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Managing Clinical Problems in Diabetes, Case Study #19: Peripheral Neuropathy and Vitamin B

Edited by Trisha Dunning AM, RN, MEd, PhD, CDE, FRCNA and Glenn Ward MBBS, BSc, DPhil (Oxon), FRACP, FRCPath

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Mr. LOQ self-referred to a diabetes center. “I have a horrible burning feeling in my feet especially at night. I have had diabetes for a while and find it hard to stick to my diet and exercise because of this feeling. What can I do? Do you think vitamin B supplements will help?”…

Podiatrist

The burning feeling might be due to a condition called peripheral neuropathy. Peripheral neuropathy is one of the complications of diabetes that affects the nerves, especially to the feet. It is a very distressing condition and can be difficult to treat. Often the symptoms diminish over 12-18 months.

Different people respond to different treatments. Some treatments include medicines such as tricyclic antidepressants and quinidine. Other treatments include foot massage, applying a special film called Op-Site or food wrap over the painful areas, electrotherapy and acupuncture. Cold compresses made by soaking a washcloth in cold water, wringing out the excess water and applying the cloths over the area may help. The compresses can be repeated and used with other treatments.

Vitamin B is essential to healthy nerve function and some enzymes that enable carbohydrate to be used for energy. Supplements might help, especially if the diet is low in vitamin B and cannot be changed. It is found in cereals, bran, corn, whole meal bread, soya products, nuts, seeds and vegemite. It is destroyed by cooking, so fresh foods are the best source.           

Controlling your blood glucose, limiting alcohol intake and not smoking are also important. You should check your feet carefully because you most probably have some reduced sensation in your feet and are at risk of not recognizing foot trauma. Footwear needs to be checked and advice about appropriate footwear and exercise is important. 

Diabetes educator 

Peripheral neuropathy is the most likely cause and the podiatrist has addressed the most important issues. However, there are other causes of the burning sensation Mr. LOQ describes and these include hypothyroidism, spinal nerve compression, and musculoskeletal problems. These causes need to be excluded. His circulation needs to be checked. Often neuropathic pain is unrelenting and affects quality of life and causes depression, which need to be assessed and treated if necessary. 

Complementary therapist

Although there is no scientific evidence to support the recommendation, I have found some people respond to high dose of vitamin B5.

Long-term complications

Key points

  • Good metabolic control reduces the risk of long-term complications.
  • A prospective regular structured complication assessment program is essential to improving outcomes. It should encompass psychological, spiritual, and social factors, and a comprehensive medication review.
  • A holistic approach to managing complications is necessary.
  • Complications may be ‘silent’.
  • Achieving ‘good control’ is hard work and is very difficult to sustain especially when complications are present.
 
References

Aly N, Weston P (2002) Autonomic neuropathy in older people with diabetes mellitus. Journal of Diabetic Nursing 6(1): 10–15.

Australian and New Zealand Dialysis and Transplant Registry (ANZDATA) (2000) ANZDATA Registry. ANZDATA, Adelaide.

Australian Institute of Health and Welfare (AIHW) (2007) Medicines for Cardiovascular Health. Australian Government Report, May.

Bate KL, Jerums G (2003) Preventing complications of diabetes. Medical Journal of Australia 179: 498–503.

Bethel MA, Sloan FA, Belsky D et al. (2007) Longitudinal incidence and prevalence of adverse outcomes of diabetes mellitus in elderly patients. Archives of Internal Medicine 167(9): 921–927.

Braun L (2007) Cranberry Vaccinium macrocarpon. Journal of Complementary Medicine 6(3): 553–555.

Department of Health (2001) Diabetes National Service Framework: Standards for Diabetes Services. Department of Health, London.

de Zeeuw D, Remuzzi G, Parving H (2004) Albuminuria, a therapeutic target for cardiovascular protection in type 2 diabetic patients with nephropathy. Circulation 110(8): 921–927.

Diabetes Control and Complications Trial Research Group (DCCT) (1993) Effects of intensive insulin therapy on the development and progression of long-term complications of IDDM. New England Journal of Medicine 329: 977–986.

Recommended reading

Apelqvist J, Bakker K, Van Houtum W et al. (2000) The international consensus and practical guidelines on the management and prevention of diabetic foot disease. Diabetes/Metabolism Research and Review 16(1): s84–s92.

International Diabetes Federation Consultative Section on Diabetes (2000) Position Statement on Diabetes Education for People Who Are Blind or Visually Impaired. International Diabetes Federation, Brussels, pp 62–72.

International Working Group on the Diabetic Foot (1999) International Consensus on the Diabetic Foot. International Working Group on the Diabetic Foot, The Netherlands.

National Kidney Foundation (2002) Clinical practice guidelines for nutrition in chronic renal failure. Kidney Outcome Quality Initiative (N/DOQI). American Journal of Kidney Disease 35 (96): Suppl 2.

 

The aims of the book are to: (1) address commonly encountered diabetes management problems; (2) develop comprehensive responses from a range of relevant health professionals who suggest management approaches relevant to their area of practice. The specific health professionals who provide comments about each case depend on the specific clinical issue; and (3) stimulate thought and discussion. 

The target readership is health professionals from a range of professional backgrounds and general as well as specialist professionals such as general practitioners, nurses, dietitians, and podiatrists. The book will be particularly useful for beginner practitioners specializing in diabetes. In addition, it will provide suggestions or food for thought for more experienced practitioners. The cases will be excerpts from the book are all real and are presented exactly as the information was received from the person making the referral. General practitioners, diabetes educators and people with diabetes referred most of the cases; some were self-referrals by people with diabetes. They represent referrals to various diabetic health professionals and concern commonly encountered clinical issues.

Next Week: Case Discussion #20

For more information on the book, just follow this link to Amazon.com, Managing Clinical Problems in Diabetesalt

Copyright © 2008 by Blackwell Publishing Ltd, UK

Edited by Trisha Dunning AM, RN, MEd, PhD, CDE, FRCNA and Glenn Ward MBBS, BSc, DPhil (Oxon), FRACP, FRCPath