00:01
Hi. Welcome to our series
on diabetic complications.
00:05
Now. I want to give you
a little more information
about the four types
of diabetic neuropathy.
00:10
Yeah, that's right.
00:12
As if diabetic neuropathy
wasn't terrible enough by itself.
00:15
There's actually
four different types.
00:18
So you see those
lightning bolts,
you know what I always
tell you when we see those,
those aren't super
powers, that's pain.
00:26
High blood glucose starts to impact
nerve function nerve damage over time.
00:32
There's no cure for neuropathy.
00:34
And that makes me really sad
because it is miserable for patients.
00:38
So our job is to minimize
the risk factors to work
with them to help them
do whatever it takes to try
to bring that blood
sugar closer to normal
so we can minimize the
risk of them dealing with one
or all of these four types
of diabetic neuropathy.
00:55
Now, why do I keep
saying it's so horrible.
00:57
I want you to understand
what it feels like.
01:00
So, first of all picture
somebody you really care about.
01:04
Close your eyes and think about
somebody that you just really love.
01:08
Well. I'm going to think about
my dad because sometimes talking
about all the specific stuff
makes it kind of tough to focus.
01:16
But if I think about what did my
dad experience with neuropathy
then it starts to make it come
more alive and it gives me purpose
on why I would invest this kind
of energy in studying the topic.
01:28
So it feels like sensory damage.
01:32
It feels like motor
nerve damage.
01:34
It feels like autonomic.
01:35
Wait a minute.
01:36
If I ask the average patient, do you
feel you're having sensory damage?
What about autonomic
nerve damage?
They're not going to understand
what those terms mean.
01:47
These categories are for you.
01:49
So we're going to talk about
what it feels like to be a patient.
01:52
Things like somebody you
really care about could go through
if they have this
type of damage.
01:58
So let's talk about this type of
nerve damage in real person term.
02:03
So do you have
your patient pictured?
I'm going to share what my dad.
02:08
That's the person I'm picturing
when we talk about this.
02:11
So he would tell
me how these kid...
02:13
He always called me kid,
didn't matter how old I was.
02:16
Kid you're a medical person.
02:18
I'm having these weird
feelings in my feet.
02:21
See he had that
burning sensation.
02:23
He had this weird
numbness and he had tingling.
02:27
Well, those aren't the same order that
we've got them on the the slide for you,
but I've done that on purpose.
02:32
When you're trying to encode information
you want to attach it to something.
02:36
For me, I picture my dad.
02:39
You don't always have to go in the
same order that you see the words written.
02:44
Sometimes changing it up when I'm trying
to encode things is a great way to make
it stick in my memory.
02:50
So I think about the things
that my dad said to me.
02:53
They were definitely
unusual sensations.
02:56
Sometimes if you just touched
his feet it was very painful for him.
03:00
My dad was a carpenter
and a big strong man.
03:04
So it made quite an
impression on me.
03:06
When if I just barely touched
his feet it caused him pain.
03:11
Now, he described this burning
like his legs and feet were on fire.
03:14
But at the same
time they were numb.
03:17
Sometimes a light
touch could be a problem,
but he felt like his legs and
feet were asleep all the time
and he had that weird tingling sometimes
it felt like when your leg was waking up.
03:29
Now all of this put together gave
him significant balance problems.
03:34
I can't tell you how
many times he took a fall?
I don't know how
he never broke a hip.
03:41
But getting him back up
again was quite a project.
03:44
But how does all
this lead to balance?
Okay, if you think about
it, I just want you to feel
whether you have shoes on or whether you
don't, I want you to just move your toes
like this against the
floor or against your shoe.
03:58
See you have
significant sensation.
04:01
If you have an experienced sensory
damage, you can feel each one
of your five toes inside your
shoes or on the floor. Feel that?
Patient with sensory
damage cannot feel that.
04:13
They can't tell how
hard they're stepping.
04:16
They can't have a sense of
balance or where they're going.
04:18
And so that's why they
have an increased risk for falls
because they have
balance problems.
04:24
My dad kind of looked like
Frankenstein's sometime
when he was walking
because his feet were numb.
04:30
And he couldn't tell
where things were
and that's what caused
all those issues with falls.
04:35
So that's what sensory
damage will feel like.
04:37
Those are the types of things
will put your patient at risk.
04:41
Now motor nerve
damage is even weird.
04:43
You have this weird muscle
cramping, they can have some twitching,
or if you test their reflexes,
they are not going to be normal.
04:51
Now the cramping can
be very difficult for patients.
04:53
The twitching is a little annoying
but it's not usually as problematic as
what we hear people talk about
with the sensory nerve damage.
05:02
Now, the autonomic nerve damage.
05:04
There's five things I
want you to focus on here.
05:07
So this is autonomic nerve
damage, our third category.
05:11
You can have this excess
sweating and nobody likes to sweat.
05:16
But it's not always
attributed to temperature.
05:19
They cannot take heat. They're
going to like things really really cold.
05:24
When everyone else is
freezing, they like it that way
because they cannot tolerate heat because
of the damage to their autonomic nerves.
05:32
They get full really
quickly when they eat.
05:35
Now that last one.
05:37
I don't think that picture needs
any explanation but I think
that will stick in your mind.
05:42
Because of autonomic nerve damage
they can also have problems with impotence.
05:46
Last, orthostatic hypotension.
05:49
That means it's
even more significant.
05:52
So when someone is laying
down in sitting or sitting down
and moves to standing they
have this issue with they can faint
which again puts them at risk.
06:02
Okay. Let's put these together.
06:04
If you have sensory damage
and autonomic nerve damage,
how high risk are you for falls?
Yeah, you can see how these complications
start to build upon each other.
06:16
They snowball and become an even
bigger and bigger and bigger problem.