Complicating diabetes – neuropathy

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Complicating diabetes – neuropathy

Diabetic neuropathy is the main complication in patients with a prolonged course of diabetes. Timely diagnosis and adequate treatment of various forms of complications can minimize the risk of severe consequences of neuropathy.

Distal polyneuropathy in diabetes

Distal polyneuropathy is a type of sensory and sensorimotor neurological disorder that affects most patients with advanced diabetes. In almost half of diabetics, it begins to acquire a clinically bright form approximately five years after the diagnosis of diabetes mellitus. It consists in a decrease in sensitivity (temperature, tactile, pain) and is accompanied by muscle weakness with autonomic dysfunction. Symptoms of manifestation: numbness, chilliness, paresthesia, which at the initial stage are observed in the foot or lower part of the lower leg. Later, the same sensations can be observed in the hands. In some cases, a pain syndrome develops, when even a slight touch to the skin can cause an exacerbation of a burning strong  pains. It is difficult to treat and can torment patients with diabetes for months and years.

The diagnosis of “distal neuropathy” is established, both on the basis of characteristic complaints, and according to the results of functional diagnostics. Electroneuromyography, a study of somatosensory evoked potentials are carried out, the speed of the nerve impulse conduction along the motor and sensory fibers is studied.

Often, distal neuropathy is accompanied by the formation of trophic ulcers, which contribute to the formation of another complication in diabetes – the diabetic foot.

Diabetic foot in patients with diabetes

Diabetic foot – a serious complication that can lead to amputation of the leg. The state of hyperglycemia triggers a cascade of changes in metabolic processes, which leads to microangiopathy (impaired microcirculation in blood vessels). Clinical signs preceding the development of this disease: motor and autonomic failure, ischemic syndrome. Patients complain of chilly feet, impaired mobility of the joints, their swelling, discoloration of the skin. During the examination, they observe atrophy of the soft tissues of the foot, cyanosis of the skin, deformation of the joints, almost complete loss of sensitivity. Such “anesthesia” leads to injuries, the development of ulcerative and purulent-necrotic lesions, with which the diabetic is in no hurry to seek medical help, because he may not experience strong pain.

Microangiopathy, in addition to the lower extremities, attacks the retina of the eyes and kidneys.

Radiculopathy and mononeuropathy cause acute pain

Patients with diabetes mellitus with a mild course of the disease are susceptible to the development of radiculopathy, which attacks the body after the weakening effect of provocative factors (hypothermia, excessive physical exertion). It is characterized by the occurrence of acute intense pain in the cervicothoracic or lumbosacral zone.

The pain syndrome can persist after the termination of the irritating effect and concentrates more often on one side. The reason is that neuropathy in diabetes leads to edema and ischemia of the spinal roots.

And in the case of damage to individual peripheral nerves in diabetes, mononeuropathy is diagnosed. In this case, the trunk of the nerve is subjected to ischemia. Mononeuropathy most often affects the cranial nerves, for example, oculomotor or facial. Patients with diabetes suffer from pain of an intense and persistent nature in the eye, forehead or in the region of the behind the ear, complain of a split image, drooping upper eyelid, hearing loss.

Visual Impairment in Diabetes – Retinopathy

Long-term diabetes can cause visual impairment, which affects most patients with a disease duration of more than ten years. This complication is called diabetic retinopathy. It is also a manifestation of an even more dangerous disorder – insufficient blood supply to the brain.

Autonomic neuropathy

Autonomic (autonomic) neuropathy is another complication of diabetes that affects the central and peripheral parts of the autonomic nervous system. Depending on the place of its localization, it can be: urogenital, cardiovascular and gastrointestinal.

If the disorders affected the urogenital system, then the patient experiences difficulties in the genital area and with urination. Erectile dysfunction, manifested in the reduction and weakening of an erection, is directly related to the defeat of the parasympathetic nervous system of the sacral spine. With this form of neuropathy, atony of the bladder also develops, and, as a result, inflammatory processes in it.

With cardiovascular neuropathy, a pulse increases, which does not depend on a change in position, rest regimen, stress, etc. One of the most common symptoms of this complication is monotonous tachycardia. 

Gastrointestinal neuropathy is manifested by dysfunction of the corresponding organs: peristalsis disorder, atony of the esophagus sphincters. Patients with diabetes in this case suffer from heartburn, nausea, bloating, alternating constipation and diarrhea.

Autonomic neuropathy is diagnosed using tests, for example, a deep breathing test, a test with pressure on the eyeballs, clenching a hand into a fist, etc. Despite the fact that all these methods are affordable and very simple, they are quite informative for the doctor character.

Diabetes mellitus requires the observance of adequate ongoing therapy and monitoring by both the doctor and the patient. Only in this case is it possible to avoid the severe consequences of diabetic neuropathy.

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