Diabetic Neuropathy: Introduction (Nursing)

by Rhonda Lawes, PhD, RN

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    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.

    About the Lecture

    The lecture Diabetic Neuropathy: Introduction (Nursing) by Rhonda Lawes, PhD, RN is from the course Diabetes Type 1 and 2: Complications and Symptoms (Nursing).

    Included Quiz Questions

    1. The client winces in pain at a light touch to their legs.
    2. The client isn't able to feel the nurse touching their feet.
    3. The client has an unsteady gait and has fallen twice.
    4. The client has +2 reflexes in both legs.
    5. The client can feel both light touch and painful touch equally on both sides.
    1. The client is sweating during their examination.
    2. The client reports rapidly gaining weight.
    3. The client's blood pressure drops when standing.
    4. The client isn't able to spend much time outside during the summer.
    5. The client reports feeling full after only a few bites.
    1. "My feet often feel like they are on fire."
    2. "Sometimes achieving and maintaining an erection is difficult."
    3. "I had to start using a cane because my balance is so poor."
    4. "I had shingles last year that was very painful."
    5. "I often have to wear a sweater because I feel so cold."

    Author of lecture Diabetic Neuropathy: Introduction (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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