Diabetic Amyotrophy: What Is It?

After answering the question what is diabetes, you may continue to ask what diabetic amyotrophy is and get an answer that goes:  it is a type of neuropathy experienced by Type 2 diabetic patients, the outcome of which is pain, weakness, etc. Obviously, your second question could be: what is neuropathy in the first place?

To get the basic facts right, neuropathy is inflammation of the nerves that are outside the brain and spinal cord. Hence this condition is often called ‘peripheral’ neuropathy. The inflammation could be due to injury to the nerves or a result of some metabolic disorder. Incidentally,  Diabetics suffer from some form of neuropathy. 

Coming back to our topic of discussion, diabetic amyotrophy is a painful condition characterized by muscle wasting and weakness. It primarily affects the muscles of the thigh and pelvic girdle.  The pain can also affect toes, feet, legs, hands and arms.  It is also known by other names including proximal diabetic neuropathy or lumbosacral radiculoplexus neuropathy, Bruns-Garland Syndrome, etc.

 

Diabetic neuropathy can be of different types 

They can be classified as peripheral, autonomic, proximal, or focal, depending on the nerves damaged by diabetes. Diabetic amyotrophy is in essence peripheral neuropathy, the most common typ,  characterized by damage of nerves of the arms and legs.

 

 What are the early symptoms of diabetic amyotrophy?

Generally affecting more Type 2 diabetic patients than Type 1, severe pain and weakness of thigh muscles along with that of hip and buttocks at night is one of the early signs. Such pain and subsequent weakness may be centralized on one side and gradually move on to the other side also. The pain could also affect the shin and feet. Other symptoms include loss of knee and ankle reflex.

 

Other symptoms , that usually worsen and get aggravated at night include:

-          Numbness to pain or temperature

-          Tingling, burning, or prickling sensation

-          Muscle cramps and shooting pains

-          Excessive sensitivity to touch

-          Loss of balance and coordination

 

 How does one know about its onset?

Apart from the recurrent signs of muscle weakness and loss of reflexes, there are several other features of this condition. These include:

-          Feet deformities like hammer toes or collapse of the mid foot.

-          Blisters and sores could appear on areas that have gone numb. When such conditions are not treated on time, the infections spread to the bones when the leg might have to be amputated.

 

Who is at risk for diabetic amyotrophy?

-          Older men and middle aged women

-          Approximately 1% of diabetics suffer from this condition.

 

What causes this condition?

This is a common yet very serious complication of diabetes. It is essentially caused when the functioning of nerves is impaired. Reduced flow of blood to the legs is a common problem faced by many diabetics. This leads to short supply of nutrients required for the legs to function properly. This aggravates the condition further.

Other causes include:

-          Metabolic factors like long record of diabetes, abnormal levels of fat content in blood, and inappropriate type 2 diabetes diet.

-          Neurovascular disorders that impair blood supply to the nerves.

-          Autoimmune disorders causing inflammation of nerves.

-          Genetic factors

-          Smoking and alcohol are major contributory factors.

 

How is diabetic amyotrophy diagnosed?

 

All neuropathies are diagnosed on the basis of clinical symptoms and physical examination of the patient that includes checking of BP, heart rate, muscle strength, joint reflexes and degree of sensitivity to change of position, vibration, touch and temperature. As far as diabetic amyotrophy is concerned, the following diagnostic examinations may be necessary:

 

-          Examination of the feet: Many experts are of the opinion that all diabetic patients need their feet examined every year to check the presence of peripheral neuropathy. Such examinations include a comprehensive check up of skin, muscles, bones, blood circulation and sensitivity of the feet. It is done with the help of a nylon monofilament, that resembles a hairy toothbrush and touching the feet with it.  Those who cannot feel any sensation are likely to develop diabetic foot sores that normally do not heal properly. A tuning fork could also be used to check temperature sensitivity of the feet and vibratory senses.

-          Other studies include nerve conduction studies or electromyography to assess the extent of damage to the nerves. Nerve conduction study involves passing electricity through a nerve and electromyography records muscle response to such electrical impulses.

-          Checking variability of heart rate denotes the heart response to deep breathing and changes in blood pressure and body posture.

-          Ultrasound can also be used to check the functioning of internal organs.

-          A glucose tolerance test may also be performed before the actual diagnosis.

 

How is diabetic amyotrophy treated?

The first aim of therapy is to lower blood glucose levels to prevent any further damage to nerves. Monitoring of blood sugar levels, diabetic meal planning, physical exercises and diabetic medicines or insulin therapy are used.

 

Additional treatments for the management of diabetic amyotrophy are as follows:

-          Patients suffering severe pain respond to pain medicines combined with other treatments. Nerve pain is reduced with the help of tricyclic antidepressants, such as amitriptyline; other types of antidepressants, such as duloxetine; anticonvulsants, such as pregabalin; opioids and opioid-like drugs, such as controlled-release oxycodone. Duloxetine and pregabalin are FDA-approved for  treating painful diabetic nerve complications.

-          Diabetic skin treatment, especially skin of the feet is done with the help of capsaicin cream and lidocaine patches. Nitrate sprays or patches are also effective for pain in the feet.

-          Acupuncture, biofeedback, or physical therapy is effective with some patients for relieving pain.

-          Physical therapy is effective for improvement of muscle weakness or when the patient is affected by loss of coordination

Foot Care: management of diabetic amyotrophy remains incomplete without taking special care of the feet as nerves of the feet are most affected by the condition. Circulation impairment causes foot ulcers, sores and injuries that can worsen quickly. In fact, in the US, more than half of all lower-limb amputations take place with people suffering from diabetes. For special information on the management of complications arising out of diabetic amyotrophy, visit www.diabetes.niddk.nih.gov/dm/pubs/complications_feet

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