Disorders of the nervous system in diabetes. Neurological pathology in diabetes
Diabetes mellitus is one of the most common forms of disorders of carbohydrate metabolism. The frequency of pathology in various populations is 1-2%. Diabetes mellitus is pathogenetically heterogeneous, however, in all forms, the metabolic conversion of glucose in the body is disrupted, which is accompanied by a high content of glucose in the blood and the accumulation of keto acids and other metabolites in biological fluids and tissues, which have a toxic effect on the nervous and vascular system, liver, kidneys .
Diabetes mellitus in young children manifests itself, as a rule, in a severe coma, which often develops against the background of an infectious disease or 5-6 days after an acute respiratory illness. It can also be triggered by trauma and emotional stress. The child is usually taken to the hospital by ambulance. In neurological status: sluggish reaction of the pupils to light, nystagmus, floating movements of the eyeballs, pronounced autonomic disturbances, hyperthermia, dry mucous membranes, indomitable vomiting; moderate meningeal syndrome; motor disorders are caused by edema and swelling of the brain. There may be a polymorphic convulsive syndrome with a predominance of the tonic component. Vomiting with the smell of acetone, anuria and polyuria is characteristic.
Significantly less often in children aged 2-3 years, diabetes occurs subacute and is manifested by symptoms such as loss of appetite, polydipsia, polyphagia, polyuria. The child becomes inactive, complains of a headache, pain in the arms and legs. Often with diabetes, dermatitis, itching in the vagina. Pathology of the nervous system in subacute diabetes mellitus mainly relates to the peripheral nervous system and is characterized by mono- and polyneuritis. They describe transient neuritis of the abducent nerve, manifested by convergent squint, neuritis of the facial nerve, in which the asymmetry of the face is usually not rough. Polyneuritis in diabetes mellitus is characterized by dissociation between a bright pain syndrome, mainly in the form of a burning sensation, and a moderate severity of motor disorders. Pathology of the peripheral nervous system is confirmed by electromyography. Astheno-neurotic syndrome is one of the most characteristic disorders of the central nervous system in diabetes mellitus.
The treatment of neurological disorders is part of the complex treatment of diabetes. According to indications, sedatives are prescribed. With lesions of the peripheral nervous system, anticholinesterase drugs and B vitamins are indicated. Massage, physiotherapy exercises, physiotherapy and balneotherapy are recommended.
Prevention of lesions of the nervous system in children with diabetes is based on clinical follow-up. Genealogical analysis is of great importance, which in combination with stress tests is a prerequisite for the diagnosis of latent forms of sugar diagnostics of latent forms of diabetes.
Idiopathic familial hypoglycemia (McCurry syndrome)
In 1954, McQuarrie described a hereditary carbohydrate metabolism disorder caused by an enzymatic block in an insulin-inactivating system. The disease manifests itself in the neonatal period with convulsions, lethargy, coma. When examining the nervous system, myositis, strabismus, the absence of corneal, conjunctival, palatine and pharyngeal reflexes are detected. Severe muscle hypotension is combined with the absence of tendon and periosteal reflexes. Unconditioned reflexes in newborns cannot be caused. These symptoms are the result of cerebral edema, which quickly also leads to respiratory failure and cardiac activity. In severe cases, death occurs on the 1st day after birth.
In milder cases, idiopathic familial hypoglycemia occurs paroxysmally. It manifests itself more often at the age of 2-3 years with tremors, episodes of seizures. Attacks are triggered by a high protein content in the diet, especially leucine. After the crisis, sweating, weakness, polyphagy are noted. Sometimes severe recurrent crises lead to mental retardation. Usually there are spontaneous remissions at the age of 6-10 years. The diagnosis is confirmed by a glucose tolerance test, a breakdown with a load of leucine. The differential diagnosis is carried out with insuloma, pituitary insufficiency, adrenal glands, starvation, etc.
Hypoglycemia is corrected by the appointment of ACTH for 2-3 weeks in decreasing doses, starting from 4 ED / kg. A biochemical criterion for the adequacy of therapy is an empty stomach sugar content of at least 0.4 g / l, as well as the absence of clinical manifestations of hypoglycemia.