar levels during exercise to prevent major fluctuations. This may involve educating clients and monitoring blood sugars, ideally through a multi-disciplined approach in rehabilitation. Some of the Physiotherapy intervention includes focus on:
• Flexibility (progressive stretching and self-stretches)
• Muscle strengthening (using a variety of modes as appropriate e.g isometric, graded weight progression, open and close chain)
• Aerobic activity (aiming for 30 minutes 4 times a week)
• Balance (for falls prevention and stability)
• Gait (can improve gait pattern or walking in patients with diabetic neuropathy) Evidence shows that resistant strengthening exercises lower blood glucose level.

Please talk to your doctor as soon as possible if your hands or feet start to feel tingling or burning or if you begin to have problems walking or grasping items. The sooner we can treat you, the sooner that your condition can improve.

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