Now diabetic neuropathy is as common as type 2 diabetes. Pathology is accompanied by physical and moral suffering of a person. In ICD 10, diabetic neuropathy is coded E10-E14+ with a common fourth character.4.
As you know, high sugar over time has a negative effect on body tissues, including nerve fibers. Their shell is damaged, the wire mechanisms of nerve impulses are disturbed. After that, doctors diagnose neuropathy. What it is - diabetic neuropathy, how it manifests itself and how to deal with it, will be described below.
Causes of occurrence
The disease develops due to prolonged exposure to high concentrations of sugar on the nerve fibers. As a result, their damage begins. Until now, scientists cannot accurately answer what is the mechanism for the development of diabetic neuropathy. But it is known that some negative factors can provoke the onset of such a state:
- Violation of metabolic processes, due toAs a result, blood sugar rises, diabetes becomes prolonged, insulin decreases, and blood fats rise to abnormal levels.
- Neurovascular factors. Due to the increased content of glucose in the blood, the nerve cells stop sending signals, and the capillaries through which oxygen and other useful substances enter the nerve cells become soft and poorly conductive.
- Autoimmune disorders that cause inflammation in nerve cells.
- Mechanical damage to nerve fibers.
- Genetic factor, due to which the body has a tendency to disrupt the nervous system.
- Unhe althy lifestyle, in particular smoking and alcoholism.
Symptoms. Peripheral neuropathy
With diabetic neuropathy, there may be several symptoms, everything will depend on the type of disease. There are three varieties, one of which is peripheral neuropathy.
This condition can develop for a long time. Numbness, tingling and burning are felt in different parts of the body. Gradually, the pain descends to the feet. Outwardly, the disease also manifests itself: the feet become dry, the skin on them cracks. Calluses form, an ingrown nail appears on the thumb. This condition is called diabetic foot syndrome.
Signs of diabetic foot
Most diabetic limb amputations are due to a condition such aspolyneuropathy, when a diabetic foot is formed. Depending on which symptoms of diabetic neuropathy prevail in this case, neuropathic, ischemic and mixed forms of the disease can be distinguished.
But the neuropathic form of diabetes is more commonly diagnosed. Due to impaired sweating, the skin becomes thinner, dry and susceptible to various damages. Dilated vessels, in which blood accumulates, cause edema that spreads to the entire leg. Their difference from cardiac edema is that they do not disappear with bed rest.
Due to malnutrition, not only blood vessels suffer, but also tendons and ligaments, with the defeat of which the patient's gait changes. And due to the redistribution of the load, the metatarsal bones are deformed, the sensitivity of the leg decreases, and a neuropathic ulcer develops.
Initially, the ball of the thumb is affected, on which a round ulcer forms. Subsequently, an infection may penetrate or osteomyelitis develops. The hallmark of a diabetic foot is the absence of pain.
If diabetic neuropathy with pain has an ischemic form, then the following distinctive features will be observed:
- No pulse in foot.
- Skin is cold and blue.
- Pain is felt at rest and worse at night.
- The person begins to limp on one leg.
Autonomic neuropathy
With autonomic neuropathy, nerves are damaged that pass through many systems of the body:vascular, digestive, genitourinary, sweat glands, bone tissue, respiratory organs. Against this background, secondary diseases develop. For example, cystitis, heart rhythm disorders, etc. The most dangerous condition is when there is a risk of developing a massive heart attack.
This form of diabetic neuropathy is detected in the later stages, as it does not manifest itself for a long time. In this regard, the condition has an unfavorable prognosis, because the probability of death increases five times. This is especially true for cardiac manifestations of autonomic neuropathy, it can occur in the form of tachycardia at rest, an elongated QT interval is detected on the ECG, pressure decreases with a sharp rise, and heart pain is often absent.
Failures in the digestive system occur due to a violation of the motor regime. They appear as follows:
- After a small meal, there is a feeling of fullness.
- Abdominal pain.
- Nausea and vomiting.
- After eating food, diarrhea can begin, especially at night.
- Fecal incontinence.
Local diabetic neuropathy
Neuropathy of the local course is characterized by damage to the motor nerves. The disease manifests itself at night or at the time of rest of a person. There is weakness and soreness in the limbs. The coordination of movements is disturbed, the joints become less mobile, muscle weakness develops. If the nerve fibers in the muscle tissue of the eyes are damaged, then a person has double vision and pain ineyeball.
This condition is accompanied by severe pain that goes away on its own, and after a few months of local neuropathy, there is no pain at all.
In addition, additional ailments develop:
- Difficulty focusing.
- The appearance of the effect of double vision.
- Paralysis of one half of the face.
- Pain occurs in the legs, feet, lower back, hips, chest, eyeballs and abdomen.
Also, diabetic neuropathy of the lower extremities may be accompanied by a decrease in the fat content of the feet (and palms), impaired thermoregulation, the appearance of apnea and the gradual development of exhaustion.
Risk group
At the risk group, first of all, are people with diabetes. But there are circumstances that can accelerate or provoke the development of diabetic neuropathy. So, the risk group includes people with such problems:
- Long history of diabetic disease.
- Kidney diseases that often develop on the background of diabetes mellitus, due to this, toxins in the blood increase, which destroys nerve fibers.
- Extra pounds.
- Cigarette addiction. Such a bad habit can constrict blood vessels, and blood does not flow well to the limbs. As a result, the wounds become non-healing, and this violates the integrity of the peripheral nerves.
- Those who are not in control of their blood sugar.
Diagnosis
Due to the localization of the disease in any part of the human body, diagnosis is sometimes difficult. Therefore, a number of studies are required to detect diabetic neuropathy.
- First, the doctor talks to the patient, listens to his complaints. Questions are asked about the presence of dizziness, headaches, cardiac disorders, cramps, stomach discomfort, etc., whether there are pains in the limbs, whether fainting occurs.
- Physical examination. Features such as reduced skin sensitivity, unsteady gait, drooping eyelids, and neuritis in the facial area may prompt the physician to think of diabetic neuropathy. In particular, the doctor examines the feet, which are primarily affected by the disease.
- Neurological analysis. The doctor uses various devices to establish the tactile, pain, temperature and vibration sensitivity of a person. If the indicators are reduced, we can talk about a violation of nerve cells.
- Electroneurography - this method determines the speed of impulses along nerve fibers and their response. The presence of the disease can be indicated by poor signal conduction and the absence of muscle contraction.
- Laboratory tests. With their help, increased sugar in the urine and blood is detected.
Since the signs of the disease can be different, you will also need differential diagnostics to detect pathologies of the kidneys, heart, stomach, intoxication of the body due to alcohol addiction, malignant tumors, tuberculosis. Diagnosisis based on the results of ultrasound of the digestive organs.
Treatment
Until now, doctors are looking for the best treatment for this disease, since the mechanism of its development has not been fully studied.
To date, the treatment of diabetic neuropathy is reduced to the following activities:
- The actions of doctors aimed at preventing the progression of pathology. First, it is necessary to maintain the level of glucose in the blood within the normal range, so the development of the disease will not only be suspended, but some of its signs will also disappear.
- Measures aimed at reducing pain. In this case, painkillers such as Desipramine, Gabapentin, Phenytoin, Duloxetine are used.
- Combating complications and restoring lost body functions. Often, drugs from the group of tricyclic antidepressants are included in complex therapy. But the doctor determines their dosage, since it should be less than with depression. Drowsiness is a side effect, so it is recommended to take the medicine before going to bed.
Anti-epileptic drugs are prescribed as needed. In order not to develop side effects, drugs are given in a small dosage, gradually increasing it. It should be noted that the treatment of diabetic neuropathy of the lower extremities is not limited to local therapy, an integrated approach is required.
Prevention measures
The following preventive measures reduce the risk of developing diabetic neuropathy:
- Constant monitoring of blood pressure. Often, elevated blood pressure in people with diabetes is a common occurrence. If it is not controlled, then complications will begin as a result of vascular damage and impaired blood flow.
- Proper nutrition. It is aimed primarily at maintaining a he althy weight of a person, therefore, it includes a maximum of plant foods and grains. Portions should be reduced, fatty and spicy foods excluded.
- Keeping an active lifestyle. Daily physical activity improves the functioning of the heart and blood vessels, normalizes blood pressure.
- Rejection of bad habits. This is nicotine and alcohol addiction.
Reviews
Patient feedback suggests that diabetic neuropathy can be kept under control. To do this, you need to regularly visit doctors of various specializations. This is a gastroenterologist, cardiologist, dermatologist, urologist and ophthalmologist. Everything will depend on how the pathology manifested itself.
