Diabetic neuropathy

Definition
Common complication of diabetes, is damage to the nerves that allow you to feel sensations such as pain. There are a number of ways that diabetes damages the nerves, but they all seem related to blood sugar being too high for a long period of time. Neuropathy:nerve disorder that results in distortion of nerve function.

Risk factors
Glucose control Duration of diabetes Damage to blood vessels Mechanical injury to nerves Autoimmune factors Genetic susceptibility Lifestyle factors
Smoking Diet

Nerves of the Foot

Causes
Lifestyle factors Metabolic factors Autoimmune factors Nerve and blood vessel factors Nerve injury

Pathophysiology
Metabolic factors
High blood glucose Advanced glycation end products Sorbitol Abnormal blood fat levels

Ischemia Nerve fiber repair mechanisms

Revision
Peripheral neurons can be categorized broadly as;
motor sensory autonomic

Motor neurons originate in the CNS then go to the anterior horn of the spinal cord. From the anterior horn, exit the spinal cord (via ventral roots) and combine with other fibers to go through the brachial or lumbar plexuses and innervate their target organs through peripheral nerves.

 Sensory neurons originate at the dorsal root ganglia (which lie outside the spinal cord) and follow a similar course with motor neurons. Sensory neurons are subdivided into categories according to the sensory modality they convey. Autonomic neurons consist of sympathetic and parasympathetic types. In the periphery, preganglionic fibers leave the CNS and synapse on postganglionic neurons in the sympathetic chain or in sympathetic ganglia.

Classification of DN
Classified based on the affected nerves:-

Peripheral neuropathy Autonomic neuropathy Focal neuropathy Proximal neuropathy

Peripheral Neuropathy
The areas of the body most commonly affected are the feet and legs. Nerve damage in the feet ;result in a loss of foot sensation (foot problem). Injuries and sores on the feet may go unrecognized due to lack of sensation. Should practice proper skin and foot care. Symptoms may include:
Tingling Numbness (severe or long-term numbness can become permanent) Burning (especially in the evening) Pain

Regions of the body affected by peripheral neuropathy

Autonomic neuropathy
Affects the autonomic nerves controlling internal organs
Peripheral Genitourinary Gastrointestinal Cardiovascular

To prevent, continuously keep your blood sugar levels well controlled.

Regions of the body affected by autonomic neuropathy

Symptoms may include: Bloating Diarrheal Constipation Heartburn Nausea Vomiting Feeling full after small meals Blacking out when you stand up quickly Increased heart rate Dizziness Low blood pressure Decrease in vaginal lubrication Decrease in number of orgasms or lack of orgasm Unable to completely empty bladder Incontinence (leaking urine) Increased urination at night Nausea Vomiting Early fullness erectile dysfunction

Focal neuropathy
Appear suddenly and affect specific nerves, most often in the head, torso, or leg, causing muscle weakness or pain. Symptoms may include:
double vision eye pain paralysis on one side of the face (Bell's palsy) severe pain in a certain area, such as the lower back or leg(s) chest or abdominal pain that is sometimes mistaken for another condition such as heart attack or appendicitis

Proximal neuropathy
Causes pain (usually on one side) in the thighs, hips, or buttocks. Also lead to weakness in the legs. Treatment for weakness or pain is usually needed and may include medication and physical therapy. The recovery varies, depending on the type of nerve damage. Prevention consists of keeping blood sugar under tight control.

Diagnosis
GTT/OGTT Foot examto assess sensation in the foot Nerve conduction studiesto test nerve activity Electromyographyto determine how muscles respond to nerve signals Quantitative sensory testingthe use of stimuli (eg, vibration) to check for neuropathy QSART (quantitative sudomotor axon reflex test) a test which evaluates the inervation of sweat glands. Heart rate teststo determine how the heart responds to changes Ultrasoundto view internal organs Biopsyto remove a sample of nerve or skin tissue for examination

Treatment
Tighter control of blood glucose Pain relief (amitriptyline, nortriptyline etc) Regular exercise Avoiding smoking Medications to treat autonomic problems and prevent bladder infections Physical therapy Meticulous care of the feet

Prevention
Well controlled diabetes. Patient education about foot care. Inspect their feet regularly by physician. Avoid smoking.

Complication
Cardiovascular autonomic neuropathy can cause death. Peripheral neuropathy can lead to foot ulcers and leg amputations. Autonomic neuropathy is associated with dizziness and falling with associated injuries, nausea and vomiting, severe diarrhea, and dehydration, all of which can lead to hyperosmolar nonketotic diabetic coma or diabetic ketoacidosis and, hence, to death.