yulius hermanto
Diabetic Neuropathy, A Problematic Disease
Introduction
Diabetic neuropathies are group of nerve disorders caused by diabetes. Diabetes is complicated disease, can be said as the mother of others diseases, since diabetes brings lot of diseases associated with long-term hyperglycemia such as neuropathy, retinopathy, nephropathy, heart disease, and stroke. Neuropathy or nerve involvement in diabetes can develop over time throughout the body.
Diabetes neuropathy is the most common complication of diabetes, about 60-70% people with diabetes have some form of neuropathy. Persons with diabetes can develop nerve problems at any time, but the risk rises with age and longer duration of diabetes. The highest rates of neuropathy are among people who have had diabetes for at least 25 years. Another risk factors for having diabetic neuropathy are uncontrolled blood glucose, high levels of blood fat and blood pressure and those who are overweight, smoking, and alcohol consumption.
Poor managed diabetic neuropathic could leads to foot ulcers, charcot joints and amputation, therefore awareness and proper care is needed for management of diabetic neuropathy.
Pathogenesis
The development of diabetic neuropathy is believed to be caused by microvascular abnormalities in the vessels that supply the nerves. The microvascular abnormalities leads to insufficiency blood supply to the nerves. The nerves functions then impaired, causing neurological symptoms such as numbness, tingling, pain, etc.
Nerve damage is likely due to a combination of factors: metabolic factors, such as high blood glucose, long duration of diabetes, abnormal blood fat levels, and possibly low levels of insulin neurovascular factors, leading to damage to the blood vessels that carry oxygen and nutrients to nerves
autoimmune factors that cause inflammation in nerves mechanical injury to nerves, and lifestyle factors, such as smoking or alcohol use.
Types of Diabetic Neuropathy
Diabetic neuropathy can be classified as peripheral, autonomic, proximal, or focal. Each affects different parts of the body in various ways.
- Peripheral neuropathy, the most common type of diabetic neuropathy, causes pain or loss of feeling in the toes, feet, legs, hands, and arms.
- Autonomic neuropathy causes changes in digestion, bowel and bladder function, sexual response, and perspiration. It can also affect the nerves that serve the heart and control blood pressure, as well as nerves in the lungs and eyes. Autonomic neuropathy can also cause hypoglycemia unawareness, a condition in which people no longer experience the warning symptoms of low blood glucose levels.
- Proximal neuropathy causes pain in the thighs, hips, or buttocks and leads to weakness in the legs.
- Focal neuropathy results in the sudden weakness of one nerve or a group of nerves, causing muscle weakness or pain. Any nerve in the body can be affected.
Symptoms of Diabetic Neuropathy
Symptoms that occur depend on the type of diabetic neuropathy and which nerves are affected. Most common type of neuropathy is Peripheral Neuropathy, the nerve damage will give symptoms such as numbness, tingling, or pain in the feet. Symptoms are often minor at first, and because most nerve damage occurs over several years, mild cases may go unnoticed for a long time.
Symptoms of nerve damage may include:
- numbness, tingling, or pain in the toes, feet, legs, hands, arms, and fingers
- wasting of the muscles of the feet or hands
- indigestion, nausea, or vomiting
- diarrhea or constipation
- dizziness or faintness due to a drop in blood pressure after standing or sitting up
- problems with urination
- erectile dysfunction in men or vaginal dryness in women
- weakness
Diagnosis
In establishing the diabetic neuropathy, a doctor needs to do history taking about your complaints and physical examination. During the exam, your doctor may check blood pressure, heart rate, muscle strength, reflexes, and sensitivity to position changes, vibration, temperature, or light touch.
Experts recommend foot examination for people with diabetes each year to check for peripheral neuropathy. While people with peripheral neuropathy need more frequent foot exams. A comprehensive foot exam assesses the skin, muscles, bones, circulation, and sensation of the feet. People who cannot sense pressure from a pinprick or monofilament have lost protective sensation and are at risk for developing foot sores that may not heal properly. The doctor may also check temperature perception or use a tuning fork, which is more sensitive than touch pressure, to assess vibration perception.
Another supporting examination that is needed in establishing the diagnosis such nerve conduction studies. Nerve conduction studies or electromyography are sometimes used to help determine the type and extent of nerve damage. Nerve conduction studies check the transmission of electrical current through a nerve. Electromyography shows how well muscles respond to electrical signals transmitted by nearby nerves.
Treatment
The treatment of diabetic neuropathy is a part of diabetes therapy, thus controlling blood glucose levels within the normal range is important in order to help prevent further nerve damage and prevent any complication of diabetes.
Additional treatment depends on the type of nerve problem and symptoms.
Painful diabetic neuropathy usually treated with oral medications, although other types of treatments may help some people. People with severe nerve pain may benefit from a combination of medications or treatments.
Medications used to help relieve diabetic neuropathic pain include:
- tricyclic antidepressants, such as amitriptyline, imipramine, and desipramine
- other types of antidepressants, such as duloxetine, venlafaxine, paroxetine
- anticonvulsants, such as pregabalin, gabapentin, carbamazepine.
- opioids and opioid-like drugs, such as controlled-release oxycodone, an opioid; and tramadol
All medications have side effects, and some are not recommended for use in older adults or those with heart disease. Because over-the-counter pain medicines such as acetaminophen and ibuprofen may not work well for treating most nerve pain and can have serious side effects, some experts recommend avoiding these medications.
Diabetic neuropathies are group of nerve disorders caused by diabetes. Diabetes is complicated disease, can be said as the mother of others diseases, since diabetes brings lot of diseases associated with long-term hyperglycemia such as neuropathy, retinopathy, nephropathy, heart disease, and stroke. Neuropathy or nerve involvement in diabetes can develop over time throughout the body.
Diabetes neuropathy is the most common complication of diabetes, about 60-70% people with diabetes have some form of neuropathy. Persons with diabetes can develop nerve problems at any time, but the risk rises with age and longer duration of diabetes. The highest rates of neuropathy are among people who have had diabetes for at least 25 years. Another risk factors for having diabetic neuropathy are uncontrolled blood glucose, high levels of blood fat and blood pressure and those who are overweight, smoking, and alcohol consumption.
Poor managed diabetic neuropathic could leads to foot ulcers, charcot joints and amputation, therefore awareness and proper care is needed for management of diabetic neuropathy.
Pathogenesis
The development of diabetic neuropathy is believed to be caused by microvascular abnormalities in the vessels that supply the nerves. The microvascular abnormalities leads to insufficiency blood supply to the nerves. The nerves functions then impaired, causing neurological symptoms such as numbness, tingling, pain, etc.
autoimmune factors that cause inflammation in nerves mechanical injury to nerves, and lifestyle factors, such as smoking or alcohol use.
Types of Diabetic Neuropathy
Diabetic neuropathy can be classified as peripheral, autonomic, proximal, or focal. Each affects different parts of the body in various ways.
- Peripheral neuropathy, the most common type of diabetic neuropathy, causes pain or loss of feeling in the toes, feet, legs, hands, and arms.
- Autonomic neuropathy causes changes in digestion, bowel and bladder function, sexual response, and perspiration. It can also affect the nerves that serve the heart and control blood pressure, as well as nerves in the lungs and eyes. Autonomic neuropathy can also cause hypoglycemia unawareness, a condition in which people no longer experience the warning symptoms of low blood glucose levels.
- Proximal neuropathy causes pain in the thighs, hips, or buttocks and leads to weakness in the legs.
- Focal neuropathy results in the sudden weakness of one nerve or a group of nerves, causing muscle weakness or pain. Any nerve in the body can be affected.
Symptoms of Diabetic Neuropathy
Symptoms that occur depend on the type of diabetic neuropathy and which nerves are affected. Most common type of neuropathy is Peripheral Neuropathy, the nerve damage will give symptoms such as numbness, tingling, or pain in the feet. Symptoms are often minor at first, and because most nerve damage occurs over several years, mild cases may go unnoticed for a long time.
Symptoms of nerve damage may include:
- numbness, tingling, or pain in the toes, feet, legs, hands, arms, and fingers
- wasting of the muscles of the feet or hands
- indigestion, nausea, or vomiting
- diarrhea or constipation
- dizziness or faintness due to a drop in blood pressure after standing or sitting up
- problems with urination
- erectile dysfunction in men or vaginal dryness in women
- weakness
Diagnosis
In establishing the diabetic neuropathy, a doctor needs to do history taking about your complaints and physical examination. During the exam, your doctor may check blood pressure, heart rate, muscle strength, reflexes, and sensitivity to position changes, vibration, temperature, or light touch.
Experts recommend foot examination for people with diabetes each year to check for peripheral neuropathy. While people with peripheral neuropathy need more frequent foot exams. A comprehensive foot exam assesses the skin, muscles, bones, circulation, and sensation of the feet. People who cannot sense pressure from a pinprick or monofilament have lost protective sensation and are at risk for developing foot sores that may not heal properly. The doctor may also check temperature perception or use a tuning fork, which is more sensitive than touch pressure, to assess vibration perception.
Another supporting examination that is needed in establishing the diagnosis such nerve conduction studies. Nerve conduction studies or electromyography are sometimes used to help determine the type and extent of nerve damage. Nerve conduction studies check the transmission of electrical current through a nerve. Electromyography shows how well muscles respond to electrical signals transmitted by nearby nerves.
Treatment
The treatment of diabetic neuropathy is a part of diabetes therapy, thus controlling blood glucose levels within the normal range is important in order to help prevent further nerve damage and prevent any complication of diabetes.
Additional treatment depends on the type of nerve problem and symptoms.
Painful diabetic neuropathy usually treated with oral medications, although other types of treatments may help some people. People with severe nerve pain may benefit from a combination of medications or treatments.
Medications used to help relieve diabetic neuropathic pain include:
- tricyclic antidepressants, such as amitriptyline, imipramine, and desipramine
- other types of antidepressants, such as duloxetine, venlafaxine, paroxetine
- anticonvulsants, such as pregabalin, gabapentin, carbamazepine.
- opioids and opioid-like drugs, such as controlled-release oxycodone, an opioid; and tramadol
All medications have side effects, and some are not recommended for use in older adults or those with heart disease. Because over-the-counter pain medicines such as acetaminophen and ibuprofen may not work well for treating most nerve pain and can have serious side effects, some experts recommend avoiding these medications.
