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Abstract: A 65-year-old male patient with a 10-year history of diabetes mellitus, irregular oral hypoglycemic medication, poor glycemic control, and no diet, often large fish and meat, developed numbness and pins and needles sensation at the end of the extremities one month before admission, with fair limb strength. After admission and completion of relevant tests, peripheral neuropathy due to diabetes mellitus was considered, and the patient’s numbness at the extremities improved after he was given hypoglycemic and nutritional nerve therapy.
Basic information】Male, 65 years old
Disease Type】Peripheral neuropathy
Hospital】The Second Hospital of Harbin Medical University
Date of consultation】January 2022
Treatment plan】Subcutaneous injection (menthol insulin injection, glycine insulin injection) + intravenous injection (methylcobalamin injection) + oral medication (vitamin B1 tablets, Chuan Huang oral solution)
[Treatment period] 7 days of hospitalization, regular follow-up
Treatment effect] The numbness of the limbs was relieved, and the disease was controlled and stabilized.
I. Initial consultation
The patient came to our outpatient clinic with a 10-year history of previous diabetes mellitus, irregular oral hypoglycemic medication, and uncontrolled diet, with blood glucose often reaching more than 20 mmol/L. The perfect head CT The examination showed bilateral lacunar cerebral infarction, and the patient was advised that peripheral neuropathy was a high possibility and was recommended to be admitted to hospital for treatment, to which the patient agreed. The patient agreed. After admission, he was informed that he needed to improve the nerve conduction velocity of the extremities and head magnetic resonance examination.
II. Treatment history
The patient was admitted to the hospital for physical examination: clear consciousness, fluent speech, body temperature of 36.4℃, blood pressure of 130/90mmHg, heart rate of 77 beats/min, respiration of 16 breaths/min, no obvious sensory impairment, and normal muscle strength of the extremities. The cranial magnetic resonance examination was completed, and the results showed no acute cerebral infarction or sinusitis. The nerve conduction velocity of the extremities showed that the patient had bilateral sensory impairment of the ulnar nerve, median nerve and peroneal nerve. After completing the relevant examinations, peripheral neuropathy caused by diabetes was considered, which is difficult to treat and slow to recover.
After the patient and his family were informed, the patient was given menthol insulin injection and glycine insulin injection subcutaneously to lower blood glucose, while he was given vitamin B1 tablets and Chuan Huang oral solution orally to nourish the nerves and methylcobalamin injection intravenously by drip with nerve nutrition to relieve symptoms.
(The above is the result of head magnetic resonance imaging)
III. Treatment effect
After 7 days of drug treatment, the patient’s symptoms of numbness in the limbs slightly improved, and the patient complained that the end of the limbs were not so painful, and the glycosylated hemoglobin reached 10% on the recheck, and the fasting blood glucose and 2-hour postprandial blood glucose control was acceptable. The patient said that the symptoms of numbness and toe skin pain had basically disappeared.
IV. Notes
I am very pleased with the improvement of the patient’s symptoms. At the same time, I need to tell the patient that he still needs to take oral vitamin B1 and vitamin B12 tablets to nourish his nerves and insulin therapy to control his blood sugar after discharge.
If the numbness of the limbs is aggravated again, it is recommended to go to the hospital at the first time for medical consultation to clarify the cause and then treat the problem.
V. Personal insight
Peripheral neuropathy caused by diabetes is most common in polyneuropathy, which is common in middle-aged and elderly patients with long-term disease or without proper treatment, and is clinically classified into sensory type, motor type and ataxia type.
The patient in this article has sensory peripheral neuropathy, which does not involve the motor system. It is mainly caused by poor long-term blood glucose control, so we should actively control blood glucose with medication to keep fasting, postprandial and glycated hemoglobin within normal limits, pay attention to diet and actively participate in physical exercise.