Diabetic neuropathy is a complication of diabetes that affects the nervous system. Diabetes destroyed bodies of nerve cells in the brain and their processes that comprise the nerve trunks.
Symptoms of diabetic neuropathy are very diverse. They depend on which division of the nervous system affected more than others. Most people complain of numbness, loss of sensation, severe pain in the extremities and impotence. But the most dangerous consequence is the diabetic foot syndrome. The person feels no pain from minor injuries on the legs, they turn into non-healing ulcers which can lead to gangrene and amputation of the limb.
With diabetes on the planet live more than 330 ml. Diabetic neuropathy most common complication of diabetes. It occurs in 60-90% of patients, approximately 5-15 years after the onset of the disease. A danger equally threatening for people with type 1 and type 2.
The factors that lead to diabetic neuropathy:
- elevated levels of glucose in the blood;
- high blood pressure;
- genetic propensity;
- Smoking and drinking alcohol.
Treatment of diabetic neuropathy is long and expensive. But in most cases it is possible to restore the nerves and get rid of the symptoms of the disease.
How nerves work
To explain the nature of the disease, let us remember how nervous system. It consists of nerve cells called neurons. They have a body and 2 processes: the long axons and short branched dendrites.
Anatomically, the share of the Central and peripheral nervous system. Central includes the brain and spinal cord, we can say that they consist of bodies of neurons. Peripheral nervous system – nerves, consisting of the processes of nerve cells. They spread through the body from the brain and spinal cord.
There is still a division of the nervous system somatic and autonomic. Somatic NS we control consciously. She directs the work of skeletal muscles. But the autonomic system regulates glands, internal organs and does not depend on our will.
The nerve is composed of thousands of thin fibers processes of nerve cells covered in myelin sheath and endoneurium of connective tissue. To better conduct signals, the fibers are assembled in thin bundles connected by a sheath of loose connective tissue – perineurium. In perineurial are the arteries and veins that provide nourishment to the nerve. Thin beams are brought together and covered by a dense sheath of connective tissue epineurium. Its function is to protect the nerve from damage. The whole design is called a nerve trunk.
Nerves are of three types:
Sensitive nerves. Consist of a sensitive (afferent) nerve cells. They at one end are sensitive cells receptors. Through which we can hear, see, feel, temperature, pressure, vibration, pain, taste and smell. When exposed to the receptor it is the nerve impulse. A nerve as a wire, it is transmitted to the brain and processed there. We can assume that it is the brain we see, hear and feel the pain.
Motor nerves are composed of motor fibers. From brain impulse-team nerve is transferred to all our muscles and organs. And they obediently respond to the reduction or relaxation.
Mixed nerves are composed of motor and sensory fibers of the nerve cells and can perform both functions.
Every second our nervous system provides the body and coordinates all the organs. Therefore, any defeat can lead to serious consequences, dangerous to health.
What happens with the nervous system in diabetes
Diabetes in the blood glucose level is not stable. When he falls down, the nervous cells are starving. And when the glucose too much, it causes the formation of free radicals. These substances oxidize the cells and lead to oxic shock. Elevated glucose level is accompanied by the accumulation in tissues sorbitol and fructose. These carbohydrates are breaking the processes of absorption of water and minerals in the cells that leads to swelling of the nerve fibers.
If a person to the same increased pressure, there is a spasm of the small capillaries that nourish the nerve trunk. In the result, the cells experience oxygen starvation and die.
In recent years, it is believed that a major role in the development of diabetic neuropathy plays an altered gene that is inherited. It makes the neurons more sensitive to the effects of high glucose levels. The processes of the neurons atrophy and is unable to transmit a signal. Similary destroys the myelin sheath of axons, which is designed to insulate the nerve fiber and not allow the momentum to dissipate.
The symptoms of diabetic neuropathy
The symptoms of diabetic neuropathy depend on which division of the nervous system is more affected by the disease. In this article, we consider only damage to the peripheral nervous system. Although diabetes is disturbed and the Central nervous system, especially the cerebral cortex. This complication is called diabetic encephalopathy.
With the defeat of peripheral nervous system symptoms appear in a few months. This is because the nerves in the body very much, at first healthy nerves take up the function of destroyed. The first to suffer the hands and feet, because long nerve fibre, there are more areas of damage.
This is defeat of sensitive nerves, which manifests itself distorted sensations symmetrically on both legs, arms, or sides of the face.
1. Increased sensitivity to stimuli (hyperesthesia)
Manifests feeling crawling "pins and needles", tingling, burning, or sensitivity to cold, periodic sharp stabbing pain. The reason for this are disorders in the nerves, which lead to inadequate transmission of signals from skin receptors to the brain.
2. Inappropriate response to stimuli
- In response to any irritation of the skin (stroking, tingling) can be a pain. So, a person wakes up in pain due to touching the blankets.
- In response to a single stimulus, such as light, there are many senses: tinnitus, taste and smell. In the nerve trunk is broken "isolation" and the excitement that occurs in the eye, spreads to other receptors (olfactory, gustatory, auditory).
3. A reduction or complete loss of sensation
First symptoms occur in the feet and palms, this phenomenon is called "syndrome gloves and socks". The person the impression that he feels the subject of gloves, and walks barefoot, and wool socks. Numerous injuries on different parts of a nerve interfere with the signal from the receptors enter the brain.
This defeat motor nerves, which transmit the commands of the brain to the muscles. Symptoms develop gradually, they are amplified during the holidays and at night.
1. The loss of stability when walking
Reduced sensitivity leads to the fact that the legs become spongy muscles don't listen and gradually begin to atrophy.
2. Violation of coordination of movements
It is the result of cranial nerve that transmit the brain data with the vestibular system, responsible for body position in space.
3. Restriction of mobility of joints, they become swollen and deform
The first affects the joints of the toes and hands. Hands first it becomes difficult to straighten the fingers, and then the rest of the fingers. Sugar level fluctuations disrupt the microcirculation and metabolism in the joints and bones, causing inflammation and proliferation.
4. Muscle weakness and reduced strength in the hands and feet
For normal muscle function they need good blood circulation and innervation. Diabetes violated both of these conditions. Muscles become weak, and the person ceases to feel their movement. In the initial stages of the disease the muscles become swollen, and eventually decrease in size and atrophy.
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In this neuropathy nerves of the autonomic nervous system responsible for the functioning of internal organs. As a result, the organs receive the distorted command, deteriorating supply of oxygen and nutrients.
1. Disorders in the digestive system
- relaxed the sphincters of the stomach that causes frequent belching, heartburn;
- spasms of the stomach, leading to vomiting;
- reduced peristalsis of the bowel – there is chronic constipation;
- it happens that the intestinal peristalsis accelerated, then there diarrhea up to 20 times a day, usually at night. But people do not lose weight, as the food has time to digest.
2. Disruption of the pelvic organs
- impotence. Libido is preserved, but deteriorates the filling of the penis with blood. This is due to the violation of innervation and performance of the vessels in the cavernous bodies.
- decreased tone of the bladder. Bladder muscles do not receive the signal for cutting and it stretches. Urination becomes infrequent (1-2 times per day) and slow. The bladder is not completely emptied. It constantly remains in the urine and it leads to the growth in it of bacteria and development of cystitis.
3. Disorders of the heart
- heart palpitations;
- abnormal heart rhythm – arrhythmia;
- severe weakness when trying to stand up associated with a reduction in blood pressure in the upright position;
- decrease of pain sensitivity of the heart, even a heart attack is painless.
Proper functioning of the heart depends on the regulation of the autonomic nerves. Some of them accelerate the work of the heart with increased stress, while others slow the frequency of contractions, giving the heart rest. In diabetic neuropathy the balance is disturbed, and the heart is chaotic. In this context dramatically increases the risk of a massive heart attack.
4. Changes of the skin
Disrupted sweat glands. At first, there is a strong sweating, especially on the upper half of the body at night. Also sweating in the face and foot. The expansion of subcutaneous capillaries causes the redness and the blush on his cheeks.
Over time, sweat glands secrete an insufficient amount of sweat due to spasm of the capillaries, and the skin becomes dry. On it there are spots where a lot of the pigment melanin and pale areas devoid of it.
Violated the protective function of the skin, and this leads to the fact that the place is any injury appears purulent inflammation. This can lead to gangrene and amputation of limbs.
5. Blurred vision
Nerve damage leads to dysregulation of the pupil. It is manifested by blurred vision, particularly at night.
Diagnosis of diabetic neuropathy
It is very important that a neurologist received complete information about all the changes in the body. For this purpose, special scales and questionnaires: the Michigan scale of neurological symptoms, neurological symptoms scale, the total scale of symptoms.
Your detailed answers will help to find out which nerves are affected and to determine the degree of development of the disease.
During the examination the doctor examines the joints of feet and hands, the strain which speaks about diabetic neuropathy. Determine whether the skin redness, dryness and peeling. Pay special attention to the feet that suffer first. Dry or excessive sweating, calluses, corns, areas of inflammation and ulcers deserve special attention.
The study of vibration sensitivity
Conducted graded tuning fork of Rudely-Siffer. It is a steel fork with a plastic tip on the handle. The prongs strike a tuning fork starts to vibrate.
The handle of a vibrating tuning fork put to the big toe and other parts of both feet. The study was conducted three times. If you do not feel the oscillation frequency of 128 Hz, this indicates a reduced sensitivity and the development of diabetic neuropathy.
Definition of tactile sensitivity
The sensitivity level is measured using a special device – a monofilament. This tool resembles a pencil attached to a piece of thick fishing line. The doctor presses on the skin for 2 seconds with such force to the fishing line twisted. Each point examined 3 times.
For this purpose use a cotton swab or cotton wool lumps, which is carried out for different parts of the palms and feet. First touch the skin of the forearm, so you know what to expect. Then you will be asked to close your eyes. The doctor will touch the skin of the lower extremities, and for you to talk about their feelings. Start from the toes and lead up. Thus determine where the sensitivity is not, and where it is stored. This helps to determine which portion of the damaged nerve fibers.
Determination of temperature sensitivity
Sample make a device that resembles a small cylinder, one end of which is a metal and the other plastic. They alternately touch the skin.If you don't feel the temperature difference of metal and plastic, this confirms the development of diabetic neuropathy.
The definition of pain sensitivity
Pain sensitivity neurological check blunt needle, disposable toothpick or a special cogwheel. The doctor will ask you to close your eyes and will tingle the skin from the big toe to the knee on the inner side of the legs. If you feel a touch, not pain from the injection, it indicates a violation of the nerve fibers.
Assessment of reflexes in diabetic neuropathy
The knee-jerk reaction. The doctor hits a neurologic hammer on the tendon below the kneecap. If this has not decreased the quadriceps muscle of the thigh, it indicates the nerves.
Achilles reflex. You will be asked to become a lap on the couch. The doctor hits a hammer on Achilles tendon above the heel. Normally, the foot bent. If not, might have neuropathy.
The together and electromyography
Often these procedures are carried out simultaneously to study the function of nerves and muscles. With the help of electroneurography study the speed of conduction of impulse along the nerve and how to respond to the pulse in different muscle fibers innervated by one nerve. The results of the reaction of the muscles is recorded through electromyography on the paper tape or other media.
Skin fixed sensors or injected into the muscle fine needle electrodes. The nerve is stimulated with a weak electric shock, and with the help of sensors fixed below in the course of the nerve, studying the speed of its spread and the response of the muscles.
Symptom of diabetic neuropathy is considered to be:
- the propagation delay times. It takes more time to pass through the damaged nerve trunk;
- in response to the pulse is reduced not all the muscle fibers that are innervated by this nerve.
Treatment of diabetic neuropathy
Treatment of diabetic neuropathy has three main areas:
- reduce the level of glucose in the blood;
- pain relief;
- restoration of damaged nerve fibers.
Normalization of sugar level in diabetic neuropathy
The main objective in the treatment of diabetic neuropathy is the normalization of glucose levels. For this purpose, drugs that reduce the level of glucose in the blood. They are divided into 3 groups:
1. Increasing the production of insulin in the body:
- meglitinide: nateglinide, Repaglinide;
- sulfonylureas: gliclazide, liquido, glimepiride;
2. Increase tissue sensitivity to insulin (sensitizer):
- thiazolidinediones: rosiglitazon, ciglitazone, troglitazone, englitazone;
- biguanides: Metformin, phenformin;
3. Violate the absorption of carbohydrates in the intestine:
- inhibitors alpha-glucosidase: acarbose, miglitol.
Endocrinologist individually selects the drug for each patient. If the treatment proved ineffective, then prescribe insulin. It is necessary to inject 1-3 times a day, depending on the characteristics of the disease.
It happens that after the normalization of glucose levels symptoms diabetic neuropathy increase. This state can last up to 2 months. This reaction says that in the nerves originate retroactive changes, and they are recovering.
Prevention of diabetic neuropathy
The development of diabetic neuropathy can be prevented. Most importantly – a permanent control of blood sugar levels. It is the high glucose is the major risk factor for nerve cells. But there are still a number of important rules that will help avoid complications in diabetes.
- At the first sign of diabetes (constant thirst and hunger, increased amount of urine, fatigue) contact your endocrinologist. He will pick you a suitable treatment.
- Regularly measure the level of blood glucose using test strip or glucose meter. The frequency of measurements depends on the type of diabetes and stage of disease.
- Control blood pressure since hypertension causes spasm of capillaries and malnourished nerves.
- A diet №9, consume the vegetables and fruit 3-5 times a day. This will help keep the sugar normal and get rid of excess weight.
- Avoid drinking alcohol and Smoking. Alcohol is a poison to the nervous system and causes destruction of neurons. Smoking – common cause spasm of blood vessels and circulatory disorders of the nerves, and other organs.
- Keep an active lifestyle. Required daily walks for at least 30 minutes and a minimum of 15 minutes of gymnastics per day. Preferably 2-3 times a week to go to the gym or to physical therapy.
- Visit podotherapie (specialist for feet) not less than 1 time per year. Pay special attention to the hygiene of the feet, do not walk barefoot, carefully handle any damage on the skin.
Diabetic neuropathy can be successfully treated. If you normalize the blood sugar levels and improve the work of the nerves, all the symptoms including dangerous "the diabetic foot", will disappear in a few months.
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