What is
Diabetic Peripheral Neuropathy (DPN)?

Keith Horcasitas, LCSW, MHA
As I noted in last month’s overall column about the management of Diabetes Mellitus, the September column would review DPN and how it may be addressed for a home health patient.
As cited by the National Institute of Neurological Disorders and Stroke (NINDS): DPN is a peripheral nerve disorder sometimes caused by diabetes. The symptoms of DPN are often slight at first. In fact, some mild cases may go unnoticed for a long time. Numbness, pain, or tingling in the feet, or legs may, after several years, lead to weakness in the muscles of the feet.
Nerve damage caused by diabetes generally occurs over a period of years and may lead to problems with the digestive tract and sexual organs, which can cause indigestion, diarrhea or constipation, dizziness, bladder infections, and impotence. The loss of sensation in the feet may increase the possibility for foot injuries to go unnoticed and develop into ulcers or lesions that become infected and lead to amputation.
According to Richard Palecki, DPM, a local Podiatrist, “50 % of all diabetics will develop DPN at some point. Many patients will report a burning sensation – particularly in their feet. Some patients have noted that this sensation felt like ‘pins and needles in their feet or like fire.’”
One of the prescribed treatments available to diabetics experiencing DPN is known as anodyne or infrared light therapy, which can be administered per a home health therapist when ordered by a physician. Anodyne Therapy is an FDA-Cleared medical device for increasing circulation and reducing pain.
There is an approximately 80 % success rate for DPN patients using this treatment when it is in conjunction with overall good diabetes management by the patient, including compliance with dietary and an adequate exercise regimen.
Dr. Palecki noted that there are particular overall clinical protocols associated with the treatment of DPN, but that the anodyne is one that does bear some verifiable positive results. Some literature review has posed the question of whether the results of this therapy were actually a placebo (just perceived) effect. He reported that when most of his patients decided to discontinue the therapy on their own, they would, inevitably, report a return of the symptoms, and requested the light therapy again for relief.
Also, as reported by David E. Allie, MD, of the Cardiovascular Institute of the South in Lafayette, LA, “The patient with diabetes is at 7 – 40 time greater risk for amputation than the patient without diabetes, and increasingly, DPN is being implicated as a contributing factor.” Thus, diagnosing and treating DPN is critical to overall diabetes management.
The following is a fictional case of an elderly individual with DPN who may benefit from Home Health Care. Mrs. Jones, 71, is a frail widow who lives alone and gets weekly support from some of her family members, who take her to her medical appointments or arrange for this per a sitter service. She usually manages her own diabetic needs – provides self-care in monitoring her blood sugars but has had more difficulty recently with her vision.
Mrs. Jones used to drive her own car for her needs but has recently been told by her physician that she should not due to her declining health. She usually can get around safely with a walker and uses a bedside commode at home. She recently reported the loss of some sensation in her feet and made a medical appointment to address this. Anodyne therapy is a treatment modality that can be recommended for home health to assist her needs, as well Diabetic Management and the Low Vision Rehabilitation Program.
Dr. Palecki also recommended the following for ongoing management of DPN: 1) a yearly foot exam to evaluate and manage DPN and 2) patients should check their feet visually everyday to make sure the skin isn’t breaking down or anything unusual develops.
In summary, DPN is a complication of diabetes that warrants close attention and treatment. Anodyne therapy per home health is one means that can be employed to enhance the overall diabetes management of an individual.
Keith Horcasitas, LCSW, MHA