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August 2016

Test for Diabetic Neuropathy

By Samuel Kolodney 2 years ago 908 Views No comments

Diabetic neuropathy when gone unchecked can have devastating consequences including ulcerative wounds and even limb amputation. Improvement in the rates of self-care and home testing for diabetic neuropathy can have a dramatic impact on individual health outcomes.

Pinprick sensation testing using the technique recommended in the ADA's guidelines to detect diabetic neuropathy and when performed with a Medipin, it is probably the easiest test for patients to do in the home.

Why Use Medipin?

The optimal pinprick test generates as acute a sense of sharpness as possible without increasing the risk of skin penetration. For decades, since the work of the likes of De Castillo, Katz, Miledi and others, we have understood the neurophysiology of these stimuli. Pinprick is not truly about physical sharpness at all. A hypodermic needle is very sharp – a blade really – and as such and in the right hands can be almost painless. On the other hand, sharp stimulation acuity is all about skin stretch and contact demarcation of the point and its surfaces of contact.

Medipin is an FDA listed, dedicated device which has been in regular use by US Doctors for many years, as well has having been employed successfully in quite a number of international medical studies. It utilizes a well demarcated but blunted pyramidal point in order to exploit the stretching phenomenon. As well as being intended to reduce the risk of skin penetration this stretching actually heightens the sense of pinprick. This heightened sensation is then augmented by the surrounding annulus in which the point is situated that creates a perimeter of duller sensation to exploit the cortical phenomenon of lateral neural inhibition.

Lateral inhibition, is the phenomenon that suppresses information form areas of perception bordering those that more vividly garner cortical stimulation to evoke discrete boundaries and delineations. This is the same phenomenon that fools us in optical illusions and is leveraged here by positioning Medipin’s well demarcated point at the center of an area of duller stimulation created by the annulus. Effectively the Medipin device generates the perception a localized center surround field effect which further enhances the sharp element at its’ center whilst surrounding neurons are inhibited to further augment perception of the point. This tricks the brain in to perceiving greater pain than the stimulus would otherwise warrant.

This means more acute stimulation at lesser contact pressure. Or, in layman’s terms more pain sensation with no actual harm.

Learn more about Medipin for home self-care testing

The resurgence of pinprick testing

By Samuel Kolodney 2 years ago 1291 Views No comments

Pinprick is a medically useful modality by which to assess sensation, especially with an instrument designed to lend itself to an easy testing scenario and utilising the very straight forward technique described by key source material cited by ADA literature

(Boulton et al, 2008, Comprehensive Foot Examination and Risk Assessment): A report of the Task Force of the Foot Care Interest Group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists, Diabetes Care August vol. 31 no. 8 1679- 1685:

Pinprick sensation. Similarly, the inability of a subject to perceive pinprick sensation has been associated with an increased risk of ulceration. A disposable pin should be applied just proximal to the toenail on the dorsal surface of the hallux, with just enough pressure to deform the skin. Inability to perceive pinprick over either hallux would be regarded as an abnormal test result.”1

Pinprick sensory testing, whether in the doctors’ office or at the patient’s home, is a very simple procedure. By contrast the technique required for monofilament testing consistent with instructions published by the ADA is more complicated and whilst easy enough in the clinical setting, remains challenging to perform accurately in a self-care situation.

Testing sensation with a Medipin clearly represents the simplest and easily executed technique to perform in the home and empowers patients to participate in an important aspect of their own diabetic healthcare. As a testing modality for the prediction of serious diabetic complications, like the development of lower extremity ulceration, pinprick has actually been reputably demonstrated to be rather more sensitive than conventionally used techniques.

The study Abbott et al, 2002, The North-West Diabetes Foot Care Study: Incidence Of, And Risk Factors For New Diabetic Foot Ulceration In A Community Based Patient Cohort. Diabet Med 19: 377–384) utilised a population of almost 10,000 patients. This significant study undertaken at one of the most prolific neuropathy centres in the world, Withington, Central Manchester University Hospitals, UK, showed that pinprick was even more useful for predicting the development of foot ulceration than more conventional techniques including monofilament.

Rather than be dismissed for its relative obscurity, pinprick should be embraced as a clinically useful tool in helping patients with diabetes to monitor themselves for loss of protective sensation. Virtually all health care professionals working and studying in this area similarly express the view that anything that alters foot self-care behavior in diabetes has got to be a good thing. We believe that Medipin will massively encourage education and better self-care practice and all the undoubted benefits that come with it.

Medipin is an FDA listed, dedicated device which has been in regular use by US Doctors for many years, as well has having been employed successfully in quite a number of international medical studies. It is an all-plastic precision instrument which was designed to avoid skin puncture whilst, simultaneously, significantly heightening stimulation at lower application pressures by exploiting neural lateral inhibition. A specially faceted and blunted point is situated within a surrounding annular component that serves to both micro stretch the skin and create an artificial center surround field.

To summarise;

  1. Home testing for diabetic neuropathy has excellent potential to transform self-management strategy of the diabetic foot in the USA and elsewhere.
  2. Whilst pinprick has not been the historic primary choice of testing modality for diabetic neuropathy, as much though fashion and neglect rather than appropriate scrutiny it remains, nonetheless, acknowledged as a potent, justifiably efficacious and ADA recommended test.
  3. Pinprick sensation testing using the technique recommended in the ADA's guidelines and performed with a Medipin, is probably the easiest test for patients to do in the home.
  4. If the spirit of ADA assessment were to be taken to the fullest degree the optimum scenario for home testing would be to offer the patient an option to perform a pinprick test with Medipin with the addition of a simple disposable monofilament test or instructions for the ‘Ipswich Touch Test’ which has been shown to be as efficacious as the monofilament and requires no extra equipment at all: (Rayman G, Vas PR, Baker N, et al. The Ipswich Touch Test: a simple and novel method to identify inpatients with diabetes at risk of foot ulceration. Diabetes Care. 2011;34:1517-1518)

Find more about Medipin for Home Self-Care

Learn more about Medipin for Clinical Care

References

1 http://care.diabetesjournals.org/content/31/8/1679.full.pdf+html

The gift nobody wants but everybody needs?

By Samuel Kolodney 2 years ago 827 Views No comments

The Gift of Pain.

The gift of pain is what keeps our bodies healthy. Without it we can unknowingly harm ourselves. People with Diabetes are susceptible to losing the gift of pain through a condition called Diabetic Peripheral Neuropathy (DPN), which is a form of nerve damage.

Diabetes is a leading cause of peripheral neuropathy in the United States. The National Institute of Health estimates between 60 to 70 percent of people with diabetes have mild to severe forms of nerve damage that can affect sensory, motor, and autonomic nerves and present with varied symptoms.1

One of these symptoms is the Loss of Pain Sensation, which may lead to foot ulceration due to even minor trauma. As many as 25% of people with diabetes develop at least one foot ulcer during their lifetime. Studies also suggest that between 4 and 10 per 1000 people with diabetes will have a lower limb amputation.2

According to the American Diabetes association in 2010, about 73,000 non-traumatic lower-limb amputations were performed in adults aged 20 years or older with diagnosed diabetes.3

Data collected by Southern California Kaiser Permanente between 2008 and 2011 shows that the rate of lower limb amputations drop as the number of foot exams increase. The difference was significant, which improved from a country wide average of 2.2 amputations per 1000 people to 0.79 amputations per 1000 people for those undergoing regular foot exams.4

What can be done to reduce the incidents of diabetic foot ulcer and amputation?
Medipin diabetic toes test makes it easier, safer, and more convenient than ever to perform monthly self-testing for loss of pain sensation.

Learn more about Medipin:
https://www.doctorsoption.com/medipin-the-diabetic...


References:

1 Peripheral Neuropathy Fact Sheet

http://www.ninds.nih.gov/disorders/peripheralneuro...

2. Singh N, Armstrong DG, Lipsky BA. “Preventing foot ulcers in patients with diabetes.” JAMA.2005;293:217–28.
http://www.ncbi.nlm.nih.gov/pubmed/15644549

3. American Diabetes Association. “Statistics About Diabetes”
http://www.diabetes.org/diabetes-basics/statistics...

4. Lee- Reducing Amputation Rates - HealthConnect Strategies
https://www.signup4.net/Upload/KAIS13A/PHYE362E/Le...

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