Diabetic Amyotrophy

Approximately one percent of people with diabetes develop diabetic amyotrophy. Also, referred to as proximal diabetic neuropathy, this is a type of peripheral nerve disease. It is a diabetes complication that affects the nerves, mostly affecting the thighs, buttocks, hips and lower legs. The symptoms that occur are the result of damage to these nerves in these areas of the body. While rare, all people with diabetes mellitus should know about diabetic amyotrophy, so that they can tell when it is time to see their doctor.

CAUSES OF THIS TYPE OF DIABETIC NEUROPATHY
The majority of people who develop this condition have Type 2 diabetes and are over age 50. Men develop it more often than women. It is caused by nerve damage that can result from high blood sugar levels. Because of this, people with uncontrolled Type 2 diabetes are at the highest risk for diabetic amyotrophy.

When blood sugar levels remain high over time, this can cause damage to nerves throughout the body. Glucose levels that are high over a prolonged period of time may also cause issues with how the nerves send signals throughout the body. In addition, the capillaries can also experience damage from prolonged high glucose levels. These blood vessels are responsible for sending nutrients and oxygen to the nerves. Without adequate nutrients and oxygen, the nerves eventually become damaged.

POSSIBLE SYMPTOMS
Once symptoms begin, they tend to progress over time. Then, over months or years, they gradually lessen. However, most people will continue to have at least some symptoms to some degree over the long-term. The following are possible symptoms of this type of diabetic neuropathy:

• Sudden pain in the buttocks, hips or thighs that can sometimes be severe
• Losing reflexes in your lower limbs, such as the knee-jerk reflex, when the doctor is testing your reflexes by tapping your knee
• Weight loss that is unintentional
• Leg weakness that can make it hard to stand up when you are seated
• Losing muscle tissue in the affected areas, such as your thighs

In most cases, only one side of the body is affected. However, in rare cases, the condition may start to affect the other side of the body. Those with this condition tend to experience the symptoms in the lower body, from the hips down. The pain is usually one of the first symptoms. It may not be severe enough when it starts to cause alarm, but can become severe over time.

GETTING A DIAGNOSIS
To diagnose diabetic amyotrophy, doctors start with a full medical history that includes evaluating how well your diabetes is managed. Doing an A1c blood test can tell your doctor about the management of your blood sugar levels over approximately three months. If the test and other information indicates that your blood sugar levels have been uncontrolled, this can provide some insight regarding the cause of your pain, weakness and other symptoms.

Two tests that may be ordered include electromyography and nerve conduction studies. Electromyography looks at your muscle health and the health of the nerves that are responsible for controlling them. This test involves strategically inserting thin needles into the affected muscles. The doctor will look at a monitor to get information about your muscle’s electrical activity. You may be asked to flex the muscle being tested during the exam.

In most cases, nerve conduction studies are performed during the same visit. This test measures how quickly electrical signals are traveling through a nerve. Instead of thin needles, this test uses patches that are placed over the nerves that are being tested. A monitor provides the doctor with information regarding the speed of the nerve signals so that they can determine if there are abnormalities.

TREATMENT OPTIONS
Treating this condition is the same as treating peripheral neuropathy. There are different medications and therapies that may be helpful. In many cases, your doctor will prescribe more than one treatment to help to control your symptoms. The following medications might be considered:

• Over-the-counter pain medicines may be recommended to reduce your discomfort. To help with pain related to inflammation, medicines like naproxen or ibuprofen might be recommended.
• Antidepressants may help with nerve pain.
• Anti-seizure medicines affect your nerves to reduce associated pain.
• Topical medicines, such as capsaicin cream, might be helpful to reduce pain. In some cases, a lidocaine patch could be used, since it can numb a small area that is especially painful.

Your doctor might also recommend different therapies for this condition. Physical therapy is common, especially if your weakness or pain are moderate to severe. This therapy involves different exercises that can improve your pain, mobility and weakness. In some cases, occupational therapy might also be recommended if your symptoms are making it difficult to perform your usual daily activities. Other types of therapy that might be helpful include:

• Intravenous immune globulin and plasma exchange might be considered if physical therapy and medications are not reducing your symptoms enough. This therapy works to suppress immune activity.
• Transcutaneous electrical nerve stimulation may help with pain. It involves using different frequencies of a gentle electric current to affect your nerves.

PREVENTION METHODS
There is no way to 100 percent prevent this diabetes complication. However, keeping your blood sugar levels in check can reduce your risk significantly. The first step is monitoring your glucose levels regularly so that you can determine if they are getting too high. You should also take all of your medications exactly as directed. If your treatment regimen is not keeping your blood sugar levels within the healthy range, talk to your doctor about making adjustments. Other ways to help to maintain healthy blood sugar levels include:

• Exercise most days of the week to increase insulin sensitivity, allowing your body to use blood glucose more effectively
• Reduce your intake of carbohydrates, and when you do eat carbohydrates, stick to complex carbohydrates since these will not cause an acute spike in your glucose levels (examples of complex carbohydrates include whole grains, beans and lentils)
• Eat more fiber to reduce how quickly your body absorbs sugar and digests carbohydrates to reduce blood sugar spikes
• Stay hydrated by drinking plenty of water to aid your kidneys in essentially flushing out excess glucose
• Eat smaller portions more frequently to better regulate your blood sugar levels
• Keep your stress under control since glucose levels can be negatively affected by excessive stress
• Make sure to get enough sleep to ensure better insulin sensitivity

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