The nerve damage that occurs with diabetic neuropathy can involve either complete or partial loss of sensory function, which may or may not result in pain. Diagnosis can be made on disturbed sensory function in areas that are affected by pain. This is most often in areas of the feet and legs. Some patients may not experience any symptoms, but upon assessment be found they have lost all feeling in their feet. Lack of symptoms prevents an early diagnosis of diabetic neuropathy.
Diabetic patients will use a wide variety of words to describe the pain they are suffering. It is important for the physician to listen carefully and get a detailed description of pain intensity. Questions should be asked to determine how pain affects the patient’s quality of life, mental well being, moods and sleep patterns and work and recreation. If your doctor has no time or fails to ask questions about how pain affects your daily life, seek the services of a different health care professional.
Tests
There are simple clinical tests that can be done to test sensory function and reflexes. These can aid the doctor in determining how much nerve damage has taken place. Celebrated tuning forks produce vibrations of different frequencies. Disposable neurological testing pins provide pain stimuli to the feet, legs and other areas to determine loss of feeling. Monofilaments are very fine filaments that are used to determine the pressure sensation threshold. A reflex hammer is used to determine the Achilles tendon reflex in the patient’s heel.
A standard neurological examination also includes the ability to tell the difference between blunt and sharp and hot and cold sensation. A more complex test is the electrical Nerve Conduction Study, known as NCS. This test records the speed that nerves are able to send signals, as well as the size of response to particular stimuli. It entails electrodes being placed on the skin of the area while a low but painless electrical current is applied to certain nerves. Responses are measured and recorded.
Electrical Muscle Study, also known as an EMG determines if muscular activity has been affected. Low electrical currents are applied to muscles through a small, thin needle. Responses are measured and recorded.
Doppler sonography is used to determine blood flow. This test reveals if the patient has peripheral vascular disease. The tests send a beam of ultrasound along the line of blood flow. The frequency of sound waves that are reflected from moving red blood cells is used to determine the speed of the blood’s flow.
Electroencephalograms, also known as an EEG measures electrical activity in the brain to determine if it is responding to sensory sensation normally.