HOMOEOPATHIC REMEDIES FOR DIABETES INCLUDING DIABETIC FOOT AND DIABETIC NEPHROPATHY

Diabetes mellitus refers to a group of diseases that affect how your body uses blood sugar (glucose). Glucose is vital to your health because it's an important source of energy for the cells that make up your muscles and tissues. It's also your brain's main source of fuel.

If you have diabetes, no matter what type, it means you have too much glucose in your blood, although the causes may differ. Too much glucose can lead to serious health problems.

Chronic diabetes conditions include type 1 diabetes and type 2 diabetes. Potentially reversible diabetes conditions include prediabetes — when your blood sugar levels are higher than normal, but not high enough to be classified as diabetes — and gestational diabetes, which occurs during pregnancy but may resolve after the baby is delivered.

Causes --To understand diabetes, first you must understand how glucose is normally processed in the body.

How insulin works

Insulin is a hormone that comes from a gland situated behind and below the stomach (pancreas).

·        The pancreas secretes insulin into the bloodstream.

·        The insulin circulates, enabling sugar to enter your cells.

·        Insulin lowers the amount of sugar in your bloodstream.

·        As your blood sugar level drops, so does the secretion of insulin from your pancreas.

The role of glucose

Glucose — a sugar — is a source of energy for the cells that make up muscles and other tissues.

·        Glucose comes from two major sources: food and your liver.

·        Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin.

·        Your liver stores and makes glucose.

·        When your glucose levels are low, such as when you haven't eaten in a while, the liver breaks down stored glycogen into glucose to keep your glucose level within a normal range.

Causes of type 1 diabetes

·        The exact cause of type 1 diabetes is unknown. What is known is that your immune system — which normally fights harmful bacteria or viruses — attacks and destroys your insulin-producing cells in the pancreas. This leaves you with little or no insulin. Instead of being transported into your cells, sugar builds up in your bloodstream.

·        Type 1 is thought to be caused by a combination of genetic susceptibility and environmental factors, though exactly what many of those factors are is still unclear.

Causes of prediabetes and type 2 diabetes

·        In prediabetes — which can lead to type 2 diabetes — and in type 2 diabetes, your cells become resistant to the action of insulin, and your pancreas is unable to make enough insulin to overcome this resistance. Instead of moving into your cells where it's needed for energy, sugar builds up in your bloodstream.

·        Exactly why this happens is uncertain, although it's believed that genetic and environmental factors play a role in the development of type 2 diabetes. Being overweight is strongly linked to the development of type 2 diabetes, but not everyone with type 2 is overweight.

Causes of gestational diabetes

·        During pregnancy, the placenta produces hormones to sustain your pregnancy. These hormones make your cells more resistant to insulin.

·        Normally, your pancreas responds by producing enough extra insulin to overcome this resistance. But sometimes your pancreas can't keep up. When this happens, too little glucose gets into your cells and too much stays in your blood, resulting in gestational diabetes.

Symptoms--Some of the signs and symptoms of type 1 and type 2 diabetes are:

·        Increased thirst

·        Frequent urination

·        Extreme hunger

·        Unexplained weight loss

·        Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and fat that happens when there's not enough available insulin)

·        Fatigue

·        Irritability

·        Blurred vision

·        Slow-healing sores

·        Frequent infections, such as gums or skin infections and vaginal infections

Although type 1 diabetes can develop at any age, it typically appears during childhood or adolescence. Type 2 diabetes, the more common type, can develop at any age, though it's more common in people older than 40.

HOMOEOPATHIC REMEDIES

Homoeopathic remedies are very safe for treating diabetes and its complications without any side effects . Some of the important remedies are given below-Along with the following remedies consider the constitutional drug for a permanent cure.

ABROMA AUGUSTA Q - Abroma Augusta is the top Homeopathic medicine to treat Diabetes Mellitus. Its use is highly recommended in those patients who are losing flesh and suffer from extreme weakness due to Diabetes Mellitus. The patients who can greatly benefit from this Homeopathic medicine have an increased thirst with dryness of mouth. They also have an increased appetite and the urination is very frequent day and night. Excessive weakness is felt after urination. Homeopathic medicine Abroma Augusta is also of great help in treating sleeplessness in a person with Diabetes. Another sphere in which this Homeopathic remedy yields good results is skin complaints like boils and carbuncles in a diabetic patient. Burning sensation in the whole body is a prominent general symptom that can be found in persons requiring Abroma Augusta

CEPHALANDRA INDICA Q- A specific remedy for diabetes. Dryness of mouth. Great thirst for large quantities of cold water

PHOSPHORUS 200--Phosphorus is a Homeopathic medicine of great help for treating Diabetes Mellitus, though its use depends completely on the constitutional symptoms of the patient. Homeopathic medicine Phosphorus is a remedy of great help for weakness of vision in a diabetic patient

RHUS AROMATICA Q- Rhus aromatic is an effective remedy for diabetes. Passing large quantities of urine of low specific gravity

SYZYGIUM JAMBOLANUM Q-Syzygium Jambolanum is among the best Homeopathic remedies for the treatment of Diabetes Mellitus. It acts promptly and efficiently in decreasing the sugar levels. Excessive thirst and excessive urination are always present in the patient. Homeopathic medicine Syzygium Jambolanum also gives wonderful results in treatment of long-standing ulcers in a diabetic patient

PHASEOLUS 3X—Diabetes with heart disease

PHOSPHORIC ACID Q-Phosphoric Acid is an excellent Homeopathic remedy for extreme weakness, either mental or physical, in a diabetic patient. Such patients feel exhausted all the time. They have a weak memory and are forgetful. Some sort of history of grief may be found in patients requiring this Homeopathic medicine. For numbness of feet in patients of Diabetes Mellitus, Phosphoric Acid is the best Homeopathic remedy

MEMORDICA CHARANTIA Q- An excellent specific remedy for diabetes.

GYMNEMA SYLVESTRE Q--Gymnema Sylvestre is a Homeopathic medicine of great help for patients of Diabetes Mellitus who are losing weight with weakness and exhaustion. In such patients, this Homeopathic remedy works as a tonic resulting in improvement of overall health. With Homeopathic medicine Gymnema Sylvestre,the patient puts on weight and feels energeti

URANIUM NITRICUM 3X- Diabetes with weakness and losing flesh

DIABETIC FOOT

SECALE COR 30- An excellent remedy for diabetic gangrene . Dry gangrene of toe. Dusky blue tinge. Skin feels cold to touch yet covering not tolerated. Warmth aggravatio

ARSENICUM ALBUM 30- Diabetic gangrene. Burning and soreness , relieved by warmth. Fetid smell from the wound. Restlessness

APIS MELLIFICA 30-Spreading cellulitis with burning stinging pain. Sensitive. Blebs are seen

ANTIMONIUM CRUDUM 30- Callosities are seen. Dry gangrene

CARBO VEGETABIS 30- Carbuncles and boils becomes gangrenous. Wet , purple and icy cold gangrene.Moist gangrene. There is great prostration

HEPAR SULPH 30- Blebs are seen. Very sensitive to touch

LACHESIS 200- Bluish purple surroundings around gangrene. Traumatic

RHUS TOX 30- Spreading cellulitis

SULPHURIC ACID-30- Blue and purple surroundings of the gangrene. Bleeding under the skin

THIOSINAMINUM 30-Specific for callosities. Dry gangrene

TARENTULA CUB 30- Painful and inflamed abscess with a tendency to gangrene

ECHINACEA Q- Emitting a foul smell from gangrene . 5 drops in a little of water every 2 hours . Externally wash with a Echinacea lotion. It act as a cleaning and antiseptic agent.

DIABETES NEPHROPATHY

LYCOPODIUM CLAVATUM 30—Lycopodium is an effective remedy for diabetic nephropathy. Urine scanty , cries before urinating, red sand in urine, must strain, suppressed or retained. Urine milky and turbid. Sometimes haematuria . Urine is burning and hot. The right kidney is mainly affected. The patient experiences impotency.The patient likes warm food and drink, also there is intense craving for sweets.

SERUM ANGUILLAE 6X—Serum Anguilae is one of the best remedies for diabetes nephropathy. It is very effective in acute nephritis. Kidney failure. It is prescribed when hypertension and oliguria without oedema is present. Urine contains albumin.

ARALIA HISPIDA 30-Aralia hispida is found to be effective for diabetes nephropathy. There is dropsy of renal origin. Urinary tract infection is present. Urine is scanty leading to complete suppression of urine. Renal diseases with constipation.

AMPELOPSIS QUINQUEFOLIA 30- Ampelopsis quinquefolia is another effective remedy for diabetes nephropathy. There is uraemia or uremic coma. Vomiting, purging, tenesmus , cold sweat and collapse are the leading symptoms. 

CUPRUM ARSENITUM 3x-Cuprum ars is also a very effective remedy for diabetes nephropathy. There is kidney inefficiency and uremia. The urine smell like garlic. Urine of high specific gravity increased, acetones and diacetic acid.

CUPRUM ACETICUM 3X- In Cuprum aceticum the tongue is pale , coated with lot of mucus. Anemia. Pulse rapid. The patient is chilly. Breathlessness with dry cough. Cannot eat or drink without retching.

ARSENICUM ALBUM- 30-Arsenic alb. Is also an effective remedy for diabetes nephropathy. Urine is scanty, burning when urinating. Albuminuria. Epithelial cells, cylindrical clots of fibrin and globules of pus and blood in urine. Feeling weakness in abdomen after urination. Retention of urine. Urine black as if mixed with dung.

Neuropathy HIV And Foot Care

Today's post from journals.lww.com (see link below) is a very thorough examination of the relationship between HIV and neuropathy and how as a result, foot care is often overlooked in neuropathy patients. It provides relatively easy explanations for the damage process caused by either the virus itself or the medication used to treat it but misses out on the fact that HIV patients can also have other problems which may bring on neuropathy (cancer, diabetes for instance). The article goes on to provide some helpful advice as to how people should look after their feet, especially when there's a loss of feeling involved and all in all, is well worth reading, for all people living with neuropathy.

 

HIV Peripheral Neuropathy and Foot Care Management: A Review of Assessment and Relevant Guidelines
AJN, American Journal of Nursing:
December 2013 - Volume 113 - Issue 12 - p 34–40
Feature Articles
Anastasi, Joyce K. PhD, DrNP; Capili, Bernadette PhD, NP-C; Chang, Michelle MS

Author Information

Joyce K. Anastasi is an Independence Foundation endowed professor and founding director of the Division of Special Studies in Symptom Management (DS3M) at the New York University College of Nursing in New York City, where Bernadette Capili is an assistant professor and associate director of the DS3M, and Michelle Chang is a research associate at the DS3M. Contact author: Joyce K. Anastasi, ja2188@nyu.edu. The authors and planners have disclosed no potential conflicts of interest, financial or otherwise.

Abstract

Overview: Despite the decline in the incidence of central nervous system disease associated with HIV, distal sensory peripheral (DSP) neuropathy continues to be prevalent in this population, causing debilitating symptoms and affecting quality of life. Patients typically present with numbness, tingling, burning pain, and loss of sensation in the toes and soles of their feet. Although this complication causes loss of protective function and puts patients at elevated risk for injury, infection, and falls, foot care for people with HIV is often overlooked. This article reviews what is known about DSP neuropathy in HIV and discusses relevant foot care guidelines, adopted from the literature on other conditions associated with neuropathic foot disorders.

Peripheral neuropathy, a condition characterized by damaged sensory or motor peripheral nerves, may cause pain, sensory loss, or muscle weakness. Peripheral neuropathy may develop as a result of diabetes, physical injury, tumors, certain medications, heavy alcohol use, certain inherited disorders, autoimmune disease, vitamin deficiencies, and such infectious diseases as HIV.1 The prevalence of distal sensory peripheral (DSP) neuropathy (often referred to as distal symmetric polyneuropathy or distal sensory polyneuropathy) in HIV patients is estimated to range from 38% to 44%.2, 3

Presenting symptoms of DSP neuropathy in HIV typically include bilateral and symmetric tingling, burning, or loss of feeling in the toes and soles of the feet. Symptoms tend to start at the toes and travel up the feet to the ankles and, eventually, to the lower legs, a pattern known as a “stocking” distribution. Common signs include decreased or absent ankle reflexes, impaired pain and temperature perception, reduced or absent vibration sensation in the toes, and occasional intrinsic muscle weakness.4, 5 Patients may experience loss of balance, leading to falls, or have difficulty walking, bathing, or dressing. The symptoms can cause extreme discomfort, affecting employment, emotional health, independence, and quality of life.2

Foot care for people living with HIV is often overlooked as a clinical issue. HIV interferes with the body's immune system, increasing the risk of acquiring infections. Decreased sensation in the feet may lead to injuries and infections that go unnoticed. Tinea pedis (athlete's foot, a fungal infection that causes itching, scaling, blistering, and fissuring of the skin of the feet), onychomycosis (a fungal infection of the nail), and paronychia (a fungal or bacterial infection of the skin at the edge of the nail) frequently affect people who are immunocompromised and thus more prone to developing secondary systemic infections.6-8 In one study, the prevalence of onychomycosis among 500 people with HIV was 23%.7 Both onychomycosis and tinea pedis may lead to lower-extremity bacterial cellulitis.

For patients with diabetes, foot care guidelines and educational materials are ubiquitous. Although there are no specific foot care recommendations for people living with HIV, many of the principles guiding the care of patients with diabetes or cancer apply to this population as well. In this article, we integrate what is currently known about DSP neuropathy in HIV patients with the relevant guidelines for the management of other conditions that similarly render patients susceptible to neuropathic foot disorders.

PATHOPHYSIOLOGY

DSP neuropathy may be associated with the HIV infection itself or with antiretroviral toxicity. The condition is believed to be linked to axonal injury resulting from the binding of the viral envelope glycoprotein 120 to chemokine receptors and to macrophage dysregulation, which prompts the local release of proinflammatory neurotoxic cytokines.9, 10 The drug-associated neuropathies may be mediated by disrupted DNA synthesis, which interferes with mitochondrial function.11 With antiretroviral toxicity, symptom onset tends to be sudden and associated with the start of antiretroviral therapy (ART), usually peaking within the first three months of treatment.12, 13
 
RISK FACTORS

Several factors increase the risk that people with HIV will develop DSP neuropathy and associated foot problems. These include past or current use of neurotoxic drugs, advanced age, metabolic disorders, alcohol use, nutritional deficiencies, and a low CD4+ count.

Neurotoxic drugs. Some nucleoside reverse transcriptase inhibitors (NRTIs) are associated with neuropathy.14, 15 Because they inhibit mitochondrial DNA polymerase gamma, a key enzyme in mitochondrial replication, NRTIs may cause mitochondrial dysfunction, oxidative stress, increased production of free radicals, and tissue injury and toxicity— although other mechanisms likely contribute to the development of DSP neuropathy as well.16, 17 For example, infiltrating activated macrophages, proinflammatory cytokines, and other mediators may play a role in damaging peripheral nerve axons and dorsal root ganglia fibers.18 Of the NRTIs, the dideoxynucleoside NRTIs (d-NRTIs)—didanosine (Videx), zalcitabine (Hivid; taken off the market in 2006), and stavudine (Zerit)—have demonstrated the most mitochondrial toxicity and greatest association with neuropathy. The newer NRTIs demonstrate less toxicity; their association with neuropathy remains unclear.

Although the use of d-NRTIs is being phased out in developed countries, the prevalence of neuropathy remains high.2, 3 These drugs are still widely used in resource-limited regions of the world—particularly stavudine, the component most commonly found in the fixed-dose generic drugs.2 The cumulative, long-term effects of exposure to d-NRTIs are not yet clear.19, 20 A small study of patients with current or prior use of d-NRTI treatment found that subjects who had previously tolerated the drugs without developing neurotoxicity were not at significant risk for developing incident DSP neuropathy.21 Another study found that past, but not current, d-NRTI use was associated with an increased risk of pain in HIV-associated neuropathy after adjusting for other factors.2 Recent research on the potential contribution of protease inhibitors to the risk of neuropathy is inconclusive.22, 23

People living with HIV commonly manage comorbid conditions with multiple drugs, increasing the risk of neurotoxic adverse effects and drug–drug interactions. Drugs with neurotoxic potential frequently used to treat HIV include dapsone (Aczone), hydroxyurea (Droxia, Hydrea), metronidazole (Flagyl and others), vincristine, thalidomide (Thalomid), isoniazid, linezolid (Zyvox), and ribavirin (Rebetol and others).24

Advanced age. The introduction of ART greatly increased the life span of people with HIV, and advanced age has consistently been associated with DSP neuropathy in the eras both preceding and following the introduction of combination ART regimens, most often referred to as highly active ART (HAART).2, 25 As people age, the peripheral nervous system undergoes the following changes26, 27:

* the density of small and large myelinated fibers decreases

* the amplitude of nerve action potentials declines

* nerve conduction slows

By 2015, half of the people living with HIV in the United States will be over age 50.28 With the aging of the HIV population and prolonged exposure to ART, the prevalence and severity of DSP neuropathy is a growing concern.

Metabolic disorders, such as diabetes or impaired glucose tolerance, may further increase the risk of DSP neuropathy. Population studies indicate that neuropathy affects 60% to 70% of patients with type 1 and type 2 diabetes, and risk rises with age and with the duration of diabetes.29 It's been suggested that small-fiber neuropathy may be associated with impaired glucose tolerance and may also occur in prediabetes.30, 31 In both diabetes and HIV, high triglyceride levels are associated with neuropathy,32 and many people with diabetes experience neurovascular damage, which impedes blood flow to the extremities, potentially contributing to or exacerbating symptoms in those who also have HIV and DSP neuropathy.

Data suggest that the increased prevalence of glucose disorders among patients living with HIV is associated with HAART use.33 Individuals using HAART often experience such metabolic complications as lipodystrophy, dyslipidemia, and insulin resistance, which in turn increase their risk of diabetes. New-onset diabetes occurs in an estimated 1% to 6% of HIV-infected people using protease inhibitors.34

Alcohol use and nutritional deficiencies. Some people with HIV try to self-manage their neuropathic symptoms with alcohol or illegal drug use.35, 36 Long-term, heavy alcohol use can damage nerves, while causing deficiencies in the vitamins (particularly B vitamins) and minerals essential to healthy nerve function.37 The effects of nutritional deficiencies may be compounded by weight loss and poor diet, which are common problems in HIV owing to nausea, loss of appetite, diarrhea, and the adverse effects of medications.38, 39 In addition, poor diet may exacerbate impaired immunity, contributing to the progression of HIV and reducing the therapeutic effect of ART.

CD4+ count. Prior to the widespread use of HAART, a higher plasma HIV-1 RNA load and lower CD4+ count were associated with an increased risk of DSP neuropathy.40 In the post-HAART era, however, an elevated viral load no longer seems to be associated with increased risk, although DSP neuropathy remains prevalent among those with advanced, untreated HIV or a lower nadir CD4+ cell count.2
 
ASSESSMENT AND MANAGEMENT

It is useful to determine whether the patient has any neurologic symptoms, such as muscle, bowel, or bladder abnormalities. Documentation should include any history of drug or alcohol abuse, detailing the amount of the substance used and the duration of use; current and past medications; and an assessment of dietary and nutritional deficiencies.

All patients with HIV should receive an annual, comprehensive foot exam in which the skin, hair, nails, musculoskeletal structure, circulation, and sensation of the feet are assessed. Those diagnosed with DSP neuropathy may need more frequent foot exams. Inquire about and document any reports of leg discomfort, providing details about the following factors:

* symptom onset

* location

* duration

* the character or quality of described sensations (for example, whether pain is burning, sharp, or dull)

* the severity (using a 0-to-10-point scale)

* diurnal variation

* progression

* exacerbating or relieving factors

Sensory testing. An assessment should also include sensory testing of the feet. Pressure sensation is assessed using a 5.07 (10-g) Semmes-Weinstein nylon monofilament on the plantar surface of the foot while the patient's eyes are closed (see How to Perform a Pressure Sensory Exam). Practice varies as to the number (one to 10) and location of sites tested for skin breakdown.41 One study found that exams that included the first toe, third metatarsal head, and two other toes or metatarsal heads per foot produced a sensitivity of 90% to 93% for abnormal pressure sensation and required less than one minute to complete.42

Patients are tested for light touch with a cotton swab and for temperature discrimination with warm and cold stimuli. Pinprick sensation is tested using the sharp end of a disposable safety pin. Patients with a loss of protective sensation are at risk for injury, incomplete healing, and infection. Another useful assessment tool is the Brief Peripheral Neuropathy Screen used in several AIDS Clinical Trials Group protocols.43 With this tool, clinicians capture both subjective and objective findings by asking patients to rate the severity of their symptoms on a scale from 1 (mild) to 10 (most severe) and evaluating their vibration perception and deep tendon reflexes.24 Testing for reduced or absent Achilles tendon reflexes has a sensitivity of 84% and a specificity of 98% for DSP neuropathy in HIV.43 After assessing the patient's risk and documenting all foot exam findings, consider whether the patient would benefit from referral to a foot care specialist and schedule follow-up care.

Management. The Food and Drug Administration has not approved any therapies specifically for the treatment of HIV-associated DSP neuropathy. Current pharmacologic treatment is based on primary symptoms, with acetaminophen, nonsteroidal antiinflammatory drugs, antidepressants, anticonvulsants, topical agents, and opioids used as tolerated. Unfortunately, several drugs that are useful for other types of neuropathic pain—including the tricyclic antidepressant amitriptyline, topical lidocaine anesthetics, and the anticonvulsant pregabalin (Lyrica)—have been found to be ineffective for HIV-associated DSP neuropathy.44, 45

Symptom management also involves general lifestyle modifications, such as reducing cigarette smoking, attaining optimal nutrition, practicing meticulous foot care, and improving circulation through appropriate exercise. In 2010, the American Diabetes Association and the American College of Sports Medicine modified their positions to suggest that people with peripheral neuropathy who have no acute ulceration may participate in modest weight-bearing exercise.46 Moderate walking is unlikely to increase the risk of foot ulcers in people with peripheral neuropathy.
 
FOOT CARE EDUCATION

Nurses play a critical role in disseminating self-care information to patients. Since HIV-associated DSP neuropathy has many of the same signs and symptoms as diabetic and chemotherapy-induced neuropathies, foot care educational materials from such organizations as the American Diabetes Association, the National Institute of Diabetes and Digestive and Kidney Diseases, the National Cancer Institute, and the American Cancer Society may be helpful to people with HIV. In studies of people with diabetes, foot care education improved patients’ foot care knowledge and practice in the short term.47

Daily foot hygiene. It's important to emphasize to patients that their feet need to be cleaned daily, using warm—not hot—water and a mild soap, and then towel dried thoroughly, particularly between the toes.48 Dry skin is a common foot problem. Advise patients with dry skin to moisturize the tops and bottoms of their feet with a thin coat of lotion—not a heavy cream or oil—and to avoid getting lotion between the toes. Nurses should counsel patients to inspect their feet every day for any cuts, cracks, blisters, redness, calluses, swelling, or dryness. Corns and calluses should be gently filed with an emery board or pumice stone after a bath or shower. Toenails should be cut once a week or as needed after washing, when they are soft. They should be cut to the shape of the toes and not too short. Patients who are unable to cut their nails should be referred to a podiatrist.

Footwear and fall prevention. Shoes should fit well and allow the toes to move. They should be wide enough to exert no pressure on the joints and long enough to allow 1 cm of space between the longest toe and the edge of the shoe when the patient is standing.49 Shoe material should be permeable because a warm, moist environment may harbor fungal organisms. Patients should shop for new shoes at the end of the day when their feet are larger from standing and walking; until new shoes are fully broken in, they should be worn only an hour a day. Before putting shoes on, patients should always check the insides to make sure the lining is smooth and there are no sharp edges that could injure their feet. Patients should always wear socks or stockings with shoes to prevent skin irritation and blisters. Remind patients that open-toed or thong sandals do not adequately protect the feet from injury. Reinforce the importance of wearing shoes at the beach.

Many older patients wear slippers indoors. Since DSP neuropathy may cause gait and balance problems, putting patients at risk for falls, teach patients about the importance of wearing slippers that fit properly and have slip-resistant soles.50 If a patient frequently stumbles, a walker or cane may provide needed support. To further protect against falls, advise patients to51, 52

* use night lights or keep a flashlight near the bed.

* roll up area rugs.

* remove any electric cords that could impede walking.

* install no-slip bath mats in the shower and tub.

Foot exercises. To promote lower limb circulation and prevent swelling, nurses should advise patients to elevate their feet when sitting, avoid crossing their legs, and perform simple foot exercises, such as wiggling the toes and moving ankles up and down, several times a day.

CONSIDER ALL RESOURCES

Although people with compromised immune systems and reduced sensory perception are clearly at elevated risk for foot infection, foot exams are often conducted only after a patient has established foot injuries. Advanced age further escalates the risks of HIV-associated foot problems owing to reduced peripheral nerve function, gait complications, and reduced mobility.27, 53

Within the diabetes community, efforts to educate patients on peripheral neuropathy and foot care have been intensive and should serve as lessons for providers who care for patients with HIV. Studies have shown that the efficacy of foot care education may depend on the type of education employed.54, 55 Nurses should take advantage of all available resources, including smartphone applications, which can set daily foot check reminders as well as provide instructional videos. By encouraging simple, preventive foot care education, nurses can promote health and overall well-being in patients at risk for HIV-associated DSP neuropathy, while reducing the potential for complications and related health care costs.

http://journals.lww.com/ajnonline/Fulltext/2013/12000/HIV_Peripheral_Neuropathy_and_Foot_Care.20.aspx

Foot Damage From Neuropathy

Today's post from wecare.ca (see link below) discusses ulceration, one of the foot problems that can arise from neuropathy. Most people manage to avoid severe ulceration but for many it can be a serious problem. Loss of feeling and numbness in areas on the feet can lead to small cuts and wounds becoming ulcerated without you even noticing it. Normally the feet are very sensitive to injury and we can respond immediately to any warning pain but sensory loss removes that early warning system. Ulceration can severely affect the quality of your life and it is vital that you see a doctor the moment you notice it. As a general rule for people living with neuropathy, checking your feet daily is a good idea - they need looking after; they've got to carry you a long way yet!

The Pins and Needles of Peripheral Neuropathy

November 12th, 2012 | Posted by SueKelly in Care Connections

 
Most people know what it is like to experience the numbing effect of ‘pins and needles’. But if you are diabetic or suffer from circulatory problems – this ailment can be a serious and ongoing concern.

Peripheral neuropathy is damage to the nerves in the limbs and particularly the feet where the body’s nerves are the longest. The risk of developing neuropathy increases the longer a person has been afflicted with diabetes or congestive heart failure or other circulatory problems. The nerve damage prevents people from knowing when their feet are too hot, too cold or sore or painful. Therefore a person loses the warning signs that their feet could be in jeopardy. This is called “loss of protective sensation”.

Loss of protective sensation (LOPS) contributes significantly to ulcer development. In healthy individuals, irritants like bunions, blisters or calluses may cause an unconscious change of gait. In people living with diabetes who experience LOPS as a result of peripheral neuropathy, no discomfort is felt, so pressure on specific sites is continued, directly affecting the development of ulcers. Early detection of LOPS and implementation of preventative strategies will reduce the rates of limb-threatening complications.

Many foot ulcers begin in innocent ways. As a visiting nurse I was always curious how a problem started and would ask my clients what was the first sign that brought them to the doctor? Often the response was one of embarrassment and foolishness as they described the simple way it began – a blister, a piece of torn skin or a small amount of bleeding. The harmless scratch burgeoned from a trivial occurrence to a condition that threatened the maintenance of limbs and in some cases, life.

The following signs may be an indication that you have peripheral neuropathy or decreased circulation. If you have any one of these symptoms, make an appointment to see your health care professional.

Signs of Peripheral Neuropathy

Signs of Poor Circulation

Pain, tingling, burning and numbness that starts in the feet and slowly progresses up the calves; tends to be worse at night Inability to detect excessive heat such as in a bath or a heating pad Any small sore, cut or ingrown toenails Weakness in small muscles of the feet that cause the toes to claw, or in more serious cases foot drop will develop A change in gait Swelling or redness on any part of the foot The existence of a bunion, callus, corn or wart

Absence of foot pulses A pale colour of the feet when the feet are raised Feet that feel cold Pain at rest Pain at night relieved by hanging the feet over the side of the bed A blue colour to the toes A reddish colour of the feet Swelling of the feet

Given the alarming statistics of foot problems in patients living with diabetes, it is prudent to assess all diabetics for their level of risk related to foot problems. Special attention needs to be paid to the elderly and over-weight clients. In older clients limited mobility and poor eyesight may prevent them from properly examining their feet – a task that should be done daily. In obese patients, excessive weight will be an impediment to easy foot inspection.

People with diabetic foot ulcers face incredible challenges in their family, social and work lives, which sometimes affect their sense of self-worth. From the ease with which the ulcers seem to develop, to the future unpredictability imposed by the condition, people describe the dramatic impact that having a foot ulcer has on their activities of daily living. There is a great deal of stress and fear that comes with the uncertainty of not knowing when and if the ulcer will heal and in some cases whether or not amputation will become an eventuality.

http://www.wecare.ca/blog/?p=562

Stocking To Detect Neuropathic Foot Wounds

Today's post from diabetes.co.uk (see link below) talks about a new, prototype product designed to help neuropathy patients who have lost so much feeling from their feet that they become prone to injury, pressure sores and open wounds (without realising it). It's a stocking with inbuilt sensors that monitors unduly high pressures on the foot and alerts the wearer to the problem before it causes physical injury. The problem is that it's currently only a prototype and is probably going to be very expensive but if it gets past the development stage, it could be a very useful tool which will hopefully prevent the nasty injuries loss of feeling in the feet can cause.

New pressure-monitoring device could prevent neuropathy-related injuries
Thu, 14 May 2015

Researchers from Germany have developed a pressure-monitoring stocking that could prevent foot wounds in people with diabetic neuropathy.

The device, which was developed by researchers at the Fraunhofer Institute for Silicate Research ISC in Würzburg, uses integrated sensors to send warnings when pressure on the foot is too high, essentially performing the job of the nerves in the feet.
Neuropathy and foot pressure Diabetic neuropathy is one of the most common diabetic complications. Over time, prolonged exposure to high blood glucose levels damages the nerves in the feet. Diabetic neuropathy is the leading cause of amputation in the UK.

When people develop diabetic neuropathy, they lose the feeling in their feet. This can have a number of damaging effects. One such effect is the inability to notice the amount of pressure being placed on the feet. People without diabetic neuropathy have functioning nerve pathways that automatically redistribute when the person is standing up for a long time.

Over time, excessive weight placed on the feet can lead to the development of pressure sores, which can in turn lead to open wounds or damaged foot tissue.
How does the pressure stocking work? The stocking features 40 dielectric elastomer sensors that measures pressure distribution. The sensors are made from a special silicone film. When pressure builds on the foot - usually because of standing in the same place for a while - the sensors transmit a signal to a wireless electronics unit.

The stocking will cost around £180.
What makes the pressure stocking different? There are several products available to balance out pressure on the foot for people with diabetes, but this one is different, according to Dr. Bernhard Brunner, of the Fraunhofer institute:

"Existing systems on the market measure the pressure distribution only on the bottom of the foot using shoe inserts. Our sensors are attached to the stocking's sole, at the hell, the top of the foot and the ankle, so they can take readings in three dimensions. This is a totally new approach."
Moving forward The device is brand new, and some creases still to be ironed out. Dr. Brunner explained the challenges that face the team going forward:

"With the current prototype, the electronics are attached to the end of the stocking. We're planning to relocate them to a small, button-sized housing that can be detached with a hook-and-loop fastening strip. There's no way around this until a reliable method for cleaning the electronics is developed."

The sensors have to be washable, too. "The first washability tests are in planning, but cleaning using disinfectant is no problem."

The researchers have filed a patent application for the stockings. From May 19 to May 20, the team will be presenting a prototype of the stockings at the SENSOR+TEST 2015 Measurement Fair in Nuremberg.

http://www.diabetes.co.uk/news/2015/may/new-pressure-monitoring-device-could-prevent-neuropathy-related-injuries-97065315.html

Why Are You Feeling So Much Leg And Foot Pain

Today's post from huffingtonpost.com (see link below) looks at the various possible reasons for having leg pain. As neuropathy cases increase and more and more people become aware of what it is, it's important to realise that not all leg and foot pains may be the result of nerve damage. There are other better-known causes of leg and foot pain and it's important to exclude those before coming to any conclusions regarding neuropathy. This article is a useful one and provides lots of information to help you decide what may be causing your discomfort. Your doctor may tell you otherwise in the end but at least you'll have some understanding of the possible diagnoses and a basis for discussion with your doctor.

This May Be Causing Your Leg Pain And Numbness
Leg discomfort can knock you off your feet and it should never be ignored.
Winnie Yu Next Avenue 2017

Aching calves, burning legs, numbness in the feet — pain and discomfort in the lower extremities is a common complaint that sends many of us to our doctors seeking relief.

But unless the cause is something obvious, like a fall, pinpointing the source may require some medical detective work. Trying to tough it out, though, will not get you any closer to the answers.

“Leg pain that comes on acutely with a bang, is severe and doesn’t resolve within minutes probably needs to be seen right away,” as it could be a sign of a more serious condition, says Dr. Benjamin Wedro, a clinical professor of medicine at the University of Wisconsin and an emergency physician at Gundersen Medical Center in Lacrosse, Wis. “There’s no trophy for suffering.”

Here are some of the potential causes of leg and foot pain:

Blood Vessel Distress

Pain that occurs when walking or exercising may be the result of claudication or decreased blood supply to the legs. This condition is most often a symptom of peripheral arterial disease, or PAD, a narrowing of the arteries that deliver blood to your limbs, typically caused by the buildup of plaque or fatty deposits. Smoking, high cholesterol, high blood pressure and obesity are major risk factors for PAD.

“The leg pain from PAD tends to occur when you’re active,” says John Fesperman, a family nurse practitioner at Duke Primary Care in North Carolina. “When you’re active, muscles need more blood. The lack of adequate blood triggers pain, which is known as intermittent claudication. Once you stop moving, the pain usually disappears.”

Deep vein thrombosis, or DVT, a blood clot in a deep vein that develops after extended periods of inactivity, can also cause major leg pain. Long flights or car rides make it difficult for the leg to return blood back to the heart. If that blood return slows or stops, it can create a clot within the vein. And if part of a clot breaks off and travels to the lungs, it can cause a pulmonary embolism, a serious and potentially fatal blockage of blood flow to the lungs.

DVT usually occurs in only one leg, Wedro says, causing it to swell and turn a bluish hue. “The onset of pain is gradual and tends to occur over a course of hours,” he says.

Peripheral Neuropathy

In some people, leg and foot (and sometimes arm and hand) pain can be the result of neuropathy, a disorder of the peripheral motor, sensory and autonomic nerves that connect the spinal cord to our muscles, skin and internal organs. Neuropathy can cause numbness, tingling and a heavy sensation. “It usually starts in the feet and may cause a burning sensation in the legs,” Fesperman says. In some cases, people may lose their ability to feel sensation in their legs, which can put them at risk for injury and infection.

Neuropathy can be brought on by many factors, including infection, toxins and the effects of alcoholism, but diabetes is the most common cause. According to the Neuropathy Association, approximately 60 to 70 percent of people with diabetes will at some point develop peripheral neuropathy. It can also affect people who have pre-diabetes and may not be experiencing any other diabetic symptoms.

Electrolyte Imbalance

Healthy muscle function depends on nerves being supported by a well-balanced mix of electrolytes — minerals like sodium, potassium, calcium and magnesium that have an electric charge. Electrolytes transmit signals that support nerve, heart and muscle function, and affect the amount of water in your body as well.

But certain medications; dehydration; and conditions like diarrhea and kidney disease can alter your electrolyte balance. When electrolyte levels become too low, it can cause leg pain. For example, when sodium, which attracts water to cells, is depleted, cells straining to compensate for the lack of fluid can bring on painful cramps.

Diuretics prescribed to control blood pressure are the most common culprits, Fesperman says, because they can deplete electrolytes in the blood. “Potassium and calcium mediate muscle contraction,” he says. “An imbalance in either or both can cause muscle cramping.”

By reducing blood flow, dehydration can cause electrolyte imbalance, and cramps, as well. Likewise, if you drink too much water, you can flush out too many electrolytes.

Back Problems

Conditions that affect your back often lead to pain in the legs as well. Spinal stenosis, in which the spinal canal gradually narrows, pressuring the nerves, usually affects people over 50 and can be caused by arthritis, scoliosis or spinal injury. The pressure can impinge on nerve roots as they leave the spinal cord to form the sciatic nerve, the body’s largest. The irritated nerves can cause significant pain.

Sciatica, a painful inflammation of the sciatic nerve, is typically experienced on one side of the body, and can travel from your lower back down your leg to your feet or even toes. Sciatica is difficult to diagnose and sometimes goes away on its own. It can be brought on by spinal stenosis.

“Sciatic and spinal conditions may come on gradually over time but may also have an acute onset,” Wedro says. “Over time, what had been tolerable becomes an acute issue. Sciatic nerve inflammation caused by changes in the back, such as arthritis, muscle spasm or injury, may radiate into the buttocks and down the leg.”

If the leg pain is accompanied by the loss of bladder or bowel control or numbness near the anus or vagina, seek emergency care immediately. You may have cauda equina syndrome, a rare disorder affecting the nerve roots at the lower end of the spine. Without immediate treatment, the spinal cord can shut down and you may develop permanent paralysis.

Arthritis

There are many types of arthritis. Osteoarthritis, the most common form, breaks down the cartilage in your joints, causing a buildup of painful bone spurs, cartilage loss, inflammation or soreness. Rheumatoid arthritis, an autoimmune disease, attacks the lining of the joints, also causing inflammation and pain.


Although arthritis is a joint disease, the pain it causes can be felt in the surrounding leg and foot muscles. “Any joint under stress can cause pain,” Wedro says. “The pain is within the joints. But the muscles around it try to protect it and you can go into spasms and get secondary muscle pain.”

Getting Treatment for Leg Pain

The appropriate treatment for leg pain depends on the underlying cause. Diabetics may need to improve their blood glucose control to prevent diabetic neuropathy, while arthritis sufferers may need medication or surgery.

“All treatments aim for long-term control of symptoms,” Wedro says. “There may not be one cocktail that works for everybody. It all depends on what has caused the leg pain. It will be trial and error for you and your doctor to find the treatment that works.”

The bottom line? Take all leg and foot discomfort seriously. “Pain means part of the body isn’t working right,” Wedro says. “The problem might be a disaster that is life- or limb-threatening, or it may be an inconvenience that might resolve with a little time and care. But if you have pain, see your doctor. Never dismiss it.”

http://www.huffingtonpost.com/entry/this-is-what-may-be-causing-your-leg-pain-and-numbness_us_57fd2a14e4b0b6a43035e269

Foot massage for neuropathy

These two videos are a follow up to yesterday's post about caring for the feet. You may need to ignore the corny background music and the slightly New Age feel, because the techniques you see here are perfect for neuropathic feet.

You may be able to do some of these techniques on your own feet but it will be ten times better if you can get a friend to do it for you (after he or she has watched the videos!), then you can relax completely. The whole process would be better after cleansing, both for the benefit of your masseur but also because the feet will be both stimulated and relaxed, so that the massage can have maximum effect. After the massage and drying off, try some gentle exercises to keep the feet supple.

Chronic Neuropathic Foot Pain Vid

Today's post from dontpunishpain.com (see link below) is a short but graphic video designed to let people know how awful neuropathic foot pain can be. It's a tad over-dramatic but it's easy to see where he's coming from and why he presents it this way. The lack of public awareness of neuropathy means that sometimes we have to use dramatic methods to get people's attention and this short video does just that. It is important to know that you can suffer chronic foot pain from neuropathy without the sores shown in the image on the video and that that image is an extreme example but nevertheless the message of the video is entirely correct.

Feel This Pain: Peripheral Neuropathy - Crippling Foot Pain 

Ken McKim Published on 5 Jul 2014

Episode 3 of the "Feel This Pain" series, where I attempt to convey what it is like to suffer with the debilitating foot pain that comes with Peripheral Neuropathy, yet another so-called "invisible illness."


 http://www.dontpunishpain.com/journal/2014/7/5/feel-this-pain-peripheral-neuropathy-crippling-foot-pain

Foot Neuropathy A Doctors Response

Today's post from uexpress.com (see link below) is the initial conversation you would want to have with your doctor, if you turned up at the surgery with neuropathic symptoms. Unfortunately not all doctors are as clear as this during their consultation and many patients leave feeling confused and frustrated that they're not being told what's going on with their nerves. Communication is key with neuropathy. You need to get an umbrella view first and with that information in hand, move on gradually onto the treatment ladder. If you know of someone who is at their wits end as to what their problem is, show them this doctor's response - it's by no means comprehensive but at the beginning it doesn't need to be. At least the patient will have a good idea of what he or she is dealing with.

Foot Neuropathy Isn't 'Major' Problem, but It Sure Can Hurt - Ask Doctor K by Anthony Komaroff Apr 17, 2015

DEAR DOCTOR K: I have neuropathy pain in my feet. What can I do to relieve it?

DEAR READER: Neuropathy, or nerve damage, is a remarkably common problem. I get asked lots of questions about it -- both from readers of this column and from readers of the Harvard Health Letter, which I edit. It isn't considered a "major" health problem by many doctors, because it isn't potentially fatal. But, like many other problems not labeled as major by doctors, it sure can make people miserable and interfere with their lives.

Fortunately, there are several treatments that bring relief to most people who suffer with this condition. There are different types of neuropathy, but I'll assume you have the most common type, called axonal neuropathy.

Neuropathy affects many of the nerves in your body. Each nerve is like a highway that connects your brain to the rest of your body. Signals from your brain travel down the nerves sending orders, such as the order for your muscles to move different parts of your body. Signals from your body travel up the nerves to your brain. When your fingers touch something, for example, signals from your fingers tell the brain how cold and how hard that thing is, and whether touching it causes pain.

The longer a nerve is, the more likely it is to be affected by neuropathy. The nerves connecting your brain to your legs and feet are the longest, so the symptoms of neuropathy almost always begin in and are worst in the feet.

The most common symptoms of neuropathy are numbness, burning, or unpleasant sensations that people have a hard time describing. The loss of sensation in the feet can cause problems with balance when walking. If you can't tell where your weight is being carried (is it on your heels or the balls of your feet?), your brain gets confused.

Among the most common causes of neuropathy are diabetes, alcohol abuse, an underactive thyroid gland and some types of cancer chemotherapy. However, about one out of every four people with neuropathy has none of these known causes.

If you have any of the known causes of neuropathy, the first thing to do is treat the cause. If you're diabetic, do everything you can to lower your blood sugar. If you drink too much, cut down. If you have an underactive thyroid, take your thyroid pills as directed and get regular thyroid blood tests.

The most widely used medicines for reducing symptoms are an anticonvulsant -- either gabapentin (Neurontin) or pregabalin (Lyrica) -- and tricyclic drugs, including desipramine. Other anticonvulsants and drugs that decrease the number and severity of muscle spasms also can be helpful, including phenytoin, carbamazepine, topiramate and baclofen.

Not all of these drugs help for everyone. But if you work closely with your doctor, the odds are good that you can find one that will give you considerable relief.

http://www.uexpress.com/ask-dr-k/2015/4/17/foot-neuropathy-isnt-major-problem-but