Drug-Induced PN
Neuropathy is a common side effect of certain medications, especially those used to treat HIV/AIDS and those used in chemotherapy, to fight cancer.
In some people, these medications may cause nerve damage that results in a loss of sensation or movement in part of the body. Although uncomfortable and perhaps painful, this condition is not life threatening. Peripheral neuropathy will often go away if these drugs are changed or discontinued, or if the dose is reduced. It can take several months for peripheral neuropathy to completely heal after discontinuing these drugs, but the patient may start to feel better within a few weeks. In extreme cases, however, the nerve damage may be permanent.
60%
Between 60-70% of those with diabetes have PN
54000
Diabetics have amputations each year. 75% of amputations are preventable.
$58 Billion
Is the estimated annual cost to treat diabetes related chronic complications such as DPN
Some of the drugs that may cause peripheral neuropathy include:
- Anti-alcohol drugs (Disulfiram)
- Anticonvulsants: Phenytoin (Dilantin®)
- Cancer medications:
- Cisplatin, Oxaliplatin
- taxanes
- epothilones
- Vincristine
- Immunomodulatory drugs: Thalidomide
- Proteasome inhibitors: Bortezomib
- Immune checkpoint inhibtors: Nivolumab, pembrolizumab, ipilimumab
- Heart or blood pressure medications (Amiodarone)
- Hydralazine
- Perhexiline
- Colchicine
- Infection fighting drugs (Metronidazole, Flagyl®, Fluoroquinolones: Cipro®, Levaquin®)
- Nitrofurantoin
- Antituberculous drugs
- INH (Isoniazid)
- Skin condition treatment drugs (Dapsone)
- Pyridoxine (Vit B6)
- Calcineurin inhibitors (tacrolimus, ciclosporin)
Symptoms & Signs
(Not all symptoms and signs may be present)
- Numbness
- Loss of sensation
- Tingling
- Abnormal sensations
- Sensations usually first occur in feet or hands
- Weakness
Tests
(Not all evaluation and tests may be necessary)
- Physical examination
- Neurological exam
- Electromyography
- Nerve conduction velocity test
- Blood tests
Treatments
(Not all treatments and therapies may be indicated)
- Physical examination
- Neurological exam
- Electromyography
- Nerve conduction velocity test
- Blood tests
Today, doctors are exploring a link between pre-diabetes (also known as impaired glucose tolerance or IGT) and peripheral neuropathy. Approximately 10% of adults in America have what is being called “pre-diabetes” or “borderline diabetes”—a condition where the body has higher than normal blood sugar levels, but not high enough to be diagnosed as true diabetes. If left untreated, people with pre-diabetes are at risk of developing type 2 diabetes, heart disease, and nerve damage (which could result in peripheral neuropathy.)
People with pre-diabetes or IGT can significantly reduce their risk of developing type 2 diabetes through diet, exercise and learning to control their blood sugar levels.
Symptoms
(Not all symptoms and signs may be present)
People with IGT often have no symptoms. People who actually have diabetes—and who therefore are at greater risk of developing peripheral neuropathy—often don’t realize it because the symptoms of diabetes come on so gradually. Pre Diabetic symptoms and its complications include:
- Frequent urination
- Blurred vision
- Constant thirst
- Fatigue
- Frequent infections
- Cuts and bruises that heal slowly
- Tingling or numbness in the hands or feet
Tests
(Not all evaluation and tests may be necessary)
To test for pre-diabetes:
- Blood test
- Oral glucose tolerance test
Treatments
(Not all treatments and therapies may be indicated)
- Over-the-counter pain medication for mild pain
- Take safety measures to compensate for loss of sensation.
- Ask your doctor about special therapeutic shoes (which may be covered by Medicare and other insurance).
The first sign of diabetic neuropathy is usually numbness, tingling or pain in the feet, legs or hands.
Over a period of several years, the neuropathy may lead to muscle weakness in the feet and a loss of reflexes, especially around the ankle.
As the nerve damage increases, the loss of sensation in the feet can reduce a person’s ability to detect temperature or to notice pain. Because the person can no longer notice when his/her feet become injured, people with diabetic neuropathy are more likely to develop foot problems such as skin lesions and ulcers that may become infected.
Diabetic neuropathy may suddenly flare up and affect a specific nerve or group of nerves. When this occurs, the result may be weakness and muscle atrophy in various parts of the body, such as involvement of the eye muscles or eyelid (e.g., causing double vision or a drooping eyelid) or thigh muscles. Alternatively, neuropathy caused by diabetes may slowly progress over time. It also can interfere with the normal functioning of the digestive system and sexual organs.
Symptoms
(Not all symptoms and signs may be present)
- Numbness, tingling, or pain in the toes, feet, legs, hands, arms, and fingers
- Indigestion, nausea, or vomiting
- Diarrhea or constipation
- Dizziness or faintness due to a drop in blood pressure especially when rising to a standing position
- Problems with urination
- Erectile dysfunction (impotence) or vaginal dryness
Tests
(Not all evaluation and tests may be necessary)
- Comprehensive foot exam
- Physical examination
- Neurological exam
- Electromyography
- Nerve conduction velocity test
- Quantitive sensory testing (QST)
- Nerve or skin biopsy
- Blood studies (to verify diabetes (e.g., HbA1C) and to rule out other potential causes)
Treatments
(Not all treatments and therapies may be indicated)
The goal of treatment for diabetic neuropathy is to relieve discomfort and to prevent further tissue damage. The first step is to bring blood sugar levels under control by diet and medication. Another important part of treatment involves taking special care of the feet.
- Over-the-counter pain medication for mild pain
- For severe pain, take over-the-counter pain medication or prescription drugs used for peripheral neuropathy, on a regular basis—rather than waiting until nighttime when symptoms can become more severe
- Keep blood sugar levels in normal range
- Get regular exercise
- Maintain a healthy weight
- Antidepressants (for pain relief)
- Foot care: inspect your feet daily for injuries
- Special Therapeutic shoes (which may be covered by Medicare and other insurance)
- Take safety measures to compensate for loss of sensation
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