Diabetic
Neuropathy Primer
from Dale
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here to download this document as a .pdf (adobe acrobat) file
- What
is neuropathy?
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."
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).
- What
are the symptoms?
-
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
- What
causes it?
- Can
it be reversed?
- How
long does it take to reverse this condition?
- Are
there other things that can cause rear leg weakness, inability to jump?
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);
(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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