diabetic neuropathy (1)

7/29/2019 Diabetic Neuropathy (1)

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Diabetic neuropathy


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Definition

Common complication of diabetes, is damageto the nerves that allow you to feel sensations

such as pain.

There are a number of ways that diabetesdamages the nerves, but they all seem related

to blood sugar being too high for a long period

of time. Neuropathy:nerve disorder that results in

distortion of nerve function.


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Risk factors

Glucose control

Duration of diabetes

Damage to blood vessels

Mechanical injury to nerves

Autoimmune factors

Genetic susceptibility

Lifestyle factors Smoking

Diet


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Nerves of the Foot


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Causes

Lifestyle factors

Metabolic factors

Autoimmune factors Nerve and blood vessel factors

Nerve injury


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Pathophysiology

Metabolic factors

High blood glucose

Advanced glycation end products

Sorbitol

Abnormal blood fat levels

Ischemia

Nerve fiber repair mechanisms


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Revision

Peripheral neurons can be categorized broadly as; motor

sensory

autonomic

Motor neurons originate in the CNS then go to

the anterior horn of the spinal cord. From the

anterior horn, exit the spinal cord (via ventral

roots) and combine with other fibers to go

through the brachial or lumbar plexuses and

innervate their target organs through peripheral

nerves.


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Sensory neurons originate at the dorsal root

ganglia (which lie outside the spinal cord) and

follow a similar course with motor neurons.Sensory neurons are subdivided into

categories according to the sensory modality

they convey.

Autonomic neurons consist of sympathetic

and parasympathetic types. In the periphery,

preganglionic fibers leave the CNS and

synapse on postganglionic neurons in the

sympathetic chain or in sympathetic ganglia.


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Classification of DN

Classified based on the affected nerves:-

Peripheral neuropathy

Autonomic neuropathyFocal neuropathy

Proximal neuropathy


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Peripheral Neuropathy

The areas of the body most commonly affected are thefeet and legs.

Nerve damage in the feet ;result in a loss of footsensation (foot problem).

Injuries and sores on the feet may go unrecognized dueto lack of sensation.

Should practice proper skin and foot care.

Symptoms may include: Tingling

Numbness (severe or long-term numbness can becomepermanent)

Burning (especially in the evening)

Pain


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Regions of the body

affected by peripheralneuropathy


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Autonomic neuropathy

Affects the autonomic nerves controlling

internal organs

Peripheral

Genitourinary

Gastrointestinal

Cardiovascular

To prevent, continuously keep your blood

sugar levels well controlled.


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Regions of the body

affected by autonomic

neuropathy


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Symptoms may include:-

Bloating

Diarrheal Constipation

Heartburn

Nausea

Vomiting Feeling full after small

meals

Blacking out when youstand up quickly

Increased heart rate

Dizziness

Low blood pressure

Decrease in vaginallubrication

Decrease in number oforgasms or lack of orgasm

Unable to completely emptybladder

Incontinence (leaking urine)

Increased urination at night

Nausea

Vomiting

Early fullness

erectile dysfunction


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Focal neuropathy

Appear suddenly and affect specific nerves, mostoften in the head, torso, or leg, causing muscleweakness or pain.

Symptoms may include:

double vision

eye pain

paralysis on one side of the face (Bell's palsy)

severe pain in a certain area, such as the lower backor leg(s)

chest or abdominal pain that is sometimes mistakenfor another condition such as heart attack orappendicitis


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Proximal neuropathy

Causes pain (usually on one side) in the thighs,hips, or buttocks.

Also lead to weakness in the legs.

Treatment for weakness or pain is usuallyneeded and may include medication andphysical therapy.

The recovery varies, depending on the type of

nerve damage.

Prevention consists of keeping blood sugarunder tight control.


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Diagnosis

GTT/OGTT Foot examto assess sensation in the foot

Nerve conduction studiesto test nerve activity

Electromyographyto determine how muscles respond tonerve signals

Quantitative sensory testingthe use of stimuli (eg,vibration) to check for neuropathy

QSART (quantitative sudomotor axon reflex test) a testwhich evaluates the inervation of sweat glands.

Heart rate teststo determine how the heart responds tochanges

Ultrasoundto view internal organs

Biopsyto remove a sample of nerve or skin tissue forexamination


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Treatment

Tighter control of blood glucose

Pain relief (amitriptyline, nortriptyline etc)

Regular exercise

Avoiding smoking

Medications to treat autonomic problems and

prevent bladder infections

Physical therapy

Meticulous care of the feet


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Prevention

Well controlled diabetes.

Patient education about foot care.

Inspect their feet regularly by physician. Avoid smoking.


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Complication

Cardiovascular autonomic neuropathy can causedeath.

Peripheral neuropathy can lead to foot ulcers and

leg amputations. Autonomic neuropathy is associated with

dizziness and falling with associated injuries,nausea and vomiting, severe diarrhea, and

dehydration, all of which can lead tohyperosmolar nonketotic diabetic coma ordiabetic ketoacidosis and, hence, to death.


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