Curing Diabetes

Hypoglycemia caused by diabetes therapy that’s too aggressive or by poor management (for example, using insulin without eating) can cause neurologic signs such as tremors, faintness, and difficulty in communicating. If left untreated, hypoglycemia can quickly lead to a loss of consciousness, seizures, and death. Hyperglycemia can cause such abnormalities as slowed thought processes, slurred speech, irritability, and confusion. Hyperglycemia that has progressed to DKA can cause a patient to appear drunk. If the hyperglycemia goes untreated, she’ll eventually lapse into a coma.Extreme hyperglycemia that occurs in HHNK syndrome causes changes in mental status, ranging from mild confusion to coma. Some patients may suffer seizures and transient hemiplegia. Commonly, the patient’s neurologic condition is initially thought to result from a stroke; however, a routine blood glucose level quickly identifies diabetes as the source of the problem.

Long-standing hyperglycemia may lead to diabetic neuropathy, which can be further classified as peripheral or autonomic. Carefully examine your patient’s arms and legs for peripheral neuropathy. You may find signs of atrophy of the small muscles, which will be most pronounced in the interosseous space between the thumb and first finger. Trauma to the hands caused by cigarette or stove burns may indicate sensory loss.

Peripheral neuropathy that affects the feet and legs is usually bilateral and symmetric, so compare physical findings in both legs. Peripheral neuropathy may also cause deep tendon reflexes to be diminished or absent, and the patient may have leg or foot ulcers. Sensory testing involving pain, temperature, light touch, vibration, position, and discriminative sensations may reveal that sensations are decreased or absent.

Autonomic neuropathy develops when the nerves that lead to various organs are damaged by hyperglycemia. Most abnormalities of autonomic neuropathy can be detected during the health history and through diagnostic tests. Some patients with autonomic neuropathy may experience unpredictable diarrhea (especially at night) or difficulty urinating.

Filed under: Physical Examination