Diabetic neuropathy

Nerve damage from diabetes mellitus (DM) is called diabetic neuropathy (DN) and is a common and severe complication of the disease.

diabetic neuropathy

About half of people with diabetes for some years have some form of neuropathy.

Risk of DN increases when overweight, high blood pressure, high cholesterol, advanced kidney disease, alcoholic beverage overdrink, smoke, genetic problems.

Types
Peripheral (ordinary nerve damage of the feet and legs and rarer the hands and arms).
Autonomic (nerve damage of the internal organs that lead to heart, digestive system, sex organs, sweat glands, eyes, etc. loss).
Focal (damage of single nerves, most often in hand, head, torso, leg).
Proximal (nerve damage in hip, buttock, thigh), often causes severe pain and may lead to significant weight loss.
Any combinations.

Symptoms
Dependently of the type of DN patient can express
Anorgasmia
Arterial hypertension
Arterial hypotension
Burning or electric pain
Diarrhea
Difficulty swallowing
Dizziness
Dysesthesia (abnormal sensation to a body part)
Erectile dysfunction
Facial, mouth and eyelid drooping
Fasciculation (muscle contractions)
Heart arrhythmia
Muscle weakness
Numbness and tingling of extremities
Retrograde ejaculation (in males)
Speech impairment
Trouble with balance
Urinary incontinence (loss of bladder control)
Vision changes

Ordinary, symptoms develop gradually.
Peripheral neuropathy

The main symptoms of peripheral DN
Burning (especially in the evening)
Increased sensitivity to touch
Loss of balance and coordination
Loss of reflexes, especially in the ankle
Muscle weakness
Numbness (may become permanent)
Numbness or reduced ability to feel pain or temperature changes
Pain
Serious foot problems (ulcers, infections, bone, and joint pain)
Sharp pains or cramps
Tingling
Tingling or burning sensation

The main symptoms of autonomic DN
A faster heart rate than normal
Bladder problems
Difficulties speaking or swallowing
Distorted sense of touch
Excessive sweating
Feeling full after eating small amounts of food
Heartburn and bloating
Hypoglycemic unawareness
Increased heart rate at rest
Muscle contractions and weakness
Nausea, constipation or diarrhea
Orthostatic hypotension
Sexual dysfunction
Significant drooping of the face and eyelids
Vaginal dryness
Vomiting several hours after eating

The main symptoms of focal DN
Symptoms depend on which nerve is involved within the hand, shin or foot, or in the lower back or pelvis, or in front of thigh, or in chest, or in abdomen, or in the eyes (difficulty focusing, double vision, aching behind one eye) and face (paralysis on one side of face (Bell’s palsy)).
Carpal and wrist tunnel syndromes are the most common types of this neuropathy.

The main symptoms of proximal DN
Radiculoplexus neuropathy (diabetic amyotrophy) affects nerves in the thighs, hips, buttocks or legs.
Symptoms are usually on one side of the body, but sometimes may spread to the other hand and include:
Abdominal swelling, if the abdomen is affected
Difficulty rising from a sitting position
Eventual weak and shrinking thigh muscles
Severe pain in a hip and thigh or buttock that occurs in a day or more
Weight loss.

Diagnosis
Nerve conduction tests may show reduced functioning of the peripheral nerves, but seldom correlate with the severity of diabetic peripheral neuropathy and are not appropriate as routine tests for the condition.
Instrumental methods include electromyography, a nerve conduction velocity test, a blood pressure measurement, and heart rate variability investigation.

Treatment
Tight glucose control.
Pain control includes antiepileptic medications, serotonin-norepinephrine reuptake inhibitors, and tricyclic antidepressants for short term usage.
In the United States approved only the antidepressant duloxetine, the anticonvulsant pregabalin, and the long-acting opioid tapentadol ER.
Opioid medications appear to be no more effective than placebo.
Capsaicin applied to the skin is not more effective.
Monochromatic infrared photo energy treatment (MIRE) can be an effective therapy in reducing and often eliminating pain.
Heat, therapeutic ultrasound, transcutaneous electrical nerve stimulation (TENS) and interferential current (IFC) relieve stiffness, improve mobility, relieve neuropathic pain, reduce edema, and resistant for treating foot ulcers.
Gait training, posture training can help prevent and stabilize foot complications.
Exercise programs and manual therapy are useful in prevention muscle contractures, spasms, and atrophy.

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