Diabetic neuropathy
The content of the article:
- Causes and risk factors
- Forms of the disease
- Disease stages
- Symptoms
- Diagnostics
- Treatment
- Possible complications and consequences
- Forecast
- Prevention
Diabetic neuropathy is a dystrophic lesion of peripheral nerves caused by metabolic disorders arising in the setting of diabetes mellitus. The disease is manifested by impaired sensitivity and autonomic dysfunction.
Diabetic neuropathy is widespread and is diagnosed, according to various authors, in 30-50% of patients with diabetes mellitus of any type.
Diabetic neuropathy develops against the background of diabetes mellitus
Causes and risk factors
The main role in the pathological mechanism of diabetic neuropathy belongs to microangiopathies, that is, damage to the smallest blood vessels that feed both the vascular walls themselves and peripheral nerves. Insufficient blood supply to the nervous tissue causes a disorder of metabolic processes in it and contributes to the accumulation of products of oxidative stress. As a result, the nervous tissue swells, the conductivity of electrical impulses worsens. Ultimately, the nerve fiber will atrophy.
Diabetic neuropathy is based on damage to the smallest blood vessels
Factors that increase the risk of developing diabetic neuropathy:
- elderly age;
- arterial hypertension;
- decompensated hyperglycemia;
- long course of diabetes mellitus;
- smoking;
- obesity.
Forms of the disease
Depending on the topography, the following are distinguished:
- autonomous neuropathy. It is associated with a violation of the innervation of internal organs;
- peripheral neuropathy. The spinal nerves are mainly affected.
In clinical practice, syndromic classification is widely used:
- Generalized symmetric polyneuropathy. Depending on the predominant lesion of sensory or motor fibers, it is subdivided into sensory and motor neuropathy, respectively. With simultaneous damage to both types of nerve fibers, one speaks of combined neuropathy.
- Autonomic (autonomic) neuropathy. It is subdivided into sudomotor, cardiovascular, respiratory, urogenital and gastrointestinal forms.
- Multifocal (focal) neuropathy. It includes chronic inflammatory demyelinating, tunnel, cranial neuropathy, plexopathy (radiculoneuropathy), amyotrophy.
Sometimes central neuropathy is isolated in a separate form, which manifests itself:
- acute disorders of cerebral circulation;
- encephalomyelopathy;
- acute mental disorders.
Disease stages
There are three stages of diabetic neuropathy:
- Subclinical.
- Clinical (painless, acute and chronic pain forms).
- Stage of late complications (diabetic foot, foot deformity, etc.).
Symptoms
The peripheral form of diabetic neuropathy is characterized by:
- tingling sensation, burning, numbness of the skin (paresthesia);
- cramps of the calf muscles;
- pain in the area of fingers and toes, hands and feet;
- loss of temperature sensitivity;
- increased tactile sensitivity (hyperesthesia);
- muscle weakness;
- weakening of the severity of tendon reflexes;
- violations of coordination of movements and gait.
Long-term pain becomes the cause of the development of insomnia, and in the future, severe depression.
Tingling and numbness of the skin is a symptom of diabetic neuropathy
With the autonomous form of diabetic neuropathy, damage to the autonomic nervous system, which innervates the internal organs, is observed, which leads to a disorder of their functions. The clinical picture of this form of the disease is determined by which organ system suffers to a greater extent:
- Cardiovascular diabetic neuropathy. It develops in the early years of diabetes. Tachycardia, orthostatic hypotension (a decrease in blood pressure when the patient moves to an upright position) and certain changes in the electrocardiogram (prolongation of the QT interval) are characteristic. The risk of developing a painless form of myocardial infarction is increased.
- Gastrointestinal diabetic neuropathy. Clinically manifested by hypersalivation, gastroparesis (impaired gastric motility), pathological gastroesophageal reflux. Patients are often diagnosed with gastric ulcer and duodenal ulcer, gallbladder dyskinesia, gastritis with low acidity, cholelithiasis, fatty hepatosis.
- Urogenital diabetic neuropathy. There is a violation of the tone of the ureters and bladder, which leads to urinary incontinence or urinary retention, and also creates the prerequisites for the development of an infectious and inflammatory process of the urinary tract (cystitis, pyelonephritis). In men, urogenital neuropathy can cause impaired pain sensitivity of the testicles and erectile dysfunction, and in women - anorgasmia and dryness of the vaginal mucosa.
- Sudomotor diabetic neuropathy. It is characterized by increased sweating of the whole body (central hyperhidrosis) with reduced sweating of the palms and feet (with distal an- or hypohidrosis). This manifestation of neuropathy is most clearly observed at night and with food intake.
- Respiratory diabetic neuropathy. It is accompanied by a decrease in the synthesis of surfactant, hyperventilation of the lungs, periodic episodes of apnea.
Diagnostics
Diagnosis of diabetic neuropathy, especially of the vegetative form of the disease, is often difficult. First, the history is examined, then an examination is carried out, which includes:
- determination of the concentration of glucose, insulin, glycosylated hemoglobin, C-peptide in blood serum;
- blood pressure measurement;
- definition of pulsation of peripheral arteries;
- a thorough examination of the feet in order to identify corns, corns, fungal lesions, deformities.
In the diagnosis of diabetic neuropathy, in addition to the endocrinologist, other narrow specialists are involved (neurologist, gastroenterologist, cardiologist, gynecologist, urologist-andrologist, ophthalmologist, podologist, orthopedist).
A thorough examination of the feet is one of the stages in the diagnosis of diabetic neuropathy
In the presence of clinical symptoms of damage to the cardiovascular system, the algorithm of the initial examination is supplemented by ECG, EchoCG, cardiovascular tests (orthostatic test, Valsalva test). A blood test is also carried out for the content of lipoproteins and cholesterol.
Neurologic examination for suspected diabetic neuropathy includes:
- electroneurography;
- electromyography;
- assessment of reflexes and various types of sensitivity (sensory, tactile, vibration, temperature, pain).
With an atypical course of diabetic neuropathy, it may be necessary to perform a biopsy of the skin and (or) sural nerve, followed by a histological examination of the material obtained.
With signs of pathology of the organs of the gastrointestinal tract, the following are shown:
- Helicobacter tests;
- Ultrasound of the abdominal organs;
- contrast radiography of the stomach and intestines;
- EGDS.
Ultrasound of the abdominal organs is performed if there is a suspicion of gastrointestinal pathology
Diagnostics of the urogenital form of diabetic neuropathy includes:
- general urine analysis;
- test of Nechiporenko;
- Zimnitsky test;
- electromyography of the muscles of the bladder;
- intravenous urography;
- cystoscopy;
- Ultrasound of the kidneys and bladder with the obligatory determination of the amount of residual urine.
Treatment
Treatment of diabetic neuropathy is long-term and complex, affecting various mechanisms of the pathological process. It is necessary to achieve the maximum possible degree of compensation for diabetes. For this, by controlling the glucose in the blood serum, the necessary doses of hypoglycemic drugs or insulin are selected. In addition, lifestyle modifications are required:
- optimal power plan (table number 9 according to Pevzner);
- regular exercise therapy;
- control of body weight.
With diabetic neuropathy, the optimal diet is table number 9 according to Pevzner
To improve metabolic processes, B vitamins, antioxidants (vitamin E, alpha-lipoic acid), trace elements (zinc and magnesium preparations) are prescribed.
With severe pain syndrome, non-steroidal anti-inflammatory drugs, as well as anticonvulsants, are indicated.
Physiotherapy techniques are used: acupuncture, light therapy, laser therapy, magnetotherapy, electrical nerve stimulation, massage.
Proper foot care is important:
- moisturizing the skin of the feet with a special cream;
- regular foot baths;
- performing a medical pedicure;
- wearing comfortable shoes that do not squeeze the foot and do not chafe it (if necessary, wear orthopedic shoes).
Proper foot care is important for diabetic neuropathy
Therapy of vegetative forms of diabetic neuropathy should be carried out taking into account the characteristics of the developed clinical syndrome.
Possible complications and consequences
The main complications of the peripheral form of diabetic neuropathy are:
- collapse of the arch of the foot;
- hammer deformity of the toes;
- ulcerative skin defects of the lower extremities;
- diabetic foot syndrome.
Also, diabetic neuropathy can lead to the development of:
- asymptomatic hypoglycemia;
- violation of thermoregulation;
- symptomatic hemeralopia;
- diplopia;
- progressive wasting (diabetic cachexia).
Forecast
With early diagnosis and active treatment of diabetic neuropathy, it is possible to stop the progression of the disease. The prognosis for complicated forms of diabetic neuropathy is less favorable.
Prevention
To prevent the development of diabetic neuropathy, you need:
- control of serum glucose concentration;
- diet food;
- moderate but regular physical activity;
- strict adherence to the scheme of insulin therapy or taking sugar-reducing drugs prescribed by a doctor;
- timely treatment of concomitant diseases;
- regular preventive examinations by an endocrinologist, neurologist and other recommended specialists.
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
