Look at the diabetic neuropathy symptoms and see what causes it, what types of it exists and how to treat it. This disease is serious.
Diabetic neuropathy is an affectation of the autonomic and peripheral nervous system secondary to diabetes. It consists in the loss of the regenerative capacity of nerve fibers due to the joint action of metabolic and vascular factors.
Types of neuropathy and neuropathy symptoms
The clinical manifestations vary depending on the area of the nervous system that is affected:
Distal symmetrical sensory-motor polyneuropathy
This is the neuropathy with the highest prevalence. First, the symptoms that refer to patients are pain and hyperalgesia. Subsequently, degeneration of the axons of the sensory neurons occurs, causing desensitization in the process of thermo-reception and distal pain.
The manifestations appear first in the lower limbs and after the upper ones. In addition, desensitization causes ulcerous lesions on the feet that often degenerate into gangrene. The only way to treat it is amputation, otherwise the patient is prone to sepsis.
Focal mononeuropathy
It affects cranial nerves III, IV and VI, which is evidenced by the presence of abnormalities in pupillary reflexes, as well as possible unilateral pain.
Polyradiculopathy
Proximal radiculopathy that affects the medullary roots of the lumbar area (L2, L3 and L4). It occurs with atrophy and pain in the body of the thigh and pelvis and has a higher incidence in men over 65 years of age. These patients are also more prone to diabetic neuropathic cachexia due to:
- Weight loss
- A possible depression
- Poor glycemic control
- Autonomic neuropathy
This is more complex than the previous ones and has just affected the organs, even though their actions go unnoticed. For this reason, its symptoms are more general and diffuse.
What causes diabetic neuropathy symptoms?
As we saw at the beginning, it is the sum of the metabolic component and the vascular that causes this affectation:
Metabolic factors
Hyperglycemia causes the appearance and storage of glycosylated compounds and sorbitol, as well as the increase in oxidative stress.
Concentration of compounds such as myoinositol is lessened by sorbitol, which modifies cellular metabolism.
Vascular factors
The previous situation increases the permeability of the vessels and blood coagulation, which together with small microangiopathies of the capillaries that vascularize the nerve, the origin of diabetic neuropathy.
Diagnosis and prevention
The neuropathy symptoms diagnosis is based on the patient’s medical history (previously diagnosed as diabetic). Once the history is evaluated, we proceed with an evaluation of the neurological symptoms and, finally, a physical examination of the feet and other sensitivity tests.
Regarding preventive measures, it is especially important to maintain control of blood glucose to avoid as many as possible and maintain the patient’s well-being. In addition, this must be accompanied by the care of other triggers such as hypertension, obesity, tobacco and alcohol.
In general, to establish the treatment of diabetic neuropathy we must differentiate between one etiology and another:
Treatment of peripheral diabetic neuropathy
It is essential to keep glycemic peaks under control, especially in cases of patients in whom it has already been triggered. This measure must be supported by the daily care of the feet, for any type of situation that may result in ulcer and gangrene amputation. In this sense, the use of suitable footwear and personal hygiene take on special importance.
Neuropathic pain manifests in both feet. At the pharmacological level, you can treat it with tricyclic antidepressants such as amitriptyline (Tryptizol), which is the drug of choice.
Further info: People With Diabetes Should Start Eating This More Often! See What And Why!
Treatment of autonomic diabetic neuropathy
In this case, the affectation is multi-organ, so the treatment focuses on alleviating the local symptoms of the affected area:
Orthostatic hypotension. Tension drop when rising from a horizontal position. You can treat this symptom with fludrocortisone acetate, the side effect of which can be high blood pressure.
Diabetic Gastroparesis. Difficulty in proceeding with gastric emptying. It is advisable to practice frequent and light food intakes. At the pharmacological level, the drug of choice is metoclopramide and domperidone, marketed as Primperan and Motilium respectively.
Enteropathy. Due to the decrease in motility of the small intestine, it reduces the fluid absorption and stimulates bacterial proliferation. This occurs with diarrhea interrupted by the counterpart, constipation due to the alteration of the large intestine. In the most extreme cases, it affects the rectum and the patient presents fecal incontinence.
Erectile dysfunction. You can solve it by interrupting the treatment with hypotensors. If there is a contraindication, doctors recommend a treatment with phosphodiesterase 5 inhibitors in order to facilitate vasodilation and the corpora cavernosa. The most popular drug is sildenafil, which you know under the name Viagra. In the event that drug treatment is ineffective, doctors suggest penile prostheses (surgical procedure).
Hyperhidrosis in the head and trunk. You can treat it with drugs whose adverse effects limit its use. You can treat excessive sweating with botulinum toxin.
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