Description of diabetic neuropathy
Diabetic neuropathy (DN) is impaired nerves, manifested by the type of affected nerve pain, numbness (usually the legs) to problems with the digestive and urinary tract, blood vessels and heart.
It is the most common late complications in patients with diabetes. It affects about 50% of diabetics and diabetics both the first and second type.
Diabetic neuropathy leads to impaired function and structure of the nerve. According to the species affected nerves are two basic groups of diabetic neuropathy.
The first is diabetic peripheral (somatic) neuropathy affecting the nerves of the striated muscles of the limbs and the other isautonomous (vegetative) neuropathy, with involvement of the nerves affecting the muscles of internal organs whose function will not affect. When advanced neuropathy occurs combinations, they are affected both somatic and autonomic nerves.
The causes of diabetic neuropathy
The emergence of this disease is conditioned by the underlying disease, ie diabetes. The causes of neuropathy are leading to a combination of factors.
A rise in blood glucose (hyperglycaemia) keeps various complicated mechanisms to distortion and damage to the function of nerve cells and nerve fibers forming.
Microscopic examination of the nerves in diabetic patients have proven themselves as changes of nerve cells, and cells which encase nerve fibers and thereby accelerate guidance signals. The cells have an increased susceptibility to self-destruct (the so-called. Apoptosis, which is actually programmed cell suicide).
An important role in disease development and plays small vessel disease that nourish these nerves. They occur in which the thickening of their walls and then impairs nerve supply of oxygen and other necessary nutrients. The nerve is then inadequately nourished, and it exacerbates his disability.
Apart from the bad influence of increased sugar contributes to the development of neuropathy, as well as other factors. It is mainly an autoimmune inflammation when the body of the not entirely clear reason produces antibodies against its own constituents.
In addition, genetic factors, independently of diabetes when some individuals are increasingly sensitive to nerve damage.
Finally, the development of the disease, the increased consumption of alcohol and cigaretteconsumption.
Risk factors for diabetic neuropathy
Diabetes itself is a risk factor. Increased likelihood of disability neuropathy depends on the duration of diabetes proportionally. The patient suffers from diabetes longer, the greater the risk of developing this complication. Perhaps the biggest risk is rare and irregular controlling sugar levels in diabetes recognized. Frequent blood glucose control and maintain the appropriate levels are the best way to protect the health of your nerves and blood vessels.
Further risk factors are well known. Instable factors such as age and gender. The older you are, and you have to do man, you are likely to develop neuropathy greater than young women.
A so-called. Modifiable risk factors are even hypercholesterolaemia (high cholesterol), smokingand high blood pressure. Mainly elevated LDL-cholesterol, which contributes to the destruction of blood vessels, thereby limiting sufficient nutrition nerves. People with diabetes have about twice the risk of high blood pressure than individuals without diabetes. Having both, including high blood pressure and diabetes is very dangerous in terms of the development of late complications, since both the high pressure itself, so diabetes destroys blood vessels restricts blood flow.
Prevention of diabetic neuropathy
A major step in the prevention of both creation and the development of complications of diabetic neuropathy p ravidelná control levels of blood sugar (glucose). Checks should be carried out daily. Care should be taken to maintain blood glucose at an acceptable standard set by strict adherence to diet and treatment regimens.
Also important is the protection and care of the feet. The emergence of various abrasions or ulcers may result due to poor tissue regeneration and poor response to the treatment of diabetic patients to dangerous infections leading to loss of limb amputations.
Therefore it is extremely important to prevent any sores on the legs. This can be achieved by controlling the state of the regular daily feet, their daily careful washing and drying. It is important to thoroughly dry the interdigital space, and finally the legs smeared with moisturizing creams preventing dryness.
Keep your toenails clean regularly and most carefully is Trim. Wear always clean and dry, preferably cotton socks or buy easy-fitting shoes to avoid unnecessary sores creation of small shoes.
Equally important in the prevention of changes in lifestyle. Eat healthier, choose a diet containing plenty of vegetables, fruits, whole grain foods.
Stop smoking. In diabetics who smoke are more than twice the risk of developing cardiovascular diseases, including disorders of the circulation in the vessels of the legs than in diabetics who do not smoke.
Exercise regularly, get some physical activities. It reduces overweight, supports blood circulation and reduces blood pressure. For diabetics, blood pressure is guarded even more severely than in healthy people. It should not exceed the values 130/80.
Signs and symptoms of diabetic neuropathy
Neuropathy symptoms depend on which nerves are affected. Neuropathy can be classified according to whether affect somatic nerves (peripheral neuropathy), which are responsible for the management and security of sensitive mobility of muscles that can affect or autonomic nervesthat are responsible for the internal organs (autonomic neuropathy). Affecting nerves may also be symmetrical, it means that the handicap at both extremities as well expressed, or asymmetric.
peripheral neuropathy
The most common is called diabetic neuropathy. Symmetric distal (sensory and motor) neuropathy.It affects the nerves of the hands, but especially the legs and feet.
First affects the nerves that serve the perception sensitivity. It manifests as a reduced ordiminished pain perception of heat and cold, which may lead to injuries or burns, and this contributes to the formation of poorly healing wounds.
Examine also tingling, burning, stinging, which begins in inches and spreads upward. The night appeared to sharp and unbearable pain burrowing preventing sleep. It also occurs in increased sensitivity to gentle touch, for example, soft blanket at night may cause up to a very uncomfortable feeling the pain.
Later they added symptoms of impaired motor nerves. Creates difficulties with balance and coordination, hands start to be cumbersome, it may collapse arches of the foot.
Adds muscle weakness and problems with walking, there are stumbling. The skin on the legs is also changing. It is dry, creased, thin, though more transparent, with sweat and lose hair.
Among the asymmetric peripheral neuropathy belongs called. Proximal neuropathy (amyotrophy).It affects the muscles of the pelvic girdle and thighs. It occurs mostly in older men with type 2 diabetes. It manifests itself with pain in the buttocks and thighs. Usually begins on one side.Furthermore manifested muscle weakness, patients have trouble getting up from a sitting position, especially when walking to and from the stairs.
Another group is the focal mononeuropathy. Usually affects a nerve, so it is not symmetrical. It can cause great pain, but usually within a few weeks she lived.
There is involvement of oculomotor nerve. This is reflected šilháním, double vision and eyelid crash.
There is also the involvement of the facial nerve with a unilateral decrease in oral corner, the decrease of the lower eyelid. It is not possible such as wrinkled brow or purse his lips.
Sometimes the focal neuropathy occurs when the nerve oppressed and passes stěsněným space. It is, for example, the carpal tunnel syndrome, or other entrapment syndrome. Will the tingling, numbness, swelling and pain in the fingers, particularly at night, when there is inaction in reduced congestion nerve. Then just fold the hands and problems subside. Gradually developing weakness in the muscles of the hand and the tendency to renege and unstoppable objects in his hands.
autonomic neuropathy
The autonomic nervous system controls the internal organs.
Neuropathy is especially dysregulation heart rate with tachycardia (rapid heart rate) and dysregulation of blood pressure, which results in the event of sudden standing up from sitting or lying down rapidly, pressure, entangled with head and can lead to apostasy (orthostatic hypotension).
By being affected and nerves leading pain, patients with myocardial infarction may not even feel the accompanying pain.
In the digestive tract, there are problems of gastric emptying, manifested as vomiting, nausea and anorexia. Also tend diarrhea or constipation based on gut motility disorders.
As relates to the urinary system, disorders usually present emptying the bladder, in which there is a stagnation of residual urine remaining after emptying. This raises a frequent urge to urinate, urinary incontinence occurs and increases the risk of urinary tract infection.
More than half of patients over age 60 with diabetes have erectile dysfunction in women with sexual problems also occur, especially insufficient vaginal lubrication.
Sweating disorders typically manifest little sweating in the lower body and on the contrary increased sweating in the upper half.
Treatment of diabetic neuropathy
Treatment present diabetic neuropathy is not easy and causal treatment or is not known. It relies mainly on slowing the progression of the disease, the treatment of pain and other unpleasant sensations as tingling, burning.
The basis is the maintenance of a stable and acceptable blood glucose levels. This helps delay the development of disease in severe stages, and sometimes may also have to correct pre-existing symptoms. They are used oral antidiabetic agents, and if not enough insulin is injected. For some people, intensive glycemic control and regulation to reduce the risk of developing neuropathy and by more than 60%.
Pain management is very tricky. It is highly individual, whether and from whom it takes. Servedantiepileptics, antidepressants. They are also recommended ointments containing capsaicin.
Among other methods of managing pain and other unpleasant sensations neuropathy also include, for example, acupuncture, relaxation techniques and rehabilitation.
Effective in some cases administration of substances promoting the regeneration of nerve and nutrition. Mainly alpha lipoic acid and linoleic. It is recommended that the administration of vitamins B, E.
How can I help myself
Adhere to the principle of prevention. Especially good care of your feet, keep your blood glucose and blood pressure in normal, healthy eating regularly indulge in body movement, quit smoking and avoid alcohol.
Complications of diabetic neuropathy
Diabetic neuropathy is a serious disease with a number of potential complications.
Poor wound healing in particular the legs and its infections, which is incurable and leads to necrosisof tissues legs (gangrene), can reach (due to life-threatening infection of the patient by extending around the body) the need amputation of limb, sometimes the entire limb.
Fail bladder outflow is still a certain amount of urine in the bladder, it allows the bacteria in this environment to survive and multiply. They may spread to the kidneys, producing frequent urinary tract infections.
The big danger with impaired autonomic nerves is the disappearance of the symptoms of hypoglycemia (low blood sugar). These symptoms (sweating, rapid heart rate, tremors, salivation) provides just such a system, and when it comes to his disability, you may not notice them handicapped. It then presents fatal.
The danger is also a loss of blood pressure regulation. For orthostatic hypotension may result inloss of consciousness, falling and head trauma.
Other complications are eg failure to regulate body temperature as a result of changes in perspiration, digestive function disorders with fierce vomiting and diarrhea or constipation, and sexual dysfunction.
Last but not least, result in pain, disability and inability of some older people a loss of independence, depression and social isolation.
Other names: neuropathy in diabetes, disorders of the nerves in diabetes neuropathy in diabetes affects the nerves in diabetes
