Diabetic polyneuropathy – a complex of diseases of the nervous system that occur slowly and arise as a result of excess sugar in the body. In order to understand what diabetic polyneuropathy is, you need to remember that diabetes mellitus belongs to the category of serious metabolic disorders that negatively affect the functioning of the nervous system.
In the event that competent medical therapy has not been carried out, elevated blood sugar levels begin to inhibit the vital processes of the entire body. Not only the kidneys, liver, and blood vessels suffer, but also the peripheral nerves, which is manifested by a variety of symptoms of damage to the nervous system. Due to fluctuations in blood glucose levels, the functioning of the autonomic and autonomic nervous system is disrupted, which is manifested by difficulty breathing, heart rhythm disturbances, and dizziness.
Diabetic polyneuropathy occurs in almost all patients with diabetes; it is diagnosed in 70% of cases. Most often, it is detected in the later stages, but with regular preventive examinations and careful attention to the condition of the body, it can be diagnosed in the early stages. This makes it possible to stop the development of the disease and avoid complications. Most often, diabetic polyneuropathy of the lower extremities is manifested by impaired skin sensitivity and pain, often occurring at night.
Types of disease
Diabetic polyneuropathy is characterized by damage to the autonomic nervous system.
In medicine, the following types of disease are distinguished:
| Name | Description |
| Motor | The disease is characterized by muscular dystrophy, when the patient loses the ability to move. |
| Sensory | The pathology provokes an increase in pain or a complete loss of tactile sensitivity in the legs. |
| Distal (sensorimotor) | The disease provokes the death of nerve fibers, which entails a complete loss of sensation in the legs and arms. |
| Alcoholic | A type of pathological condition of the legs, when disorders of the nervous system appear due to the abuse of large quantities of alcoholic beverages. A person complains of burning and tingling in the legs. Pain, muscle weakness, and occasional numbness in the limbs are also troubling. |
Gradually progressing pathological processes lead to impaired motor function. The person loses the ability to move.
What is diabetic neuropathy of the lower extremities
One of the common complications of diabetes mellitus is damage to the lower extremities. Neuropathy occurs due to the irreversible death of nerve cells at all levels of innervation - from the spinal cord to peripheral cells. This leads to a decrease in sensitivity, muscle tone, deformation of the feet, and the formation of long-term non-healing ulcerative defects.
We recommend reading the article on diagnosing diabetic neuropathy. From it you will learn about the primary diagnosis of diabetic neuropathy, diagnostic kits, as well as electrophysiological diagnostic methods and additional examination.
Read more about diabetic feet here.
Stages and degrees
Diabetic polyneuropathy of the lower extremities (treatment, drugs are selected depending on the patient’s condition and the degree of development of pathological processes) provides for some stages of development:
| Name | Description |
| Stage I | There are no characteristic pronounced symptoms. Pathology can be diagnosed during a medical diagnosis during a preventive examination. A person experiences vibration and the sensitivity threshold decreases. If the disease is identified at an early stage, the effectiveness of therapy is high. |
| Stage II | The pathological condition is characterized by periodic painful sensations in the lower extremities. A common cause is injury, strain and muscle strain. In some situations, in the second stage, short-term numbness of the upper extremities is observed. A person complains of general poor health and heaviness in his legs. Timely therapy will not only reduce the symptoms of the disease, but also prevent serious consequences. |
| Stage III | Diabetic polyneuropathy at the third stage is accompanied by numbness of the lower extremities. Sensitivity to external stimuli also decreases. Skin rashes or trophic ulcers appear in some places on the body. |
Treatment is required at any stage of development of pathological processes. It is important not to delay visiting an endocrinologist and get examined quickly.
Signs and treatment of diabetic ketoacidosis. Emergency care for ketoacidotic coma
- Symptoms of diabetic ketoacidosis. Ketoacidotic coma
- Causes of ketoacidosis and coma
- How is diagnosis done?
- Criteria for successful treatment
- Emergency care for ketoacidotic coma
- Insulin therapy for diabetic ketoacidosis
Diabetic ketoacidosis is a decompensated form of diabetes mellitus, which occurs with an increase in not only glucose levels, but also ketone bodies in the blood. Identified in approximately 5–8 cases per 1000 patients per year with type 1 diabetes. The development of pathology is usually associated with the poor quality of medical care provided to patients. Mortality from ketoacidotic coma ranges from 0.5 to 5% and depends on the timeliness of hospitalization of the patient. In the vast majority of cases, the complication occurs in diabetics under the age of 30.
Symptoms of diabetic ketoacidosis. Ketoacidotic coma
Most often, diabetic ketoacidosis develops in patients with type 1 disease, but pathology can also develop in the non-insulin-dependent form. Symptoms appear within two to three days, in exceptional situations they are likely to develop within a period of up to 24 hours. Ketoacidosis in type 2 diabetes mellitus goes through the stages of precoma, incipient ketoacidotic coma and absolute ketoacidotic coma.
The first patient complaints indicating precoma should be considered unquenchable thirst and frequent urination. Speaking about symptoms, pay attention to the fact that:
- the patient is concerned about dry skin, peeling, and an unpleasant feeling of tightness of the skin;
- when the mucous membranes dry out, complaints of burning and itching in the nasal area are likely to appear;
- if ketoacidosis develops over a long period of time, severe weight loss is likely;
- weakness, fatigue, loss of performance and appetite - all these are characteristic complaints for patients who are in a state of precoma.
Incipient diabetic ketoacidotic coma is associated with nausea and vomiting that does not bring relief. The formation of pseudoperitonitis is likely, namely painful sensations in the abdominal area. Headaches, extreme irritability, as well as drowsiness and lethargy are evidence of involvement of the central nervous system in the pathological process. Diabetic ketoacidosis in children at this stage is associated with similar symptoms.
Examination of a diabetic makes it possible to detect the presence of an acetone odor from the mouth and a special respiratory rhythm (Kussmaul breathing). Physiological manifestations such as tachycardia and arterial hypotension are diagnosed. Complete ketoacidotic coma in diabetes mellitus is associated with loss of consciousness, worsening or complete absence of reflexes, and severe dehydration. That is why the reasons for the development of pathology in type 1 and type 2 diabetes mellitus must be carefully studied.
Causes of ketoacidosis and coma
A factor in the formation of acute decompensation is absolute (in type 1 diabetes) or relative (in type 2 disease) insulin deficiency. Diabetic ketoacidosis may be one of the manifestations of the disease in patients who were not aware of their own diagnosis and did not receive proper treatment. In the event that a diabetic is already receiving appropriate treatment, the cause for the formation of the disease may be incorrect therapy. This is about:
- incorrect selection of insulin dosage;
- untimely transfer of the patient from tableted hypoglycemic drugs to hormone injections;
- malfunction of the insulin pump or syringe pen.
Acetone (ketone bodies) may appear in the blood if the specialist’s recommendations are not followed. For example, if insulin is incorrectly adjusted depending on glycemia. Pathology can develop as a result of the use of expired medications (that have lost their medicinal properties), with an independent dosage reduction or replacement of injections with tablets, as well as due to refusal of glucose-lowering therapy.
Another reason for the appearance of diabetic ketoacidosis should be considered an increase in the need for a hormonal component. Most often, this happens during pregnancy, stress (in a child, teenager), due to injuries, infectious and inflammatory pathologies, heart attacks and strokes. The list of factors should include concomitant endocrine pathologies (acromegaly, Cushing's syndrome), and surgical interventions. The cause of ketoacidosis may be the use of medications that increase blood glucose (for example, glucocorticosteroids).
In 25% of cases, it is impossible to reliably determine the cause. The formation of complications cannot be associated with any of the presented provoking factors.
How is diagnosis done?
Consultation with an endocrinologist or diabetologist is mandatory. At the appointment, the doctor determines the patient’s condition; while maintaining consciousness, it makes sense to clarify the complaints. The initial examination is informative in terms of identifying dehydration of the skin, visible mucous membranes, worsening soft tissue turgor, as well as the presence of abdominal syndrome. As part of the diagnosis, hypotension, impaired consciousness (drowsiness, lethargy, headaches), the smell of acetone from the mouth and Kussmaul respiration are identified.
Laboratory tests are no less important. In ketoacidosis, blood and urine tests demonstrate the presence of glucose in the blood plasma in an amount of more than 13 mmol. Experts point out that:
- the presence of ketone bodies and glucosuria is detected in the patient’s urine (checking is carried out using test strips);
- a blood test identifies a decrease in acid index (less than 7.25), hyponatremia (less than 135 mmol per liter) and hypokalemia (less than 3.5 mmol);
- hypercholesterolemia indicators are more than 5.2 mmol, an increase in plasma osmolarity (more than 300 mOsm) and an increase in the anion gap are identified.
Symptoms
Regardless of the type of disease, pathological processes provoke the following clinical signs:
| Name | Symptoms |
| Sensory disorders |
|
| Movement disorders |
|
| Vegetative changes |
|
Pathological processes also provoke specific symptoms of the disease:
- speech disorders;
- urinary incontinence;
- visual acuity decreases;
- the swallowing reflex is impaired;
- sexual dysfunctions are observed.
Damage to large nerve fibers entails pathological changes in large and small joints. Light touches provoke strong painful sensations. Balance is also disturbed and the sensitivity of the skin on the lower extremities increases.
First signs
In the subclinical, that is, at the earliest stage, the disease does not bother the victim at all. However, during a neurological examination, an experienced doctor will identify the following signs of a primary lesion:
- decreased tactile sensitivity of the skin of the foot;
- violation of deep tendon reflexes.
As the disease develops, the clinical phase begins, which is accompanied by external manifestations. The first signs of the early stage include:
- decreased sensitivity of the skin of the feet to temperature;
- crawling sensation;
- tingling;
- burning;
- increased sensitivity to minor touches;
- convulsions;
- pain syndrome of varying intensity and nature.
Victims often experience a completely paradoxical reaction: on the one hand, there is no sensitivity to external influences, and on the other, there are pains that are in no way related to external stimuli.
Reasons for appearance
Diabetic polyneuropathy of the lower extremities (treatment, drugs are selected by an endocrinologist after diagnosis) most often develops against the background of abnormal blood sugar levels.
But there are numerous provoking factors that contribute to the development of pathological processes:
- chemical poisoning;
- taking certain medications;
- obesity;
- avitaminosis;
- high cholesterol;
- oncological diseases;
- poor nutrition;
- bad habits (alcohol, cigarettes);
- ischemia;
- cirrhosis of the liver;
- concomitant vascular diseases of the lower extremities.
Damage to the nervous system also occurs if the patient was not treated for diabetes or the therapy was chosen incorrectly. People over 45 years of age are at risk.
How to treat type 1 diabetes without insulin
According to WHO, the number of patients with type 1 diabetes is increasing every year. The disease causes a lack of insulin in the body, which is produced by the pancreas. Therefore, treating type 1 diabetes without insulin is currently not possible.
Causes of diabetes
Type 1 diabetes mellitus occurs due to the death of most of the cells of the pancreas. There is a chronic increase in glucose in the blood. High sugars cause metabolic disorders. This contributes to the accumulation of toxins that poison the body.
Most often, the disease is diagnosed in children and people under 35 years of age. The disease is characterized by a stable increase in blood glucose levels. A one-time jump in sugar levels cannot yet be called diabetes. The disease occurs for various reasons. Conventionally, they are divided into two large groups:
- congenital;
- acquired.
Congenital diabetes is associated with a violation of the anlage or intrauterine damage to the pancreas. It is diagnosed in the first days after the birth of a child. This form of the disease, in the absence of adequate treatment, often leads to the development of diabetic complications.
Acquired causes of diabetes mellitus include:
- abdominal injuries;
- infectious diseases;
- autoimmune processes;
- acute poisoning with chemicals.
It is believed that it is a viral infection suffered by the mother during pregnancy or by the child in early childhood that becomes the trigger for the development of diabetes mellitus. Viruses provoke an increase in the titer of antibodies that cause damage to the pancreas.
Symptoms
Since the disease is most often diagnosed in young children, parents must be observant to notice changes occurring in the child. Children are unable to clearly describe their complaints. It is much easier to detect the manifestation of the disease in adolescents and adults.
Chronically elevated blood sugar levels cause the following symptoms:
- general weakness;
- irritability;
- sleep disturbance;
- urinary incontinence in children;
- dry mouth;
- constant thirst;
- frequent urination;
- itchy skin;
- long-term wound healing.
When the first signs of diabetes mellitus appear, you should immediately contact an endocrinologist. Early treatment will help avoid complications. Indeed, according to statistics, almost half of patients suffering from diabetes die from diabetic complications.
Principles of treatment of type 1 diabetes
Type 1 diabetes mellitus should be treated immediately after diagnosis. The main glucose-lowering drug for diabetics is insulin. Auxiliary measures to reduce sugar are:
- diet;
- physical exercise;
- state of psycho-emotional balance;
- treatment of inflammatory and autoimmune diseases.
By adhering to the doctor’s recommendations, you can achieve stable compensation for the disease.
Insulin therapy
Insulin plays an important role in metabolism. It converts glucose that enters the body with food into energy. And the hormone delivers the resulting energy inside the cells. Insulin is administered subcutaneously. Tablet forms have not found use. This is due to the fact that the drug is broken down in the stomach under the influence of digestive enzymes.
Insulins are classified according to their duration of action in the body:
- ultrashort (Novorapid, Humalog);
- short (Actrapid, Humulin);
- medium (Protafan);
- prolonged (Lantus).
The insulin therapy regimen is selected by the doctor individually. The dose of the drug is affected by:
- patient's age;
- diabetic experience;
- degree of disease compensation;
- weight;
- diet;
- physical activity.
Treatment involves combining insulins of varying durations of action throughout the day.
Diet
Proper nutrition plays an important role in maintaining sugar levels. All “forbidden” foods should be excluded from the diet:
- sweets;
- smoked meats;
- fat;
- roast;
- spicy.
It is better to plan the menu a week in advance. This will help balance your diet. Good nutrition saturates the body with vitamins and microelements that are involved in metabolism.
When creating a diet, you need to take into account that some foods have the ability to reduce sugar. These are considered:
- cabbage;
- Jerusalem artichoke;
- nettle;
- grapefruit;
- rose hip;
- onion;
- garlic.
People suffering from diabetes should completely avoid drinking alcoholic beverages. Alcohol promotes the accumulation of under-oxidized glucose breakdown products, which can cause ketoacidotic coma.
Physical exercise
Moderate physical activity accelerates the breakdown of glucose, which helps keep sugar levels within normal limits. However, sports exercises also need to be approached with caution. You can start exercising only after monitoring your glucose levels. If sugar is below 5 mmol/l or above 13 mmol/l, then it is better to refuse sports training.
Classes should not be longer than 40 minutes and more than three times a week. Prolonged or too frequent training leads to a hypoglycemic state. Physical activity must be taken into account when administering an insulin dose.
Treatment of diabetes with folk remedies
For type 1 diabetes, treatment with folk remedies is auxiliary. Various recipes are used from herbs that have a hypoglycemic effect. Some plants have a rich chemical composition that accelerates overall metabolism.
A decoction of flax seeds has a positive effect on the body. To prepare the recipe, you need to pour 15 g of seeds into a glass of water and boil for 5 minutes. Set aside the resulting liquid and drain it. Take the medicine one tablespoon three times a day 30 minutes before meals. The course of treatment is 1 month.
The healing properties of linden blossom have been known since ancient times. Linden blossom not only reduces glucose levels, but also saturates the body with essential vitamins. To prepare linden infusion you will need 2 cups of dry linden blossom and 3 liters of water. The linden is filled with water and boiled for 10 minutes. Then the broth is cooled and filtered. The liquid should be stored in the refrigerator. The decoction is used instead of water and tea. After finishing taking the resulting liquid, you need to take a break for 1 month and repeat the course of treatment.
Collections of medicinal plants allow sugars to be stabilized. Motherwort leaves, mulberry leaves and strawberry leaves in the right ratio have a good therapeutic effect. To prepare the decoction you will need 1 teaspoon of crushed motherwort, 1 dessert spoon of dried mulberry leaves, 1 tablespoon of strawberry leaves. The resulting mixture should be poured with a glass of boiling water and boiled for 5 minutes. Cool the broth and strain. For therapeutic purposes, it is necessary to consume the resulting liquid 2 tablespoons 30 minutes before meals three times a day.
Developments in the treatment of type 1 diabetes
Every year, more and more people are diagnosed with diabetes around the world. This fact pushes scientists to discover new methods of treatment without the use of insulin. But at the moment, the results obtained are not used outside the laboratory.
The first technique to be studied was pancreas transplantation. The operations were performed on laboratory animals. However, scientists have noticed that in the early postoperative period, the body of a sick animal very often rejects the donor gland. This causes severe complications, often fatal.
When diabetes is caused by an autoimmune process, vaccination could be the answer. The vaccine suppresses factors that inhibit beta cells. The method has not been widely used, which is due to the lack of a sufficient base of clinical trials.
A new technology for treating diabetes is the introduction of stem cells into the patient's pancreas. However, it is not yet possible to predict and control cell growth and differentiation. A number of postoperative complications are associated with this fact. Therefore, the research is only in the clinical development phase.
Conclusion
Despite rapid progress in medicine and the development of new techniques to combat type 1 diabetes, there is no treatment without insulin. The introduction of insulins of varying durations of action allows you to compensate for the daily requirement. Perhaps scientists will soon find a way to defeat diabetes.
Diagnostics
An endocrinologist will help you establish an accurate diagnosis. If a specialist suspects diabetic polyneuropathy, he prescribes neurological studies for patients, during which certain tools are used:
| Name | Description |
| Monofilament | Tactile sensitivity in the affected area is assessed. |
| Fork | The vibration sensitivity of the affected tissues is determined. |
| "Neuro-type" (neurological needle) | A diagnostic method that allows you to determine pain sensitivity. |
| "Tip-Term" | Studies allow you to evaluate the temperature sensitivity of affected areas of the body. |
| Hammer | An instrument with which the doctor determines tendon reflexes. |
| Laboratory research |
|
| Instrumental diagnostics |
|
Additionally, laboratory tests of blood and urine are carried out, the results of which will show the general condition of the body.
It is important to differentiate diabetic polyneuropathy of the lower extremities, since the pathology is accompanied by numerous symptoms similar to the manifestations of other diseases (vitaminosis, infection of the body, alcoholism, oncology, damage to the thyroid gland).
Prevention
Diabetic polyneuropathy of the lower extremities (treatment, drugs are prescribed by an endocrinologist, taking into account the person’s condition) more often occurs against the background of diabetes mellitus.
To reduce the risk of its development, patients are advised to follow simple preventive rules:
- give up bad habits (abuse of alcohol, drugs, tobacco products, caffeine);
- monitor blood pressure indicators;
- engage in physical activity;
- monitor blood glucose levels;
- maintain a work-rest regime (a weakened body after stress, lack of sleep and fatigue cannot resist pathological processes);
- control body weight, get rid of extra pounds;
- constantly undergo preventive examinations and examinations by a doctor in order to promptly determine the development of concomitant diseases and begin treatment;
It is important to adhere to a healthy lifestyle, eat right and exercise, and walk more in the fresh air. Drink vitamin complexes and coordinate therapeutic actions with your doctor.
What can you do to relieve pain?
It has been established that in diabetic neuropathy it is necessary to influence the central and peripheral mechanisms of pain. However, nonsteroidal anti-inflammatory drugs are not effective for relieving neuropathic pain. Therefore, the following groups of drugs are used:
- tricyclic antidepressants - have analgesic effects due to the accumulation of serotonin in the brain. Clofranil and Amitriptyline are most often recommended;
- anticonvulsants – Finlepsin, its use is limited in patients with high physical activity. Gabalept reduces sensitivity to pain at the level of the spinal cord. Lyrica has fewer side effects, but is also less effective;
- local, based on capsicum pepper - capsicum . It stimulates the release of pain conductors and depletes its reserves. it is rarely prescribed, since the use is accompanied by irritation of the skin and severe burning; it is contraindicated for varicose veins;
- central painkillers - Tramadol . It is recommended if there is no effect from other medications; the result appears only when using high doses, which increases the likelihood of complications of therapy.
The success of pain reduction depends on the degree of compensation of hyperglycemia. Recent studies have proven that it is also important to normalize blood pressure and its lipid spectrum. The choice of drug is often done by trial and error, as patients respond differently to therapy. It is also important to take into account that a period of time passes from the moment you start taking it to the first results, the duration of which also varies from person to person.
Treatment methods
The correct and effective therapy is selected by an endocrinologist based on the results obtained after a medical diagnosis. It is impossible to completely get rid of diabetic polyneuropathy of the lower extremities. Complex treatment will slow down pathological processes and prevent serious complications.
Medications
The doctor selects medications for the patient, taking into account his condition, individual characteristics of the body and the degree of development of diabetic polyneuropathy of the lower extremities. It is important to adhere to the treatment regimen and dosage, since many medications cause side effects.
| Group of medicines | Name | Application |
| Antidepressants | Amitriptyline, Duloxetine | The medicine is prescribed orally after meals or during meals. The adult dosage is 50-125 mg 2-3 times a day, taking into account the patient's condition. The course of therapy lasts 2-4 weeks. |
| Anticonvulsants | Pregabalin, Carbamazepine | The drug is taken orally at 150-600 mg per day 2-3 times. The course of treatment depends on the person’s condition, on average it lasts 7 days. |
| Analgesics | Targin, Tramadol | The medicine is taken in the morning and evening, 10 mg/5 mg of oxycodone hydrochloride/naloxone hydrochloride. |
| Antioxidants | Neurolipon, Thiogamma | The medicine is administered intravenously. The adult dosage is 600 mg per day. The course of treatment lasts 2-4 weeks. |
| Nonsteroidal anti-inflammatory drugs | Ibuprofen, Nimesulide | The medicine is taken with meals, washed down with water, 400-600 mg 2-3 times a day. |
| Vascular drugs | Actovegin | Adults are recommended to take 1-2 tablets 3 times a day before meals. Do not chew the drug, wash it down with a sufficient amount of water. The course of treatment lasts 4-6 weeks. |
Patients are additionally prescribed vitamin complexes to maintain immunity (Milgamma, Benfotiamine). If there is an increased likelihood of a secondary infection, the doctor will prescribe antibacterial agents.
Traditional methods
Recipes from healers and healers for diabetic polyneuropathy of the lower extremities are used in complex therapy. It is important to consider contraindications, the likelihood of an allergic reaction, and individual sensitivity to the components used. Therefore, it is necessary to consult a doctor before using traditional medicine.
Effective means:
| Name | Recipe | Application |
| Clay compress | Mix blue clay and water in equal parts. | Place the resulting mixture on the affected area and leave until completely dry. The course of therapy includes 14 procedures. Clay promotes the regeneration of nerve fibers, and also increases the sensitivity of receptors. |
| Decoction | Mix chamomile and nettle in equal proportions (1 tbsp each). Add 200 ml hot water. Place the resulting mass in a water bath and heat for 15 minutes. Cool and strain. | It is recommended to take the finished product 1 tbsp. 3 times a day for 2 months. |
| Calendula | Pour hot water (400 ml) over the flowers of the plant. Infuse the resulting solution for 2-3 hours, then strain and take the finished product orally. | The recommended dosage for adults is 0.5 tbsp. 4 times a day. The medicine is taken before meals. |
| Dates | Grind 1 kg of dates through a blender or meat grinder. | It is recommended to consume the resulting mass in 2 tbsp. 3 times a day after meals. You can drink it with milk. The course of treatment lasts at least 1 month. |
Goat's milk helps reduce the unpleasant symptoms of diabetic polyneuropathy. It is used for compresses, procedures are carried out every day 3-4 times.
Other methods
Complex therapy involves not only the use of medications and folk remedies.
Patients with diabetic leg polyneuropathy are advised to adhere to a healthy and balanced diet:
| Authorized Products | Prohibited Products |
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The products included in the diet are a source of microelements and vitamins (potassium, magnesium, B vitamins). These essential substances have a positive effect on the conduction of nerve impulses in nerve and muscle tissue. It is recommended to eat small meals, 5-6 times a day.
Diabetic polyneuropathy of the lower extremities (treatment, drugs are selected by the doctor after diagnosis based on the results obtained) requires complex therapy.
Patients are prescribed medications and are additionally recommended to attend physiotherapeutic procedures:
| Name | Description |
| Magnetic therapy | The magnetic field improves microcirculation in the affected area. The inflammatory process is reduced and tissue regeneration is enhanced. After magnetic therapy, the pain syndrome weakens. |
| Hyperbaric oxygenation | The therapy involves the use of oxygen at high pressure. The sensitivity of tissues to insulin increases due to oxygen saturation of the blood. |
| Acupuncture | The treatment improves blood circulation and lowers blood sugar. |
| Massage | Classic or acupuncture acupressure reduces pain and promotes increased nutrition of nerve and muscle tissue. Massage helps prevent the development of atrophic processes. Neuromuscular conduction improves. |
Physical therapy will help reduce the negative manifestations of the disease. We are talking about daily warm-ups, stretching your feet with your hands. It is also recommended to bend and straighten your fingers and make rotational movements of the ankle joint.
In the absence of positive dynamics after the use of medications, the patient is indicated for surgical intervention. The patient is implanted with a stimulator implant that will support electrical stimulation of the spinal cord.
Diabetic neuropathy and polyneuritis: symptoms, causes, treatment
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Diabetes mellitus, together with alcoholism, is one of the most common causes of neuropathy. A connection has been proven between the degree of increase in blood glucose and the severity of neurological disorders.
However, from 60 to 90 percent of patients suffer from peripheral or autonomic diabetic neuropathy and its symptoms increase as diabetes progresses.
If a diabetic does not receive adequate treatment, diabetic foot develops due to neuropathy of the lower extremities, and the risk of amputation in diabetics increases by almost 50% compared to people without hyperglycemia.
The occurrence of neuropathy in diabetes mellitus - causes and mechanism
The leading factor in neuropathy, as well as other complications of diabetes, is an increase in glucose levels in the circulating blood and its toxic effect on organs. Diabetic neuropathy develops as a result of damage to the nerves themselves and the blood vessels that feed them.
Glucose from the blood can penetrate into the nerve cell without the participation of insulin, but cannot enter the process of glycolysis to produce energy. This activates an alternative pathway of utilization, in which sorbitol is formed.
Sorbitol, accumulating inside the cell, destroys it, and also inhibits vasodilation with its participation. Vascular spasm and decreased oxygen pressure disrupt the nutrition of nerve cells.
Another mechanism of nerve damage in diabetes is the increased production of free radicals. These are defective molecules with high chemical activity that have the ability to destroy enzymes, cell membranes and DNA.
The following mechanisms are also involved in the development of neuropathy in diabetes mellitus:
- The attachment of a glucose molecule to proteins is glycosylation, including nerve sheaths.
- Microangiopathies of nerve vessels.
- Impaired nerve conduction.
- Formation of antibodies against nerve cells.
Polyneuropathy in diabetes mellitus, symptoms and diagnosis
Diabetic polyneuritis most often manifests itself as symmetrical damage to the lower extremities. The most common complaint of patients is sensory disturbance. When large nerve fibers are damaged, the perception of vibration, touch and position is affected.
Thin nerve fibers are responsible for the sensations of pain and temperature. Most cases of neuropathy occur with a pathological pain syndrome against a background of decreased sensitivity, that is, all types of fibers are affected.
Skin sensitivity disorders depend on the degree of compensation of diabetes, it begins with the toes, and then progresses to the “socks”, “stockings”, and also “gloves” type.
Symptoms of diabetic neuropathy include the following sensations:
- Paresthesia is a crawling sensation.
- Unsteady gait.
- Burning pain in the feet, worse at night.
- Muscle cramps, muscle twitching.
- Increased sensitivity to cold.
Impaired sensitivity may be accompanied by motor function disorders in the form of paralysis or muscle paresis.
Since this complication is common, and the effect of treatment depends on early detection, all patients with diabetes are recommended to undergo examination at least once every six months by a neurologist. Functional tests are performed for diagnosis.
The determination of sensitivity is examined by touching with a cotton swab or a thin brush, the tactile appearance is determined on the sole, touching with a thin nylon thread. A needle wheel is used to study pain perception. Temperature sensitivity can be determined with a special device “Type Therm”.
The state of reflexes, muscle strength and the feeling of vibration are also determined.
If, upon examination of the feet, skin damage or absence of pulse is revealed, then a conclusion is drawn about damage to peripheral vessels and nerve fibers with the formation of a diabetic foot.
Signs of diabetic foot
The most common cause of leg amputation in diabetes mellitus is polyneuropathy syndrome with the formation of diabetic foot. Depending on the prevalence of various symptoms, neuropathic, ischemic and mixed forms of the disease are distinguished.
Most often, the neuropathic variant of this pathology is detected. Disruption of the innervation of the autonomic nervous system leads to changes in sweating, the skin becomes thin and dry, susceptible to damage.
Dilated vessels, overflowing with blood, lead to swelling, which gradually spreads to the entire lower leg. Such edema, unlike cardiac edema, does not go away when bed rest is prescribed.
Malnutrition affects not only the skin, but also tendons and ligaments, causing gait disturbances and deformation of the metatarsal bones due to load redistribution. A decrease in sensitivity to pain during subsequent exercise leads to the development of a neuropathic ulcerative defect.
A typical location is the pad of the thumb. The ulcer is round, often becomes infected, complicated by osteomyelitis. A characteristic diagnostic sign is the absence of pain.
Diabetic neuropathy in the ischemic form is characterized by the following distinctive features:
- Absence of pulse in the foot.
- The skin is cold with a bluish tint.
- Pain in the foot occurs at rest, worsening at night.
- Intermittent claudication occurs when walking.
With a mixed type of damage to the extremities, all symptoms have varying intensities and combinations.
Autonomic neuropathy
When there is a violation of the autonomic innervation of organs, the symptoms depend on the location of the lesion. Most often it is detected in late stages, as it has no distinctive clinical signs. At the same time, the development of neuropathy has an unfavorable prognosis, as it leads to a fivefold increase in mortality.
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The most serious are cardiac forms of autonomic neuropathy. It can occur in the form of tachycardia at rest, absence of pain in the heart area, prolongation of the QT interval on the ECG, and a drop in pressure with a sharp rise.
In this case, patients do not have any complaints other than weakness and dizziness. With such forms of neuropathy, painless forms of heart attacks often occur. Patients may not feel its signs, which leads to the development of severe forms of heart failure with a fatal outcome.
Symptoms of damage to the digestive system are associated with impaired motor function:
- Feeling of fullness in the stomach after eating.
- Abdominal pain.
- Nausea and urge to vomit.
- Frequent, watery stools after eating, as well as at night.
- Fecal incontinence.
To make a diagnosis, an x-ray or ultrasound examination of the stomach and intestines is performed.
Cystopathy in diabetes mellitus manifests itself in the appearance in the morning of a large volume of urine with a weak stream and subsequent discharge in drops. Urine retention occurs in the bladder in the absence of the urge to urinate. Due to the accumulation of residual urine and the addition of infection, cystitis and pyelonephritis develop.
In approximately 60% of men, diabetes mellitus occurs with a decrease in potency. As the disease progresses and with age, these disturbances intensify, leading to the addition of depressive symptoms. At the same time, the psychogenic component aggravates erectile dysfunction.
One of the serious complications of autonomic diabetic neuropathy is decreased sensation of low blood sugar. Patients no longer feel the approach of hypoglycemia, which can be life-threatening, especially if at this time they are driving vehicles or operating machinery at work.
Usually, with diabetes mellitus, patients begin to feel the appearance of palpitations or sweating, trembling hands at the earliest manifestations, which allows them to take preventive measures in time. With neuropathy, patients are at risk of sudden hypoglycemic coma.
At the same time, uncompensated surges in blood glucose increase metabolic disorders.
Treatment of diabetic neuropathy
To treat neuropathy, you need to stabilize blood glucose levels at target levels. This requires strict adherence to the diet (frequent split meals) and a diet with limited carbohydrates. In this case, it is preferable to exclude simple carbohydrates and limit complex ones to an acceptable level.
In addition, it is necessary to reduce the content of fatty animal products and introduce a sufficient amount of dietary fiber from fresh vegetables and bran into the diet. It is recommended to get protein from fish and low-fat dairy products.
Drug treatment must be selected in such a way as to prevent sudden changes in blood sugar levels, since both its increase and drop to hypoglycemia are dangerous.
For patients with type 2 diabetes mellitus who have failed to stabilize their glucose levels with tablets, a dose of insulin is selected both in the form of monotherapy and for combination treatment.
If compensation for diabetes mellitus occurs, then the symptoms of diabetic neuropathy may disappear within two to three months.
Treatment of peripheral neuropathy is carried out with the following groups of drugs:
- Thioctic acid: Espa-Lipon, Thiogamma, Dialipon or Belithion are prescribed in tablets or injections.
- Preparations of B vitamins: injection forms Milgamma, Neurorubin, Neurobion, Beviplex, Compligam, Trigamma, as well as tablets Nurobex, Neurovitan, Folic acid.
- Painkillers: Diclofenac, Nimesulide, Revmoxicam, Dexalgin.
- Anticonvulsants: Lyrica, Finlepsin, Gabalept.
- Antidepressants: Anafranil, Amitriptyline, Venlafaxine.
- To improve peripheral blood circulation: Actovegin.
- Local preparations: ointments with lidocaine or ketoprofen.
Neuropathy in diabetes mellitus (in the absence of contraindications) can be treated using the method of hyperbaric oxygenation, modulated current stimulation, magnetotherapy, and electrophoresis.
Prevention of neuropathy in diabetes
The most important method to prevent complications of diabetes is constant monitoring of blood sugar. It is examined on an empty stomach, after a meal (after 2 hours), and before bedtime. In addition, blood pressure is monitored at least twice a day. Once every three months, an analysis for glycated hemoglobin is performed.
Visits to an endocrinologist should be every three months, a neurologist, surgeon and podologist once every six months.
It is also necessary to completely stop smoking and drinking alcohol, as they cause vasospasm and damage to nerve fibers, which aggravates the manifestations of neuropathy, increasing pain and numbness in the legs.
Exercise therapy for diabetes is recommended, which includes walking, swimming or yoga. The total time of physical education, which can prevent neuropathy in diabetes mellitus, should be at least 150 minutes per week.
To prevent the development of diabetic foot, the following measures are recommended:
- Daily hygiene and examination of the feet for microtraumas and abrasions.
- Burns, frostbite and injury to the feet should not be allowed.
- It is forbidden to walk barefoot, especially outside the home.
- For shoes, as well as hosiery, you need to choose natural ventilated materials.
- Comfortable shoes are recommended, with orthopedic insoles if necessary.
- When performing a pedicure, it is forbidden to cut out calluses.
- For home wear, choose shoes with closed backs.
- Every day your feet should be lubricated with a rich cream to protect them from drying out.
To prevent autonomic neuropathy, you need to be examined by a cardiologist, urologist and gastroenterologist.
In the video in this article, Elena Malysheva will continue to cover the topic of diabetic neuropathy.
Possible complications
The disease cannot be ignored, since diabetic polyneuropathy of the lower extremities provokes serious consequences:
Diabetic foot is a complication of polyneuropathy of the lower extremities
| Name | Description |
| Cachexia | A severe complication of the disease in which anorexia occurs and internal organs are destroyed. |
| Diabetic foot | A pathological condition that is accompanied by numbness and chilliness in the lower extremities. A person is bothered by pain, often at night. |
| Charcot foot | The disease is characterized by destruction of the musculoskeletal system of the lower extremities. |
Against the background of diabetic polyneuropathy, a patient with diabetes mellitus develops gangrene, as a result of which the surgeon amputates the lower limb. The last stages of the disease entail the appearance of paresis and limited mobility. Damage to the cranial areas can lead to visual impairment, and muscle fibers on the face atrophy.
Diabetic polyneuropathy of the lower extremities is a severe neurological complication resulting from diabetes mellitus. A person’s quality of life noticeably deteriorates; in some situations, pathological processes lead to disability.
Proper treatment with medications after timely diagnosis will prevent the destruction of nervous tissue. The main goal of therapy is not only to eliminate the provoking source, but also to achieve stable remission.
Article design: Vladimir the Great
Forecast
The key to successful treatment of diabetic polyneuropathy of the distal sensorimotor form is the elimination of the main cause of nerve destruction, that is, normalization and stabilization of glucose levels in the blood plasma. Without fulfilling this condition, the entire effectiveness of therapy, which is aimed at restoring the functions of nerve fibers, is negligible.
In the case of long-term maintenance of glucose in the body at a certain level, therapy for polyneuropathy is most effective. This is especially true provided that treatment is started at an early stage, since it is in the initial phase that pathological changes are still completely reversible.
In rare cases, stable remission cannot be achieved even with normalization of sugar levels. Patients from this group and those who, for whatever reason, did not start complex treatment, very often develop serious complications, such as:
- diabetic foot;
- Charcot's foot.
In such cases, gangrene can often occur, which entails amputation of the affected area.
