Management Of Diabetic Neuropathy

Fluoroquinolones and Peripheral Neuropathy

Peripheral neuropathy, this is an often devastatingconditionwhich people develop pain and numbnesstheir hands and feet. Basicallythey're told on the evening news that they should be taking this or that mediion sothat they can get through life. That's treating the smoke and ignoring thefire. Those medicines that you're seeing advertised don't treat the neuropathy, they only treatthe symptoms. But what's causing peripheral neuropathy? Well we know thatAmerica,one of the biggest causes of peripheral neuropathy is being diabetic, which is clearly relatedto the foods that you eat by and large. Becoming a type 2 diabetic amatically increases yourrisk for having peripheral neuropathy and

fact being devastated by it. This is adisease that effects 115 Americans. Let's take a look. So again this is 115 Americans—thisis 20 million Americans afflicted by this disease, that aside from diabetes, we're toldthe cause is unknown. Well maybe that's not exactly true. Last month,the journal Neurology,an incredible study was published describing a relationship between what are called fluoroquinolones,and the risk of developing a peripheral neuropathy. You may not know what fluoroquinolones are,but chances are you may have actually been exposed to fluoroquinolone. These are antibioticsused for treating things like upper respiratory

infections and even urinary tract infections.Things like Levaquin and Cipro are commonly usedwalks. If you have a urinarytract infection, you may have received these mediations. Well, here's what the study showedus: So this is a study publishedSeptember2014 that looked at men between age 45 to 80 years of age followed for a 10 year periodandthis group there were over 6,000 cases of peripheral neuropathy. And they comparedthese individuals to about 25,000 aged match controls, and what they found was that riskfor developing this devastating condition called peripheral neuropathy was doubled inthose individuals exposed to this class of

antibiotics called fluoroquinolones. And whatthe researchers also told us is that, and I quote, quot;Fluoroquinolones have been shownto neurotoxic. Oral fluoroquinolones have also been associated with reported cases ofpsychosis and seizures, which similar to peripheral neuropathy have been shown to be acute eventsoccurring within days of fluoroquinolone use. In light of strong evidence of unnecessaryprescribing of oral fluoroquinolonesthe United States, ians must weigh the riskof PN against the benefits of prescribing FQ when prescribing these ugs to their patients.quot; We've got to practice medicine under the dictumof quot;above all do no harm.quot; One of our most

well respected peer journals is nowtelling us that the use of these mediions—these fluoroquinolone antibiotics is associatedwith doubling of the risk of peripheral neuropathy. A disease which often is not treatable. Sokeep thatmind the next time you think you need an antibiotic for this or that problem,discuss this study with your treating physician. I'm David Perlmutter.

Diabetic nephropathy al presentation treatment

Diabetic nephropathyis one of the most common and serious chronic compliions associated with diabetes mellitus. In this tutorial, let'sdiscuss how the mechanisms underlying diabetic nephropathy correlate with the al presentation as well as the treatment of the disease. Now fortunately the mechanisms

underlying diabetic nephropathy, directly correlate withthe al presentation. And the first alfinding of the disease is somewhat paradoxicallyan increased kidney filtration rate orglomerular filtration rate. So, diabetic nephropathy,if you break down the term into nephro and pathy literally means kidneydisease caused by diabetes.

Now typically kidney disease is marked by a decreased filtration rate, so why is it that the first al stage of diabetic nephropathy is that of an increased glomerularfiltration rate? Well recall that the earliest mechanism contributing to diabetic nephropathy is an increased pressurestate, over hereblue.

And this is due to hypertension and efferent vasoconstriction. So let's use a common garden hose to help illustrate how thisincreased pressure state will ultimately resultan increased glomerular filtration rate. So, imagine you have this garden hose and it has a small holein the middle of it.

So first you're gonna open up the spigot and increase the pressureand flow through the hose. Intuitively, this isgoing to increase the rate at which water is leakingfrom the holethe hose. Next, you partially kink off the end of the hose distal to the hole, and once again this isgonna further increase the rate at which waterleaks from the hose.

This is essentially what'soccurringthe glomerulus with the hypertension representing the opening up of the spigot and increasing the pressurebefore the glomerulus,front of the glomerulus, and the efferent vasoconstriction representing the kinking off of the hose, which causes this back pressure.

Category: Peripheral Neuropathy

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