Neuropathy associated with diabetes mellitus is Diabetic neuropathy. The overall prevalence of neuropathy is 66% for type-1 and 59% for type-2 diabetes. -:
Symptoms of Diabetic Neuropathy
(1) Somatic :- When symptoms refers to peripheral nerves that carry signals from the peripheral organ and that control voluntary actions in the body, Again it is divided into two types
(I) Symmetric Diabetic neuropathy – symptoms are related to a particular nerve and affect the body in symmetric pattern. Most Common type Of Diabetic Neuropathy. It is a length-dependent polyneuropathy because long nerves are affected initially. Diabetic sensorimotor polyneuropathy (DSPN) has all insidious progressive courses.
Symptoms are :
– Numbness tingling buzzing burning or pricking sensations affecting the toes and feet initially.
– The paresthesias ascends up to the legs and then hands in a stocking glove distribution, i.e. when symptoms starts in longest nerve of the body.
– Over time, gait disturbance and distal weakness may occur.
– Insensitiveness in limbs Predispose to ulcers and lead to Amputations of limb.
(II) Asymetric Diabetic neuropathy –
(i) Limb mononeuropathies
(iii) Diabetic amyotrophy
(1) Limb Mononeuropathies –
It affects the nerves supplying upper and lower extremities.
Diabetic patient are also susceptible for entrapment neuropathies affecting, Wrist (carpel tunnel syndrome), Fibular (peroneal), Ulnar Neuropathy elbow, Meralgia Paresthetica etc.
(2) Radiculopathies & Plexopathies :-
when site of injury is at the nerve root or the plexus of nerves. Usually seen in middle or later life of diabetic patients. Prior history of DSPN might be predisposing factor. Symptoms are gradual in onset or may be of sudden onset.
Symptoms are :
-Severe pain in thoracic spine flank, rib cage or in upper abdomen
-Pain is burning, stabbing type.
-Symptoms associated with weight loss
(3) Diabetic amyotrophy:-
(a) (Femoral Neuropathy, Proximal Diabetic Neuropathy)
– It is usually seen in diabetic patient and may be associated with radiculopathies and Plexopathies.
– Severe pain anterior thigh and may affect buttock and lower back Pain may be of sudden – — onset and worse at night
– Burning type of pain which leads to difficulty climbing stairs and walking
– Weight loss may be present
(b) Visceral (Autonomic) Diabetic neuropathy – :- When the peripheral nerves that carry signals from the brain and that control involuntary actions in the body, are affected.
It have following types :-
(I) Cardio Vascular –
– Postural hypotension or orthostatic hypotension(form of low blood pressure happen when person stand up from sitting or lying down).
– Resting tachycardia (increase heart beat even during rest).
(II) Gastrointestinal –
– Dysphagia (difficulty in swallowing)
– Abdominal fullness nausea vomiting due to delayed gastric emptying
– Nocturnal diarrhoea with or without faecal incontinence
(III) Genitourinary –
– Difficulty in micturation urinary incontinence, recurrent urine infection
– Erectile dysfunction
– Retrograde ejaculation (when serum redirected to the urinary bladder rather to ejaculate urethra/penis)
(IV) Sudomotor –
– Gustatory sweating (profuse head & neck sweating during eating)
– Nocturnal sweats without hypo
– Anhidrosis – fissures in feet
(V) Vasomotor –
– Feet cold, due to loss of skin vasomotor response
– Dependent oedema (oedema influenced by gravity i.e. in feet,ankle usually)
– Bullous formation (skin filled with serous fluid)
(VI) Pupillary –
– Double vision
– Unilateral ptosis (dropping or falling of upper eye lid)
– Delayed or absent reflexes to light
– Restricted moments of eyeball
Diagnosis of Diabetic neuropathy-
- Rule out the contributor to the neuropathy (vitamin B1 & B12) and folate deficiency toxic (alcohol & vitamin B6 toxicity)Immune mediated neuropathy and inherited neuropathy).
- Family history of diabetes & neuropathy.
- Glucose tolerance test – Test for diabetes mellitus
- Nerve conduction test – It is the measurement of conduction of electrical signal through nerves.
- Electromyography- Measurement of electrical discharges produced by nerves into muscles.
- Quantitative sensory testing- Test to assess the response of nerves to temperature and vibration.
Treatment and Management of Diabetic Neuropathy –
(1) Treatment of Somatic Diabetic Neuropathy –
-Intensive insulin therapy
-Strict diet control
-Anticonvulsants (Gabapentins, pregabalin, carbomazepine etc.)
-Antidepressant (Amitriptyline, imipramine duloxetive)
-Opiates (kind of steroids)
-Antioxidants (α-lipoic acid)
(II) Treatment of Viseral Diabetic Neuropathy –
Treatment of Viseral Diabetic Neuropathy is devided in the following types on the basis of organ involved.
-Support/compression stocking (hosiery clothing which prenent and guard against venous disorders)
-Non-steroidal anti-inflammatory drugs (NSAIDS)
(b) Gastrointestinol :-
-Gastric pacemaker to improve delayed gatrine emptying
-Loperamide,clonideve,octreobide and other broad spectrum antibiotics to prevent diarrhea
-Stimulant laxatine (senna) for constipation
– Anticholinergic drugs (propantheline, poldine)
-Topical antimuscarinica agents (glycopyrrolate creams)to reduce sweating
(d) Erectile dysfunction
-Sildenafil, vardenafil, tadalfil tablets (to improve blood flow towards penis)
-Vacuum erection device
-Implanted penile prosthesis (device implanted into penis)
-Psychological counselling ; psychosexual therapy