Diabetic neuropathy is an affectation of the autonomic and peripheral nervous system secondary to diabetes. It consists in the loss of the regenerative capacity of nerve fibers due to the joint action of metabolic and vascular factors.
Types of neuropathy
The cynical manifestations vary according to the area of the nervous system that is affected. They can be distinguished:
Distal symmetrical sensory-motor polyneuropathy
The manifestations appear earlier in the lower limbs and then in the upper ones. In addition, desensitization causes ulcerous lesions on the feet that often degenerate into gangrene. The only way to treat it is amputation , otherwise the patient is exposed to sepsis.
It affects cranial nerves III, IV and VI, which is evidenced by the presence of abnormalities in pupillary reflexes , as well as possible unilateral pain.
Motor proximal radiculopathy that affects the medullary roots of the lumbar area (L2, L3 and L4). It occurs with atrophy and pain in the muscles of the thigh and pelvis and has a higher incidence in males over 65 years of age. This sector of patients is also more susceptible to diabetic neuropathic cachexia due to:
- Weight loss.
- A possible depression.
- Poor glycemic control
This is more complex than the previous ones and ends up affecting different organs, although in its early stages it can go unnoticed. For this reason, its symptoms are more general and diffuse.
How is diabetic neuropathy produced?
As we saw at the beginning, it is the sum of the metabolic component and the vascular that causes this affectation:
Hyperglycemia causes the appearance and storage of glycosylated compounds and sorbitol, as well as the increase of . At the neuronal level, sorbitol modifies cellular metabolism and lowers the concentration of compounds that favor neuronal regeneration such as myoinositol.
The previous situation increases the permeability of the vessels and the blood coagulation, which together with small microangiopathies of the capillaries that vascularize the nerve, cause diabetic neuropathy.
Diagnosis and prevention
The diagnosis is made based on the patient’s medical history (who must have been diagnosed as a diabetic previously). Once the history is evaluated, we proceed with an evaluation of the neuropathic symptoms and, finally, a physical examination of the feet and other sensitivity tests ( pain, temperature, sensation, among others) will be done.
Patients usually report discomfort in the lower extremities, numb feet and heavy, as if they had 10 kg above the legs or their boots were too large for their feet
With regard to prevention measures, it is particularly important to maintain control of blood glucose levels in order to avoid as many complications as possible and to maintain the patient’s well-being. In addition, this must be accompanied by the care of other triggers such as
In general, to establish the treatment of diabetic neuropathy we must differentiate between one etiology or another:
Treatment of peripheral diabetic neuropathy
It is essential to keep under control, especially in cases where patients have already been triggered. This measure should be supported by the daily care of the feet , in order to prevent any situation that may lead to ulcer and amputation due to gangrene. In this sense, the use of suitable footwear and personal hygiene take on special importance.
Treatment of autonomic diabetic neuropathy
In this case, the affectation is multi-organ, so the treatment is focused on alleviating the local symptoms of the affected area:
- Orthostatic hypotension. Tension drop when rising from a horizontal position. This symptom can be treated with fludrocortisone acetate, the side effect of which can be high blood pressure.
- Diabetic Gastroparesis Difficulty in proceeding with gastric emptying. It is advisable to practice frequent and light food intakes. At the pharmacological level, the drug of choice is
- Enteropathy Due to the decrease in motility of the small intestine, fluid absorption is reduced and bacterial proliferation is stimulated. This occurs with diarrhea interrupted by the counterpart, constipation due to the alteration of the large intestine. In the most extreme cases, the rectum is affected and the patient presents fecal incontinence.
- Erectile dysfunction. It can be solved by interrupting the treatment with hypotensors. If there is a contraindication, treatment with phosphodiesterase 5 inhibitors is recommended in order to facilitate vasodilation and the corpora cavernosa. The best known drug is sildenafil, which is sold under the name Viagra. In the event that drug treatment is ineffective, penile prostheses (surgical procedure) may be used.
- Hyperhidrosis in the head and trunk. It is treated with drugs whose adverse effects limit its use. Excessive gustatory sweating is treated with botulinum toxin.