Diabetic Lumbosacral Plexopathy Treatment & Management

Updated: Mar 07, 2019
  • Author: Divakara Kedlaya, MBBS; Chief Editor: Milton J Klein, DO, MBA  more...
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Treatment

Approach Considerations

Most patients are able to avoid inpatient care for diabetic lumbosacral plexopathy. Good glycemic control through the adjustment of diabetes medication (eg, oral agents, insulin) is of paramount importance. Education on proper diet and exercise is also essential. However, because of the sudden onset of functional loss, some patients with the condition may need to be transferred to a subacute rehabilitation facility or a convalescent home for several months, until they recover strength.

A literature review by Kazamel and Dyck suggested that in evaluating patients with diabetes, clinicians should be aware that different types of diabetic neuropathy produce different patterns of abnormal sensation and arise from different pathophysiologic mechanisms. [34]

Go to Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Neuropathy; and Electrophysiology for more information on these topics.

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Surgical Intervention

No surgical intervention is needed for diabetic lumbosacral plexopathy.

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Consultations

Consider consultation with an endocrinologist (eg, with a diabetologist) to assist with the management of diabetes mellitus.

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Physical Therapy

Neurologic recovery is slow for patients with diabetic lumbosacral plexopathy. A physical therapist (PT) can assist in improving a patient's functional mobility (eg, transfers, ambulation). The PT instructs the patient in the use of assistive devices when necessary. A therapeutic exercise and range-of-motion program supervised by the PT is helpful in maintaining and improving lower extremity prime-mover muscle function and avoiding major lower extremity joint contractures.

These patients may derive further benefit from a course of outpatient physical therapy, achieving their maximum potential in terms of functional mobility and lower extremity strength.

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Occupational Therapy

An occupational therapist can recommend appropriate adaptive equipment (eg, a reacher, an elevated toilet seat, a tub bench) based on the degree of proximal weakness the patient is experiencing, so that the patient can be independent in activities of daily living and perform self-care tasks in a seated position.

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Medical Care

Good glycemic control through the adjustment of diabetes medication (eg, oral agents, insulin) is of paramount importance. Education on proper diet and exercise is also essential.

Medical management includes neuromodulator medications for chronic neuropathic pain management such as anticonvulsant medications (gabapentin or pregabalin) and selective norepinephrine reuptake inhibitors (such as duloxetine). Anecdotal experience indicates that topical counter-irritant medications such as menthol and wintergreen are also valuable as comfort measures.

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