Diagnosis and Treatment of Diabetic Neuropathy

There are approximately 26 million Americans with diabetes. Among them, about half are likely to develop some form of neuropathy, even if they have good blood sugar control.

Diabetic neuropathy usually involves tingling, burning and/or numbness in the extremities, particularly the feet. When this painful condition results in a complete lack of sensation, we worry about major complications such as wounds and amputations.

Neuropathy can be caused by nerve loss or nerve compression. Because the two are treated differently, it’s essential to make the distinction through accurate diagnosis.

With compression neuropathy, something is trapping the nerve. Performing outpatient nerve decompression relieves approximately 80 percent of patients. Following this treatment, I have yet to see a recurrence.

In order to understand the cause of a patient’s neuropathy, we first perform standard office exams including a mono lament exam, vibratory exam, and a check of nerve thresholds.

One of the best new protocols for diagnosis is the Epidermal Nerve Fiber Density test.  is simple, in-office test takes a 3-millimeter biopsy of tissue requiring no stitches. The skin specimen is sent to a lab, where the exact number of nerve fibers to the skin can be counted.

In addition to helping us make an accurate diagnosis, this test also serves as a baseline to measure the effectiveness of subsequent treatments.

Other forms of testing include quantitative sensory testing to assess damage to the small nerve endings. Now used less frequently for diabetic neuropathy, nerve conduction velocity testing can indicate how quickly electrical signals move through the nerves.

If nerve loss is found to be causing the neuropathy, I usually prescribe Metanx, a highly effective new treatment that can achieve remarkable results. is prescription vitamin is specifically targeted at providing what the body needs to combat peripheral neuropathy with diabetes.

The body is actually capable of re-growing peripheral nerves. Metanx can encourage nerve regrowth by helping to stimulate local circulation.

Metanx begins to work immediately. Patients’ symptoms usually begin to improve within six months. After six months to one year, we perform a second 3-millimeter biopsy. We then compare those results with the original baseline results to see how many nerves have regrown.

If the response to any given therapy is poor, we have alternative options to try. In all cases, we urge patients to continue to control their blood sugar, and we continue work with their primary care doctor and other specialists.

Breakthrough diagnosis and treatment protocols represent a paradigm shift in how we’re effectively managing diabetic neuropathy.  The future will soon bring more exciting protocols for treating diabetic neuropathy giving us the ability to inject a patient’s own stem cells in and around the nerves. In trials, patients’ symptoms have improved following this treatment.

Mark A. Jones, DPM, is a Methodist Physician Group board certified podiatric surgeon. Dr. Jones is also a core surgical instructor for the PM&S podiatric residency at Weiss Memorial Hospital in Chicago.

Author
Dr. Mark Jones Dr. Mark Jones, DPM with the Methodist Physician Group in Merrillville, IN specializes in all things podiatry: diagnosis and treatment of conditions that affect the foot and ankle. Dr. Jones underwent training at the William Scholl College of Podiatric Medicine with honors in clinical studies. He went on to complete his surgical residency training, acting as chief resident in his section. He received national recognition after obtaining advanced training in a complex nerve surgery.

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