Currently, diabetic neuropathy is as common as type 2 diabetes. Pathology is accompanied by physical and moral suffering of a person. In ICD 10, diabetic neuropathy has the code E10-E14 + with a common fourth character .4.
As you know, over time sugar has a negative effect on body tissues, including nerve fibers. Their shell is damaged, the wire mechanisms of nerve impulses are disturbed. After that, doctors diagnose neuropathy. What it is - diabetic neuropathy, how it manifests itself and how to deal with it, will be described below.
Causes of occurrence
The disease develops due to prolonged exposure to sugar nerve fibers in high concentration. As a result, their damage begins. Until now, scientists can not accurately answer what is the mechanism of development of diabetic neuropathy. But it is known that some negative factors can provoke the onset of such a condition:
- Violation of metabolic processes, because of this, blood sugar rises, diabetes takes a long nature, insulin decreases, and blood fats rise to an abnormal level.
- Neurovascular factors. Due to the increased glucose in the blood, nerve cells stop sending signals, and the capillaries through which oxygen and other useful substances enter the nerve cells become soft and poorly conducted.
- Autoimmune disorders, due to which inflammation begins in nerve cells.
- Mechanical damage to nerve fibers.
- Genetic factor, because of which the body has a tendency to disturbances in the functioning of the nervous system.
- Unhealthy lifestyles, particularly smoking and alcoholism.
Symptoms Peripheral Neuropathy
With diabetic neuropathy, there may be several symptoms, everything will depend on the type of disease. There are three varieties, one of which is peripheral neuropathy.
This condition can develop for a long time. In different parts of the body, numbness, tingling, and burning are felt. Gradually, the pain descends to the feet. Outwardly, the disease also manifests itself: the feet become dry, the skin crackes on them. Calluses form, an ingrown nail appears on the thumb. This condition is called diabetic foot syndrome.
Signs of a diabetic foot
Most limb amputations in diabetes mellitus are associated with a condition such as polyneuropathy, when a diabetic foot is formed. Depending on which symptoms of diabetic neuropathy prevail in this case, they can distinguish between neuropathic, ischemic and mixed forms of the disease.
But more often a neuropathic form of diabetes is diagnosed. Due to a violation of sweating, the skin becomes thinner, dry and susceptible to various injuries. Dilated vessels in which blood accumulates cause edema that spreads to the entire leg. Their difference from cardiac edema is that they do not disappear during bed rest.
Due to malnutrition, not only blood vessels suffer, but also tendons and ligaments, with the defeat of which the patient's gait changes. And due to the redistribution of the load, the metatarsal bones are deformed, the sensitivity of the leg decreases, and a neuropathic ulcer defect develops.
Initially, the thumb pad on which a round ulcer forms is affected. Subsequently, an infection can penetrate or osteomyelitis develops. A characteristic feature of a diabetic foot is the absence of pain.
If diabetic neuropathy with pain has an ischemic form, then such distinctive features will be observed:
- There is no pulse on the foot.
- The skin is cold and blue.
- The pain is felt at rest and intensifies at night.
- A person begins to limp on one leg.
Autonomic neuropathy
With autonomic neuropathy, nerves are damaged that pass through many body systems: cardiovascular, digestive, genitourinary, sweat glands, bone tissue, and respiratory organs. Against this background, secondary diseases develop. For example, cystitis, heart rhythm disturbance, etc. The most dangerous condition is when there is a risk of developing a massive heart attack.
This form of diabetic neuropathy is detected in the later stages, since it does not manifest itself for a long time. In this regard, the condition has an unfavorable prognosis, because the likelihood of death increases by five times. This is especially true for cardiac manifestations of autonomic neuropathy, it can occur in the form of tachycardia at rest, an elongated QT interval is detected on the ECG, pressure rises with a sharp rise, and heart pain is often absent.
Malfunctions in the digestive system occur due to a violation of the motor regime. They appear as follows:
- After a small portion of food, a feeling of fullness arises.
- Stomach ache.
- Nausea and vomiting.
- After eating food, diarrhea can begin, especially at night.
- Fecal incontinence.
Local diabetic neuropathy
Neuropathy of the local course is characterized by damage to the motor nerves. The disease manifests itself at night or at the time of a person’s rest. There is weakness and soreness in the limbs. The coordination of movements is disturbed, the joints become less mobile, muscle weakness develops. If nerve fibers in the muscle tissue of the eyes are damaged, then a person has double vision and pain in the eyeball.
This condition is accompanied by severe pain, which goes away on its own, and after a few months of local neuropathy, the pain is completely absent.
In addition, additional ailments develop:
- Difficulties with focusing vision.
- The appearance of double vision in the eyes.
- Paralysis of one half of the face.
- The pain occurs in the lower leg, feet, lower back, thighs, thoracic region, eyeballs and abdomen.
Also, diabetic neuropathy of the lower extremities may be accompanied by a decrease in the fat content of the feet (and palms), a violation of thermoregulation, the appearance of apnea and the gradual development of exhaustion.
Risk group
The risk group primarily consists of people with diabetes. But there are circumstances that can accelerate or provoke the development of diabetic neuropathy. So, the risk group includes people with the following problems:
- A long history of diabetic disease.
- Renal diseases, which often develop on the background of diabetes mellitus, due to this, toxins in the blood increase, which destroys nerve fibers.
- Overweight.
- Addiction to cigarettes. Such a bad habit can constrict the blood vessels, and blood flows poorly to the extremities. As a result, wounds become non-healing, and this violates the integrity of the peripheral nerves.
- Those who do not control blood sugar.
Diagnostics
Due to the localization of the disease in any part of the human body, diagnosis is sometimes difficult. Therefore, a number of studies are required to detect diabetic neuropathy.
- First, the doctor conducts a conversation with the patient, listens to his complaints. Questions are asked about the presence of dizziness, headaches, heart problems, cramps, stomach discomfort, etc., whether there are pains in the limbs, or fainting.
- Physical examination. Doctors may come across the idea of diabetic neuropathy features such as decreased skin sensitivity, unstable gait, drooping eyelids and neuritis in the face. In particular, the doctor examines the feet, which are affected by the disease primarily.
- Neurological analysis. The doctor uses various devices to establish the tactile, pain, temperature and vibration sensitivity of a person. If the indicators are reduced, we can talk about the violation of nerve cells.
- Electroneurography - this method determines the speed of impulses along nerve fibers and their response. Poor signal conductivity and the absence of muscle tissue contraction can indicate the presence of the disease.
- Laboratory tests. With their help, elevated sugar in urine and blood is detected.
Since the symptoms of the disease can be different, differential diagnostics will also be needed to identify pathologies of the kidneys, heart, stomach, intoxication of the body due to alcohol dependence, malignant tumors, tuberculosis. The diagnosis is made based on the results of an ultrasound of the digestive system.
Treatment
Until now, doctors are in search of an optimal treatment option for this disease, since the mechanism of its development has not been fully studied.
At present, the treatment of diabetic neuropathy boils down to the following measures:
- Doctors' actions aimed at preventing the progression of pathology. Firstly, it is necessary to maintain the level of glucose in the blood within normal limits, so the development of the disease will not only be suspended, but some of its symptoms will disappear.
- Measures aimed at reducing pain. In this case, such painkillers as Desipramine, Gabapentin, Phenytoin, Duloxetine are used.
- Fighting complications and restoring lost body functions. Often, complex therapy includes drugs from the group of tricyclic antidepressants. But their dosage is determined by the doctor, since it should be less than with depression. Drowsiness acts as a side effect, so it is recommended to take the medicine before going to bed.
If necessary, antiepileptic drugs are prescribed. In order not to develop side effects, drugs are given in a small dosage, gradually increasing it. It is worth noting that the treatment of diabetic neuropathy of the lower extremities does not boil down to local therapy; an integrated approach will be needed.
Preventive measures
The following preventive measures reduce the risk of developing diabetic neuropathy:
- Continuous monitoring of blood pressure. Often, elevated blood pressure in people with diabetes is a common occurrence. If it is not controlled, then as a result of damage to blood vessels and impaired blood flow, complications will begin.
- Proper nutrition. It is aimed primarily at maintaining a healthy weight, therefore, it includes a maximum of plant foods and crops. Servings should be reduced, to avoid fatty and spicy foods.
- Maintaining an active lifestyle. Daily physical activity improves the functioning of the heart and blood vessels, normalizes blood pressure.
- Rejection of bad habits. This is nicotine and alcohol addiction.
Reviews
Patient reviews suggest that diabetic neuropathy can be controlled. To do this, you need to regularly visit doctors of various specializations. This is a gastroenterologist, cardiologist, dermatologist, urologist and optometrist. Everything will depend on how the pathology manifests itself.