Case Reports

Diabetic Peripheral Neuropathy: The Learning Curve

Living with diabetes mellitus and its complications can be challenging, but treatment by a specialized wound care staff adept in treating diabetic foot ulcers and educating patients about care can ensure favorable outcomes.

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When R was a 19-year-old sailor heading out to sea, he had no idea of the forthcoming medical diagnosis that would change his life. R was like any other young seaman: ready to do his assigned tasks and ready to serve his country. He was stationed on a Los Angeles class, nuclear-powered, fast attack submarine. R was living his lifelong dream of serving in the U.S. Navy. The submarine was conducting sound trials and tactical readiness exams off the southeast U.S. coast near Bermuda. The days were long, but he loved what he was doing, so he ignored his symptoms of fatigue, attributing it to his busy schedule. He was enjoying his time in the navy and looking forward to a long career.

Diagnosis

R was assigned watch duty during the day, but he couldn’t understand why he felt so fatigued during his watch or his ability to fall asleep while standing. R didn’t complain because he knew everyone was working hard, long hours. He knew he was not sleeping well, mainly due to the frequent trips to the bathroom to urinate, and at first attributed it to drinking large amounts of coffee and sugar to stay awake during the drills. He also knew he was constantly hungry, thirsty, and tired. After falling asleep while on duty during the exercise, R found himself facing possible disciplinary action. He had no idea what was happening but realized it was not in his nature to fail at a task and certainly not to fall asleep on duty. Having a chronic disease that would affect him for the rest of his life was certainly not on his mind. He recalled, “At the time I didn’t even know what diabetes was.”

R finally admitted his array of symptoms to one of the corpsman. He often urinated every 20 minutes and at times did not make it to the bathroom. His vision was blurred to the point he could not make out faces just a few feet away from him, and the lethargy was overwhelming.

The corpsman immediately knew something was wrong with R and instructed R to report to the boat’s sick bay. Fortunately for R, the classic symptoms of hunger, thirst, frequent urination, and fatigue struck a chord with the corpsman who also noticed that R had lost a great amount of weight, a fact R had not noticed. Labs were drawn, and a urine specimen was obtained. R had a blood glucose level of > 1,000 mg/dL, was in severe ketoacidosis, and was diagnosed with type 1 diabetes mellitus (T1DM). The corpsman was surprised he was even coherent at this point. He was given IV infusions in both arms. The boat’s mission was halted. The immediate thought was to send for a medical evacuation helicopter. The weather conditions were too severe at the time to arrange for air evacuation, so the captain decided to head back to port and transfer R to the Portsmouth Naval Medical Center. R will never forget that day; however, the days and weeks following became somewhat of a blur. R recalls, “Time seemed to standstill some days, then others were on fast forward.” He was hospitalized for the next 2 weeks. His condition was stabilized, and he learned how to care for himself.

Learning About Diabetes

The following weeks and months while on medical hold and being processed for discharge, R was assigned a variety of duties. He felt well prepared to manage his disease on a daily basis and at first had hopes of continuing his navy career. He recalls now, he had no clue what the diagnosis would mean in the years to come. R learned he would eventually be medically retired from the navy and rejoined civilian life.

Initial Complications

After leaving the navy, R decided to become a law enforcement officer. He joined a local police department and quickly rose through the ranks. He began to settle into a routine, learning to manage his insulin, control his diet, and enjoy his new career. For the next several years, he experienced few complications, although he never regained the 50 pounds he had lost when he was first diagnosed. Around 25 years old, he began to notice pain in the bottom of his feet. He was still able to run, had great balance, and didn’t think his symptoms of sore feet were attributable to his diabetes. He did notice that without shoes on, his feet were extremely sensitive to any texture.

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