- 1 Etiology and causes of the disease
- 2 Symptomatology
- 3 Diagnostic methods
- 4 Therapeutic activities
- 5 Possible complications
Diabetes mellitus, which lasts for more than 15 years, causes the destruction of many internal organs and leads to oxygen deficiency in the peripheral nervous system. Diabetic polyneuropathy is diagnosed in 50% of diabetics.
The disease affects equally patients with type 1 and 2. Damage to nerve tissue can cause serious complications, which include foot deformities and death.
Etiology and causes of the disease
Diabetes mellitus is an endocrine disorder, accompanied by an increased concentration of sugar in the bloodstream. 150 million people in the world have diabetes. If the patient controls the concentration of glucose, not allowing a rise above 8 mmol / l, the risk of developing polyneuropathy (neuropathy) will be minimal.
To understand what diabetic polyneuropathy (DPN) is, you need to understand that an increase in blood sugar leads to destruction of the vascular walls. Because of this, nerve tissues do not receive the required amount of oxygen, the blood supply and metabolism are disturbed. Ischemia gradually develops, impulse transmission is blocked.
The peripheral nervous system is divided into vegetative and somatic. The somatic task is to control the functioning of the body. The vegetative system regulates the functions of the internal organs. Diabetic neuropathy disrupts both systems. Pathology (ICD code 10: G63.2) is one of the most dangerous conditions.
Note! The disease can manifest itself after several years from the time diabetes is diagnosed.
The dominant cause of diabetic polyneuropathy of the lower extremities is an increased sugar concentration and a prolonged lack of insulin. The deterioration of metabolism at the cellular level has a detrimental effect on peripheral nerve sites.
Other factors affecting the development of pathology are:
- endocrine disorders;
- kidney disease, liver;
- infectious attacks;
- reduced immune status;
- depressive states;
- alcohol abuse;
- chemical intoxication;
- tumor neoplasms.
The disease occurs when blood sugar rises to the maximum. Diabetes mellitus provokes failures in metabolic processes, which is the cause of disorders in the peripheral part of the nervous system. The brain begins to experience a lack of oxygen, a deficiency of which leads to a deterioration in blood supply and damage to nerve tissues. There are sharp painful attacks, patients note weakness of muscles, numbness of the extremities.
Neuropathy in diabetes is manifested in several stages: subclinical and clinical. At the first stage, the person feels completely healthy, there are no complaints. But a neurologist reveals a worsening of the threshold of temperature and pain susceptibility, a decrease in the Achilles reaction.
At the clinical stage, the symptoms of the disorder are clearly manifested. The functioning of many nerves is impaired. The patient loses sensitivity. The formation of ulcerative inclusions on the lower extremities.
Initially, diabetic polyneuropathy is expressed in numbness, pain and goosebumps in the limbs. Painful syndrome is felt even at rest. Later, the discomfort begins to bother during stressful situations and at night, burning in the feet increases. The person is tormented by insomnia, anxiety. The threshold of pain and temperature susceptibility decreases.
Among other signs, there is weakness in the muscles and toes. Extremities acquire a red tint, dark spots appear. There is a deformation of the nail plate: the nail is much thicker or thinner. The shape of the foot changes: it increases in the transverse direction, flat feet are formed, and the ankle is deformed.
As the disease progresses, death in some parts of the foot occurs, leading to gangrene.
Initially affected long muscles that go to the feet and hands. Feet undergo a disastrous effect in the first place. Due to damage to the thick nerve endings, the skin becomes hypersensitive. Allodynia is diagnosed – a condition in which the patient feels a sharp pain from touching.
Fingers lose sensitive receptivity. After damage to small nerve tissues, temperature sensitivity disappears, burning, tingling appear. There is swelling of the feet, the skin on which dries and peels off. Actively formed corns, cracks, ulcers.
Tendon reactions gradually fade away, weakness of the muscular system develops, the functioning of internal organs is disturbed – visceral polyneuropathy is diagnosed. The disease is accompanied by hypotension, urinary incontinence, erectile dysfunction, and digestive problems.
With damage to the optic nerve, cataracts and other visual impairments are formed. Intolerable pains are manifested in the region of the liver, pharynx. Numbness and stiffness of the limbs becomes permanent. The gait of the patient indicates the irreversibility of the situation: since the patient does not feel his feet, he walks strangely and unnaturally, as if falling.
Gradually all muscles atrophy. This leads to a change in speech skills. The diabetic begins to speak incomprehensibly, distorting the correct pronunciation of words.
The systems of the peripheral section gave the name to the types of diabetic polyneuropathy. Somatic appearance leads to trophic formations on the lower extremities, vegetative – to difficult urination, impotence, irreversible heart attacks.
Based on the location of the lesion, these types of polyneuropathies are distinguished:
- sensory, which manifests itself in a painful syndrome in the limbs, loss of sensitive susceptibility;
- motor, accompanied by difficulties with movement, muscular dystrophy;
- sensorimotor, combining features of the types described.
The latter type of neuropathy can cause destruction of the peroneal nerve fiber. This is manifested in the absence of a reaction to thermal irritation, the diabetic does not feel pain in some parts of the foot, lower leg. Patients can not regulate the movement of feet, which provokes an unnatural “cock” gait.
To identify polyneuropathy in diabetes, it is necessary to conduct a comprehensive examination of the patient. The doctor collects anamnesis, interrogates the patient, evaluating the functionality of organs and systems.
Sensitive susceptibility to vibrations is assessed using a tuning fork, leaning the device to different parts of the foot. A neuropathologist uses monofilament to determine tactile susceptibility. This requires pressure on the skin, waiting for results. The study should be repeated three times.
The threshold of susceptibility to temperature is detected by means of a two-sided instrument, which consists of plastic and metal. The doctor alternately applies the cylinder to the skin with different sides. With neuropathy, the patient does not feel the difference between plastic and metal. Sensitivity to pain is assessed using a special needle or gear.
Note! An important diagnostic value is the determination of the knee and Achilles reflex.
It is necessary to take blood to determine the concentration of glucose. You will also need to conduct an ultrasound scan, an electrocardiogram and electromyography. The latest survey reveals the rate of impulse transmission between the brain and muscles.
Treatment of diabetic polyneuropathy of the lower extremities should include a large range of therapeutic methods. The effectiveness of therapy depends on the correctness of exposure to all the factors that caused the pathology. To cure the affected peripheral nerve fibers, you must follow these rules:
- Regulate the amount of sugar in the bloodstream. The patient must maintain performance at an acceptable level, to avoid sudden changes in values.
- Use antioxidant medicines that reduce the concentration of free radicals. These elements damage the peripheral nervous system.
- Use vascular and metabolic agents to restore the affected fibers. Drugs do not allow the destruction of new nerves.
- Apply anesthetic medications.
It is recommended to supplement the treatment with methods of alternative therapy, physiotherapy.
Sugar concentration control
Since elevated glucose is the main cause of polyneuropathy in diabetes, symptomatic treatment is required to stop the development of the disease.. In type 1 diabetes, insulin is required, and in type 2, various pharmacological preparations in the form of tablets are required.
Choosing the dosage of the preformed tablet or insulin is not an easy task, since it is necessary to ensure that there are no sharp jumps in the values. Fluctuations of indicators are dynamic, and this affects the different dosages of medicines. The change in values depends on the diet of the diabetic, the length of the pathology, and associated diseases.
Even with normal amounts of sugar can not eliminate the signs of destruction of nerve tissue. Degenerative processes stop, but to get rid of the painful symptoms, you need to use additional medications.
Treatment of lower extremity neuropathy in patients with diabetes mellitus requires the use of drugs, the main component of which is lipoic acid. The most effective drugs include Neurolipon, Thiogamma, Berlition. Acid is characterized by a cumulative effect, absorption of free radicals occurs, and normalization of nutrition in peripheral areas.
The dosage of the drug should not be less than 600 mg. The duration of the therapeutic course is affected by the severity of signs of pathology. Usually the treatment lasts about six months.
Means of vascular and metabolic nature
Diabetic polyneuropathy requires replenishment of vitamin B1, B6, B12 deficiency:
- B1 increases the production of acetylcholine, which is involved in the transmission of nerve signals.
- B6 synthesizes several elements necessary for the transmission of impulses, does not allow free radicals to accumulate.
- B12 has an analgesic effect, promotes tissue nutrition, restores the affected nerve sheaths.
Note! To improve the therapeutic effect, it is recommended to take a combination of these vitamins, as presented in Milgamma, Vitagamme, Neurobiology.
Actovegin, which improves tissue nutrition and nerve regeneration, is one of the effective metabolic drugs. Pentoxifylline is distinguished from vascular medications. The drug improves blood circulation, dilates capillaries, helping to improve the quality of the power of nerve cells.
Pain in diabetes is difficult to eliminate, because the pain is neuropathic. That is why traditional painkillers are ineffective. To relieve pain, it is necessary to take antidepressants, opioids, anticonvulsants, non-opioid analgesics. The choice of a specific medication is carried out by the attending physician.
Diabetic polyneuropathy of the lower extremities can be eliminated with the help of physiotherapy. The most effective use of magnetic therapy, electrical stimulation, currents, electrophoresis. Patients are prescribed massage, physical therapy, acupuncture.
Sometimes, in order to eliminate excruciating pain, special implants that stimulate its functioning are implanted in the spinal cord. Such an intervention is indicated for diabetics, whose body does not accept drug therapy.
Comprehensive treatment of neuropathy involves recourse to popular recipes. One of the most common is a compress from clay. It is necessary to mix in equal proportions blue clay with water, apply on the affected surface and leave to dry completely. It is necessary to carry out manipulations for 14 days. Such a compress contributes to the regeneration of nerve fibers, increasing the receptor susceptibility.
To get rid of the disease, you can prepare a healing broth. You need to mix a tablespoon of chamomile and nettle, pour a mixture of 200 ml of boiled water. Then you need to keep the solution in a water bath for 15 minutes. It is recommended to use the decoction 3 times a day for 2 months.
DPN in the last stages of development leads to paresis, restriction of mobility. When the cranial areas are damaged, the facial muscles atrophy, and vision is impaired. Gangrene may develop leading to amputation of the limbs.
Tip! Do not violate the schedule of receiving hypoglycemic agents and diet. Such diabetics increase the risk of irreversible effects.
Cachexia is the hardest consequence of the disease, which is accompanied by anorexia and the destruction of internal organs. Pathology has an unfavorable prognosis for recovery.
To reduce the risk of developing neuropathy in diabetes, you need:
- regularly monitor the concentration of glucose in the bloodstream;
- systematically determine arterial indicators;
- stop smoking, alcohol, caffeine;
- engage in feasible physical activity.
The main preventive measure is the passage of the annual examination of the nervous system. This will help in time to identify existing diseases and begin the necessary treatment.
The presence of diabetes requires constant monitoring of blood glucose levels and regular monitoring by a doctor. With the development of symptoms of polyneuropathy, you should promptly seek medical help. This will help avoid serious health problems.