THE diabetic neuropathy It is a disease of the autonomic and peripheral nervous system secondary to diabetes. Thus it consists in the loss of the regenerative capacity of the nerve fibers due to the joint action of metabolic and vascular factors. Next, we will detail what it consists of, its symptoms and treatment.
types of neuropathy
Clinical manifestations vary according to the area of the nervous system involved. We can therefore distinguish:
1. Distal symmetric sensorimotor polyneuropathy
This is the most common neuropathy. Primarily, the symptoms reported by patients are pain and hyperalgesia (excessive sensitivity to pain). Subsequently, degeneration of the sensory neuron axons occurs. Hence desensitization is caused in the process of thermoreception and distal pain.
Manifestations appear first in the lower limbs and later in the upper limbs. Additionally, desensitization causes foot ulcers that often progress to gangrene. Sometimes the only way to cure it is amputation. Otherwise the patient is exposed to sepsis.
2. Focal mononeuropathy
It affects cranial nerves III, IV and VI. Which is evidenced by presence of abnormalities in pupillary reflexes. As well as possible one-sided pain.
proximal motor radiculopathy it affects the spinal roots of the lower back (L2, L3 and L4). It presents with atrophy and pain in the muscles of the thigh and pelvis. It has a higher incidence in men over the age of 65. This sector of the population is more susceptible to suffering from diabetic neuropathic cachexia, due to:
- Weight loss.
- A possible depression.
- Poor glycemic control.
4. Autonomic neuropathy
This one is more complex than the previous ones and ends up affecting different organs, despite this in its early stages it can go unnoticed. For this reason, its symptoms are more general and widespread.
How does diabetic neuropathy manifest itself?
As we saw at the beginning, it is the sum of the metabolic and vascular components that cause this affectation:
1. Metabolic factors
Hyperglycemia causes the appearance and storage of glycosylated compounds and sorbitol, as well as an increase in oxidative stress. In fact, a neuronal level, sorbitol modifies cellular metabolism and lowers the concentration of compounds that promote neuronal regeneration such as myo-inositol.
2. Vascular factors
The above situation increases the permeability of vessels and blood clotting. Then, added to small microangiopathies of the capillaries that vascularize the nerve, they originate diabetic neuropathy.
Diagnosis and prevention of diabetic neuropathy
The diagnosis is made on the basis of the patient’s medical history (who must have previously been diagnosed as diabetic). Once the history has been assessed, we proceed with an assessment of neuropathic symptoms and, finally, a physical examination of the feet and other sensitivity tests will be performed (pain, temperature, sensation, among others).
As far as preventive measures are concerned, it is particularly important to maintain glycemic control to try to avoid as many complications as possible and maintain the patient’s well-being. Also, this must be accompanied by the care of other triggers such as high blood pressure, obesity, tobacco and alcohol.
Treatment of diabetic neuropathy
In general terms, to establish the treatment of diabetic neuropathy we must distinguish between one etiology and another:
1. Treatment of diabetic peripheral neuropathy
It is essential to keep glycemic peaks under control. Especially in cases of patients where it has already been activated. Furthermore, this measure must be supported by daily foot care, in order to prevent any situation that could lead to ulcer and amputation for gangrene. In this sense, the use of suitable footwear and personal hygiene are particularly important.
Neuropathic pain will occur in both feet and this is combated by walking. At the pharmacological level, treated with tricyclic antidepressants such as amitriptyline (Tryptizol), which is the drug of choice.
2. Treatment of diabetic autonomic neuropathy
In this case, the affectation is multi-organ, so treatment focuses on relieving the local symptoms of the affected area:
- Orthostatic hypotension. Blood pressure drop when rising from a horizontal position. This symptom can be combated with fludrocortisone acetate, the side effect of which can be high blood pressure.
- Diabetic gastroparesis. Difficulty in proceeding with gastric emptying. It is recommended 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 reduced motility of the small intestine, fluid absorption is reduced and bacterial growth is stimulated. This occurs with diarrhea interrupted by the counterpart, constipation due to alteration of the large intestine. In the most extreme cases, the rectum is affected and the patient experiences faecal incontinence.
- Erectile dysfunction. It can be resolved by discontinuing antihypertensive treatment. In case of contraindication, treatment with phosphodiesterase 5 inhibitors is recommended to promote vasodilation and corpora cavernosa. The best-known drug is sildenafil, sold under the name Viagra. In case drug treatment is ineffective, penile prostheses can be used (surgical process).
- Hyperhidrosis on the head and trunk. It is treated with drugs whose adverse effects limit its use. Excessive gustatory sweating is treated with botulinum toxin.
Diabetic neuropathy: final comments
In short, it is essential to quickly specialist treatment of diabetic neuropathy. It is recommended to strictly follow the medical treatment. Fortunately, today there are increasingly better and less aggressive treatments. Therefore, today there is more hope for these patients.
Post diabetic neuropathy first appeared in research-school.