Diabetic Neuropathy

Diabetic Neuropathy is a neurometabolic disorder that is found in diabetic patients.

• About 60-70% of people with diabetes have mild to severe forms of nervous system damage, including:                                                                                                                                                                -Impaired sensation or pain in the feet or hands                                                                          -Slowed digestion of food in the stomach                                                                                        -Carpal tunnel syndrome                                                                                                                   -Other nerve problems

• More than 60% of nontraumatic lower-limb amputations in the United States occur among people with diabetes.

Risk Factors
-Glucose control
-Duration of diabetes
-Damage to blood vessels
-Mechanical injury to nerves
-Autoimmune factors
-Genetic susceptibility
-Lifestyle factors
-Smoking
-Alcohol
-Increased Height
-Pathogenesis of Diabetic Neuropathy
Metabolic factors
-High blood glucose
-Advanced glycation end products
-Sorbitol
-Abnormal blood fat levels
-Ischemia
-Nerve fiber repair mechanisms
Pathophysiology-biochemical and vascular factors

Ways of Diagnosis
-Assess symptoms - muscle weakness,
-muscle cramps, prickling, numbness or pain, vomiting, diarrhea,
- poor bladder control and sexual dysfunction
-Comprehensive foot exam
-Skin sensation and skin integrity
-Quantitative Sensory Testing (QST)
-X-ray
-Nerve conduction studies
-Electromyographic examination (EMG)
-Ultrasound

Classification of Diabetic Neuropathy
-Symmetric polyneuropathy
-Autonomic neuropathy
-Polyradiculopathy
-Mononeuropathy
-Symmetric Polyneuropathy

Most common form of diabetic neuropathy 
Affects distal lower extremities and hands (“stocking-glove” sensory loss) 
Symptoms/Signs
-Pain
-Paresthesia/dysesthesia
-Loss of vibratory sensation
Complications:
-Ulcers
-Charcot arthropathy
-Dislocation and stress fractures
-Amputation

Foot Ulceration

Treatment of Symmetric Polyneuropathy

-Glucose control
-Pain control
-Tricyclic antidepressants
-Topical creams
-Anticonvulsants
-Foot care
                                                                             -Visual inspection of feet at every visit with a health care professional
-Use lotion to prevent dryness and cracking
-Cut toenails weekly or as needed
-Always wear socks and well-fitting shoes
-Notify their health care provider immediately if any foot problems occur

Autonomic neuropathy

Affects the autonomic nerves controlling internal organs
-Peripheral
-Genitourinary
-Gastrointestinal
-Cardiovascular
Symptoms/Signs:
-Neuropathic arthropathy (Charcot foot)
Aching, pulsation, tightness, cramping, dry skin, pruritus, edema, sweating abnormalities
Weakening of the bones in the foot leading to fractures
-Treatment: Symptomatic therapy due to have foot ulceration, pain, edema and so on.

Polyradioculopathy
-Lumbar polyradiculopathy (diabetic amyotrophy)
-Thigh pain followed by muscle weakness and atrophy
-Thoracic polyradiculopathy
-Severe pain on one or both sides of the abdomen, possibly in a band-like pattern
-Diabetic neuropathic cachexia
-Polyradiculopathy + peripheral neuropathy
-Associated with weight loss and depression
-Polyradiculopathies are diagnosed by electromyographic (EMG) studies
Treatment
-Foot care
-Glucose control
-Pain control

Mononeuropathy
-Peripheral mononeuropathy
-Single nerve damage due to compression or ischemia
-Occurs in wrist (carpal tunnel syndrome), elbow, or foot (unilateral foot drop)
-Cranial mononeuropathy
-Affects the 12 pairs of nerves that are connected with the brain and control sight, eye movement, hearing, and taste
Symptoms/Signs
-paratesia
-Edema
-unilateral pain near the affected eye
-paralysis of the eye muscle
-double vision
So we should concern about diabetes

Article Written By: Md. Enamul Hoque Khan
Student of MPharm,Department of Pharmacy,
East West University,Dhaka.

Posted in: Clinical Pharmacy,Diseases Information