Diagnosing diabetic neuropathy can be challenging because so many conditions mirror the effects of it. The most common type of neuropathy found in diabetes is peripheral neuropathy, a type of neuropathy which affects the extremities of the body first. Usually symptoms begin in the feet and legs, followed by the hands and arms. According to Podiatry Today, when diagnosing diabetic neuropathy it is a “diagnosis of exclusion”. In other words the practitioner must “cast a very wide net of tests and keep an open mind regarding clinical suspicion in order to reach an accurate diagnostic conclusion.”
When diagnosing diabetic neuropathy your physician must consider possibilities such as whether another type of neuropathy could be affecting the lower extremities. Other things to be considered are usually thyroid problems, vitamin B12 deficiencies, nerve entrapments, lupus, kidney failure, nutritional deficiencies, and alcoholism. Failure to diagnose and treat other conditions which may have induced the neuropathy could bring about catastrophic outcomes for the patients.
To Begin Diagnosing Diabetic Neuropathy
Diagnosing diabetic neuropathy is done on the basis of symptoms, a physical exam, and a number of other tests. The physician usually begins diagnosing diabetic neuropathy by giving the patient a physical exam checking the blood pressure and heart rate of the patient, as well as their muscle strength and reflexes. The examination continues with the physician testing the patient’s sensitivity to position, vibration, temperature, and light touch.
A comprehensive foot exam will also be used in diagnosing diabetic neuropathy in which the doctor assesses the patient’s skin, circulation, and sensation. In order to assess the feeling in the foot, a nylon monofilament is used. A nylon monofilament is similar to a hair brush; it is used to gage the reaction of the senses. Those that do not sense the pressure have lost their sensation and are at risk of developing foot sores, according to Diabetes.eMedTV.com. The physician will continue the exam by checking reflexes and assessing the vibration perception in the feet. Other tests that a doctor may use to determine the type and extent of the nerve damage include:
Nerve conduction studies – A nerve conduction study checks the transmission of electrical current through a nerve.
Electromyography (EMG) – This test shows how well the muscles respond to the electrical signals transmitted by the nerves nearby the area being tested.
Quantitative sensory testing (QST) – A QST is used to recognize the sensation loss and irritability of the nerves in response to stimuli like pressure, vibration, and temperature.
Heart rate variability – This test shows how the heart responds to deep breathing and changes in blood pressure.
Ultrasound – An ultra sound may be used to examine internal organs in an attempt to see if they are functioning normally or if they have been affected by nerve damage.
Nerve or skin biopsy – A biopsy may be used to examine nerve tissue and skin tissue by microscope.
