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Neuropathy

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Diabetic Neuropathy-what does it mean for your feet:Diabetes Monitor:"Diabetic nerve damage to the feet, sometimes called diabetic neuropathy, or more correctly, diabetic distal symmetric sensory polyneuropathy, frequently causes people with diabetes to lose sensation in their feet, which is usually describe as "numbness." There's really not much available to help this loss of sensation. However, diabetic neuropathy occasionally creates a severe burning pain, or other very unpleasant sensations, that are extremely frustrating. The following treatment program is suggested for painful diabetic neuropathy.Get your diabetes straightened out as best you can! Aim to keep your blood sugar tests normal as often as possible, and to get your glycosylated hemoglobin value into the normal range. The blood sugar should ideally be about 100 before meals, and 140 or 150 as the highest blood sugar that is ever seen. This extremely tight control may require shots of insulin several times daily, very careful attention to meal planning and frequent monitoring of your blood sugar level, under the care of a knowledgeable physician specializing in diabetes, working together with a nurse who is a Certified Diabetes Educator"
http://www.diabetesmonitor.com/dm-feet.htm

A MULTIDISCIPLINARY APPROACH TO DIABETIC NEUROPATHY TREATMENT:Yngve Bersvendsen, Bergen, Norway:"The information about diabetic neuropathy which is presented here represents up-to-date research work. By publishing this document on a Website, we hope that others can find information which can be useful in managing this painful disease. If someone personally wants to follow up on some of the suggestions given here, we would appreciate knowing.First, it is important to get an examination by a physician to get a correct diagnosis. Second, controlling neuropathy means very strict control of BG levels and the avoidance of hyperglycemia. Near-normoglycemia is the aim. (Personally, I think that diabetics should aviod the use of artificial sweeteners such as Aspartame (NutraSweet), which is used in sodas etc. The merest hint that Aspartame could possibly metabolize into formaldehyde and methanol should cause defections en masse. Rather, drink clean water! YB). But the intention of this article is to set up a nutritional programme ancillary to conventional treatments of diabetic neuropathy."
bersvendsen@nsd.uib.no
http://www.geocities.com/bsy53/dn/neuropat.html

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Local wound care in diabetic foot complications:POSTGRADUATE MEDICINE:"Foot infection is the most common reason for hospitalization among diabetic patients, accounting for up to 25% of admissions (1,2). Regrettably, less than 14% of patients admitted for diabetic foot complications receive adequate lower extremity evaluation (3,4), and when foot ulcers do develop, one in five of these patients eventually has to undergo amputation (1,2). It has been estimated that with appropriate knowledge of risk factors and treatment by a multidisciplinary team, up to 85% of foot and leg amputations in diabetic patients could be prevented (3,4). Early identification of risk factors for diabetic foot ulcer and initiation of proper treatment reduce the occurrence of complications, including the need for amputation. Several factors contribute to ulceration in diabetic patients (5). Among the most common are neuropathy, structural deformity or limited joint mobility, previous history of ulceration or amputation, and poor glucose control (3,5). Effects of these risk factors are cumulative."
http://www.postgradmed.com/issues/1999/07_99/muha.htm

Diabetic Foot complications includes photos:Denver Diabetic Foot and Ulcer Clinic:"CIRCULATION / BLOCKED ARTERIES Diabetes causes reduced blood flow to the legs and arteries. Reduced circulation can cause swelling and decreased feeling. Decreased feeling causes other problems with the nerves, bones and skin.NERVES / NEUROPATHY Sensations; sharp/dull, hot,cold and pain feeling can change. Reduced pain feeling in the skin can cause pressure sores or ulcerations. The wrong sensations can cause changes in the bones and joints to soften and shift."
Phone: (303) 761-5454
Fax: (303) 761-5458
info@DenverFoot.com
http://www.denverdiabeticfoot.com/English/Complications/complications.htm

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Foot care and Prevention of Amputation in Diabetic Patients:The Diabetic Foot Clinic at M.V.Hospital For Diabetes:"The foot of the patient with a long standing Diabetes is often the site of neuropathic and vascular process which pose a considerable threat, not only to the lower limb to the life of the patient. This demands much care and attention by both the patient and health care personnel. Two major problems which predispose the diabetic patients to amputation are the development of neuropathy due to uncontrolled diabetes over several years whih result in damage to the nerves in the feet leading to the loss of sensation. They also develop ceratin high pressure points under the feet which results in the formative of callus which later turns in to ulcer. In addition cigarrette smoking will lead to nerve damage and reduce blood flow in the feet."
http://www.mvdiabeticfoot.com/diafoot1.html

Proper Foot Care May Prevent Diabetic Complications:Dr. David Zuckerman, D.P.M.:"The patient was completely unaware of the ulcer. They couldn't feel any pain. This is why Diabetisc need to be seen by a Podiatrist four times per year. The last picture is an after treatment of toe ulcer two weeks later. This shows how toes can be saved with the care of a foot specialist Even the most trivial injury - such as stepping on a tack or stubbing a toe - can, if untreated, lead to amputation and even death to diabetics. But they often neglect foot injuries, even scalds, burns and frostbite, because diabetes attacks the insulation surrounding nerve endings and short circuits a patient's ability to feel pain or heat.A podiatrist is often the first health practitioner to diagnose diabetes. A patient might schedule an appointment to question me about a bump on his foot, and I discover he is walking on a fractured bone. Another person might want a bunion treated, and I find she has a needle in her foot and no idea how it got there. Whenever I see a patient who fails to notice injuries that are normally painful, I suspect diabetes."
David Zuckerman DPM
The Foot Specialist, P.C.
341 S. Evergreen Ave.
Woodbury, NJ 08096
Telephone: (856) 848-FEET (3338)
Fax: (856) 848-5122
info@thefootspecialist.com
http://www.thefootspecialist.com/diabetic.html

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Temperature monitoring device may help prevent diabetic foot complications:Doctor's Guide Publishing Limited:"Diabetics with nerve damage often develop ulcers on their feet because they cannot feel that their foot is sore from an injury, Dr. Lavery said. "However, prior to developing an ulceration, the surrounding tissue becomes inflamed, and the inflammation can be measured by a change in local skin temperatures, often days before the tissue is damaged enough to ulcerate," he explained. In order to find out if a home temperature-monitoring device could help high-risk diabetics prevent foot ulcerations, Dr. Lavery and colleagues performed a randomised, single blind study, using 173 diabetics with a previous history of foot ulceration. Participants were randomly assigned to one of three groups: a standard therapy group; a structured exam group; or an enhanced therapy group. All patients received therapeutic footwear, diabetic foot education and regular foot care throughout the trial, which lasted 15 months."
http://www.docguide.com/news/content.nsf/News/8525697700573E1885256C2B0066BBB2?OpenD ocument&id=48dde4a73e09a969852568880078c249

New treatment for diabetic foot ulcers:Office of Public Affairs:"FDA today approved used of a new type of wound dressing to help heal diabetic foot ulcers, open foot sores that lead to thousands of amputations each year in people with diabetes. The product, called Apligraf, is intended to be used on patients who have not responded well to standard methods of treating foot ulcers. Manufactured by Organogenesis Inc., Canton, Mass., Apligraf was previously approved by FDA to treat leg ulcers caused by circulatory problems. Apligraf is a cellular, bi-layered skin substitute produced from bovine collagen and cells derived from human infant foreskins. Its special composition allows it to provide wound protection and foster the growth of healthy new skin."
http://www.fda.gov/bbs/topics/ANSWERS/ANS01022.html

Onychomycosis-a fungal infections common to diabetics:Healthcommunities.com, Inc.:"Patients with diabetes commonly develop onychomycosis because blood circulation is poor in the extremities, and the body's ability to fight infections is compromised. Small cuts, infections, and foot injuries can have serious consequences for diabetics. It is important to inspect the feet closely each day and work with a physician on a program of thorough foot care.The primary fungi that cause onychomycosis are trichophyton rubrum and trichophyton mentagrophytes. They are dermatophytes (fungi that infect hair, skin, and nails) and feed on keratinized (nail) tissue. The infections they cause are normally confined to the nails, but occasionally spread to the surrounding skin.Onychomycosis is difficult to treat. Medicines can be taken orally to kill these infections (e.g., Lamisil, Sporanox). Because the nail grows slowly, the medicine works gradually, requiring several months to completely eliminate the infection."
http://www.podiatrychannel.com/onychomycosis/

Foot scan may ward off diabetic foot complications:St. Joseph Health System:"A portable device that measures temperature changes in the feet may help diabetics avoid foot ulcers, researchers reported Saturday at the American Diabetes Association's annual meeting here. Foot ulcers are a common problem in diabetics, whose poor circulation and loss of sensation in the feet can lead to difficult-to-heal ulcers. Such ulcers can cause foot deformities or even lead to amputation. "Temperature monitoring may be a promising adjunct to protect patients' lower extremities," said study author Lawrence Lavery, an associate professor of podiatry at Loyola University Medical Center in Chicago, Illinois. Lavery reported on a preliminary study of the FootScan, a device that uses an infrared temperature probe to measure spikes in temperature in the foot caused by inflammation. Patients with higher foot temperature are known to be at increased risk of developing ulcers."
St. Joseph Health System
500 S. Main, Ste. 1000
Orange, CA 92868
(714) 347-7500
mtrujill@corp.stjoe.org
http://www.stjhs.org/HealthNews/reuters/NewsStory0617200218.htm

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What can I do to prevent foot problems from diabetic neuropathy?:American Academy of Family Physicians:"Check your feet every day.You may need to use a mirror to to check the bottoms of your feet. Call your doctor at the very first sign of redness, swelling, infection, pain, numbness or tingling in any part of your foot. Check inside your shoes every day for things like gravel or a torn lining. These things could hurt your feet. Never walk barefoot around the house or outside. Have your doctor look at your feet during every office visit (at least once a year) or whenever you notice anything that seems wrong. Choose the right shoes. The most common cause of foot sores is shoes that are new or don't fit properly. Buy shoes that fit properly and have a good arch support. Choose shoes made of soft leather. They should not fit tightly anywhere. To get the best fit, try on shoes at the end of the day when your feet are a little swollen. If you've had problems before with shoes that didn't fit well, you may want to be fitted for a custom-molded shoe with plenty of room for your toes. Wear white socks and check when you take them off to see if there is any blood or fluid from a sore on them. Wash your feet daily in lukewarm water. Dry them well, especially between the toes. Use a soft towel and blot gently; don't rub. Keep the skin of your feet smooth by applying a cream or lanolin lotion, especially on your heels. If your feet sweat easily, keep them dry by dusting them with nonmedicated powder before putting on your socks, nylons and shoes."
http://familydoctor.org/handouts/050.html

SURGEONS COMBINE EFFORTS TO SAVE LIMBS RAVAGED BY DIABETIC COMPLICATIONS AND TRAUMA:UPMC Health System:"Surgeons at UPMC Health System have announced the opening of the Limb Salvage Center dedicated to saving limbs damaged by diabetic complications, trauma and peripheral vascular disease. The program is a collaborative effort of vascular, orthopaedic, plastic and trauma surgeons and specialists in infectious disease.A recent study published in the journal Diabetes Care reported on the dramatic increase in the incidence of diabetes in the United States from 1990 to 1998. Diabetes can cause severe complications including difficult-to-treat foot ulcers, which can lead to foot or leg amputation. It is responsible for more than 40 percent of all non-traumatic amputations in the United States. Other causes for amputation are trauma and ischemic disease."
Local:412-647-UPMC (8762)
Toll free: 1-800-533-UPMC (8762)
mailing address:
200 Lothrop St.
Pittsburgh, PA 15213-2582
upmcweb@upmc.edu
http://www.upmc.edu/NewsBureau/medsurg1/limb_salvage.htm

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Educator (Diabetic Educator):
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Eye (Diabetic Eye Disease):
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Feline diabetes:
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Glaucoma:
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Hyperglycemia:
http://www.nursingdiabetics.com/hyperglycemia/

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Hypoglycemia:
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IGT (Impaired glucose tolerance):
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Insipidus (diabetes insipidus):
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Ketoacidosis (diabetic ketoacidosis):
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Kidney Transplant:
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Kids and diabetes:
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Management of diabetes:
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Nephropathy:
http://www.nursingdiabetics.com/nephropathy/

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Neuropathy:
http://www.nursingdiabetics.com/neuropathy/

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Prevention of diabetes:
http://www.nursingdiabetics.com/prevention/

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Research:
http://www.nursingdiabetics.com/research/

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Retinopathy:
http://www.nursingdiabetics.com/retinopathy/

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Symptoms of diabetes:
http://www.nursingdiabetics.com/symptoms/

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Traveling and diabetes:
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Treatment of Diabetes:
http://www.nursingdiabetics.com/diabetestx/

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http://www.nursingdiabetics.com/type2/

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Ulcer (diabetic ulcer):
http://www.nursingdiabetics.com/ulcer/

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Women and diabetes:
http://www.nursingdiabetics.com/women/

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Diabetic Medications:
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Last updated by Andrew Lopez, RN on Wednesday, September 29, 2010


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