Diabetic
Neuropathy Primer
from Dale
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According to the Merck Veterinary Manual it is “an uncommon complication of diabetes mellitus in cats and rarely dogs”. Signs include slowly progressive weakness, ataxia, and muscle atrophy. Affected cats often have unilateral or bilateral tibial nerve dysfunction, evident as a plantigrade stance. Several pathophysiologic mechanisms have been proposed, but prolonged hyperglycemia seems to be the important underlying factor. Pathologic findings in nerves consist of demyelination with remyelination or axonal degeneration, or both. Diagnosis is based on clinical findings, laboratory evidence of diabetes mellitus, and nerve biopsy. The prognosis is guarded, but partial or complete recovery can occur with insulin therapy." writer essay.
Diabetic Neuropathy is due to deterioration or degeneration of nerve fibers caused by diabetes mellitus. These fibers go to muscles, skin and internal organs to provide feeling and movement. Nerve fiber breakdown produces a variety of complaints such as numbness, tingling, burning and other pain in the feet. Other problems that may occur are weakness, unsteadiness, light-headedness, impotence and bowel complaints (from a paper by Dr. Vera Bril MD, FRCPC regarding human diabetic patients). Drift fun games, drift games, best drifting games.
Attitude change
Painful legs - in human diabetics there is a tingling/numbness/burning sensation in the extremeties
Appearance of walking on eggs (may resemble arthritis)
Hyperesthesia - abnormal sensitivity to touch, pain, or other sensory stimuli
Inability to jump to elevated surfaces or walk any distance
Hind limb weakness
Plantigrade stance - instead of walking on the toes the animal drops down and walks on the hocks.
references: Pet Education ; Newman Veterinary ; Journal of Neuropathology and Experimental Neurology
Current thinking is that it’s caused by high levels of glucose http://www.petalk.com/feline-diabetes.html; http://www.dcavm.org/dec99.htm
Free radical production and oxidative stress damaging nerve cells
It
is possible with good glycemic control being the first step in the process
http://www.viim.org/therapeutics/refguide_Oct01.asp#Anchor-Diabetes
2-6 months with glucose control
Yes. Diabetes and renal disease are often seen together. Therefore some symptoms of what we term neuropathy “could” actually be symptoms of renal disease. Your vet will probably have run blood work to determine the initial glucose level of your cat and should have bloodwork numbers for the kidneys also.
If there is rear leg weakness a potassium deficiency should also be considered. Unregulated diabetic cats are polyuric. Potassium is lost through diuresis. If the potassium level is below 4, potassium supplementation should be performed following your vets instructions on amount. If you are giving sub-q fluids potassium can be added to the fluids. If sub-q fluids are not being given a pill called Tumil-K can be given orally or added to the pets food. A re-check of bloodwork should be performed every 24-48 hours once potassium supplementation begins, then once a month. Too much potassium can cause heart problems so always talk to your vet about the potassium supplementation. (http://www.felinecrf.org/treatments.htm#Low potassium); Ihnen Mit Dem Suchmaschinenoptimierung seo berlin.
(http://www.dcavm.org/dec99.htm)
7. What are some of the treatments people are using for neuropathy?
Glucose regulation
Methylcobalamin B12 - the B vitamin group is good for nerve damage caused by diabetes, injury, stress, and inflammation.
See research from Life Extension Magazine (www.lef.org/magazine/mag98/aug98_abs.html)
See a success story and more information also available at Jasper’s site (www.laurieulrich/jasper)
Physical Therapy
Exercise and Neuropathy info from ADA
Kimber and Bunny’s therapy success: “I would massage his legs at least 4-5 times per week to keep the circulation going. Exercises were at least 3 times per week. I would come up to him while he was lying down and gently hold his foot and make him pull it away. I would hold him under his armpits and “walk” him. Just kept exercising the legs and doing all I could to keep the muscles alive and the blood flow going. He also went up and down the basement stairs of his own accord to use the litter box. AND, he could still jump up on to the furniture. I don’t know if that was because of the exercises or what. When his bg’s started to improve, so did his walk. It was a slow process. He started coming back up about 6 months after regulation…took about a year to get to complete normal. To see him now you would not even guess he was that bad.”
Alpha Lipoic Acids (ALAs) – there is a good deal of research suggesting that ALAs help prevent free radical damage and can also have an effect on oxidative stress (additional links below as well)
Nat’l Center for Biotechnology Information
Medical Research Institute - commercial site but lots of research and links
8. What research is on the horizon?
Acetyl-L-carnitine: studies using cats are being conducted on this supplement that may improve abnormal nerve metabolism. Dosage is 50 mg-100 mg/kg/day.
District of Columbia Academy of Vet Med
UCSD Comparative Neuromusclular Laboratory
Medical Research Institute
ldose Reductase Inhibitors (ARI's) are drugs that act on a nerve exposed to high blood sugars to prevent some of the chemical imbalances that occur and thus protect the nerve. There are ongoing studies on these drugs but various problems have arisen from them, i.e. liver damage, too small of a focus group. To date no ARI drug has been approved.
Research being done at Toronto General Hospital by Dr. Vera Bril
Explanation of what an ARI is and does at MedFriendly
Please bear in mind that most of the research and clinical studies conducted on neuropathy have been done on humans (though there’s the occasional rat research). If you see signs of neuropathy in your sugarcat a vet’s visit is in order to gain a more definite diagnosis and help with the steps to achieving tighter glucose control. Glucose regulation is the #1 tool in stopping the progression of diabetic neuropathy and reversing it.
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