Diabetic neuropathy

What is Diabetic Neuropathy

Diabetic neuropathy is a combination of syndromes affecting various parts of the peripheral and autonomic nervous system, which occurs against the background of metabolic disorders in diabetes mellitus and complicates its course. 

According to statistics, being one of the most frequent and serious complications of diabetes, various forms of diabetic neuropathy are diagnosed in almost half of all diabetic patients.

Diabetic neuropathy is characterized by signs of impaired conduction of nerve impulses, sensitivity, as well as various disorders of the somatic and autonomic nervous systems, which arose when other causes and factors of dysfunction of the nervous system (trauma, infections, etc.) were excluded. The clinical manifestations of the disease are very diverse, therefore, most doctors with a narrow specialization are faced with diabetic neuropathy – neuropathologists, urologists, endocrinologists, gastroenterologists, dermatologists, etc.

Causes and mechanisms of development of diabetic neuropathy

The main reason for the development of diabetic neuropathy is chronically elevated blood glucose levels , which ultimately lead to changes in the structure and functioning of nerve cells. Due to the violation of carbohydrate metabolism in diabetes mellitus, patients develop microangiopathies – pathological changes in the vessels of the microvasculature, due to which the normal blood supply to the nerves is disrupted. As a result of multiple metabolic disorders, edema of the nervous tissue develops, all metabolic processes in the nerve fibers are disrupted, the conduction of nerve impulses is impaired, the antioxidant system is inhibited, leading to the accumulation of free radicals that have a detrimental effect on nerve cells, the production of autoimmune complexes begins, which can ultimately lead to atrophy of nerve fibers.   

There are a number of factors that increase the risk of developing diabetic neuropathy:

– advanced age;

– long experience of diabetes mellitus;

– decompression phase;

– increased blood pressure;

– overweight and obesity;

– smoking, taking alcoholic beverages.

Diabetic neuropathy – symptoms, syndromes, types

Diabetic neuropathy is classified in several ways. Several authors distinguish four main types of diabetic neuropathy:

– peripheral neuropathy – one of the most common types, in which there is damage to the nerve fibers of the extremities, and the lower extremities are affected more often;  

– autonomic neuropathy – in which the work of many internal organs is disrupted – the heart, stomach, intestines, sexual dysfunction develops;  

– proximal neuropathy – characterized by severe pain in the thighs, buttocks and hip joints;  

– focal neuropathy – in which there is a local lesion of individual nerve fibers.  

There is a classification of diabetic neuropathy, which is based on the principle of isolating syndromes with characteristic clinical manifestations and course. According to her, diffuse neuropathy (affecting all nerve fibers) and focal neuropathy (affecting certain areas of the human body) are distinguished . The prevalence of diffuse neuropathy is much higher, it progresses rapidly and is often asymptomatic. It includes autonomous diabetic neuropathy and distal symmetric sensorimotor diabetic polyneuropathy .       

Focal neuropathy is less common, occurs acutely, losing clinical manifestations over time. It includes cranial neuropathy, radiculopathy, plexopathy, mononeuropathy.

Peripheral neuropathy

Peripheral diabetic neuropathy is observed mainly in the lower extremities, characterized by burning and painful symptoms in the legs, which often occur at night, a sensation of sudden heat or cold, and chills in the legs. Patients are very sensitive to touch, sometimes they are even painful. Deformities of the muscles of the limbs may be noted. Any damage. those that violate the integrity of the skin of the limbs become wounds that do not heal for a long period.

Autonomic neuropathy

Autonomic diabetic neuropathy is characterized by damage to the autonomic part of the nervous system, which controls and coordinates the work of internal organs. In this case, violations can be noted on the part of most organs and systems.

In particular, with damage to the nerve fibers responsible for the functioning of the digestive system, patients complain of nausea, heartburn, a feeling of heaviness in the stomach even with a small amount of food consumed, flatulence, diarrhea or constipation. These symptoms may indicate the development of gastroparesis – a dysfunction of the stomach. At the same time, there is a slowdown in the evacuation of food from the stomach into the intestine. If the process involves the nerves that control the work of the small intestine, nocturnal diarrhea develops.

With damage to the nerve fibers responsible for the work of the genitourinary system, paresis of the bladder may develop, while urine is not evacuated in a timely manner from the bladder due to the lack of urge to urinate, thereby increasing the risk of joining a urinary tract infection. Patients complain of frequent, rare or involuntary urination.

In addition, due to the negative effect on the nerves responsible for the emergence and maintenance of an erection in men during sexual arousal, autonomic neuropathy can lead to erectile dysfunction while maintaining sexual desire in the patient. Female patients may complain of a decrease in arousal and excessive dryness in the vagina, which occurs due to a decrease in the amount of vaginal secretion at the time of intercourse.

With autonomic neuropathy due to damage to the cardiovascular system, symptoms such as dizziness and causeless loss of consciousness, increased heart rate, painless angina pectoris, etc. may occur.

On the part of the skin, patients note excessive dryness of the limbs, profuse sweating or its complete absence.

Focal neuropathy

This type of neuropathy usually occurs suddenly, affecting the nerve fibers of the head, trunk, limbs. It is characterized by painful sensations of varying strength and muscle weakness. In addition to these signs, Bell’s palsy can occur, affecting one half of the face, double vision, and pain in the chest or abdomen, which are often mistaken for a heart attack or an attack of appendicitis.

If one or a complex of the above symptoms is detected, patients suffering from diabetes should consult a specialist for differential diagnosis of diabetic neuropathy with other diseases with similar symptoms, such as alcoholic neuropathy, neuropathy that occurs while taking neurotoxic drugs or exposure to toxic chemicals (solvents, heavy metal compounds, etc.).

A set of methods for the diagnosis of diabetic neuropathy

The list of diagnostic methods for diabetic neuropathy is directly related to what form of neuropathy the patient has addressed. Therefore, at the initial consultation, anamnesis and complaints are carefully collected, based on which the endocrinologist or diabetologist connects other specialists to the study.

All patients need to determine the level of sugar, insulin and glycated hemoglobin in the blood, an examination of the legs is required to identify wounds, trophic ulcers, fungal lesions, calluses, etc.

Neurological examination of patients with diabetic neuropathy includes electromyography and electroneurography, assessment of reflexes and the level of perception of all senses.

In the presence of symptoms of lesions of the digestive tract, it will not be superfluous to do an ultrasound examination of the abdominal organs, X-ray of the stomach, esophagogastroduodenoscopy. If the patient complains of the genitourinary system, it is necessary to conduct a general urine analysis, ultrasound of the kidneys and bladder with the determination of the residual urine volume, cystoscopy and urography.

How to treat diabetic neuropathy

Consistency and staging are important in the treatment of diabetic neuropathy. Since the disease is concomitant with the main one – diabetes mellitus of the first and second types, it is first of all necessary to transfer diabetes mellitus to the stage of compensation. Correction of blood glucose levels is carried out by an endocrinologist or diabetologist using insulin or antidiabetic drugs. Regular monitoring of blood sugar levels is necessary. In addition, for the complex treatment of the patient, a special diet should be developed and a mode of physical activity should be determined. If the patient is obese, an overweight reduction program needs to be developed. Monitoring blood pressure levels is equally important.

Symptomatic treatment depends on the type of diabetic neuropathy and consists of the intake of B vitamins with neurotropic action, antioxidants, magnesium and zinc preparations. When diabetic neuropathy is accompanied by severe pain sensations, they resort to prescribing pain relievers and anticonvulsants.

Specialists widely use physiotherapeutic methods of treatment in the treatment of diabetic neuropathy of the legs, such as electrical nerve stimulation, magnetotherapy, laser therapy, acupuncture, and physiotherapy. Patients with a predominant lesion of the legs are advised to thoroughly care for the feet, moisturize them and wear comfortable shoes, excluding the formation of calluses and corns.

Prevention and Treatment – Differences in Effectiveness

The likelihood of development and the severity of complications of diabetes mellitus directly depends on the completeness of compensation for carbohydrate metabolism, as well as on the implementation of a set of preventive measures. Each patient with diabetes mellitus should undergo a course of vascular therapy at least once every 6 months, aimed at preventing the development of complications, including diabetic neuropathy.

Unfortunately, it is often quite difficult to convince patients with diabetes mellitus of the need for prophylactic courses of treatment, since at the initial stages of the disease, patients are not worried about anything, and a person usually ignores an increased level of glucose altogether. At the same time, the effectiveness of treatment measures directly depends on how early they are started, and how regularly they are carried out.

After complications become visible to the naked eye (at this moment, the quality of life of patients begins to rapidly decline), almost all patients begin to actively receive treatment. Unfortunately, in the later stages of the disease, the effectiveness of vascular therapy is no longer as high as at the onset of the disease. Therefore, it should be recognized as absolutely proven that the prevention of the development of neuropathy and other complications of diabetes mellitus should begin immediately after the detection of diabetes and continue throughout the entire period of its treatment.