Diabetic neuropathy of the lower extremities: treatment for diabetes mellitus

Diabetic neuropathy is one of the complications of such an ailment as diabetes mellitus, characterized by damage to the entire nervous system. Against the background of the pathology, the cells of the nerve endings located in the brain are destroyed, while the processes that make up the nerve trunks are also affected.

Diabetes mellitus neuropathy manifests itself in different ways. The clinic depends on the department of the nervous system in which the work is disrupted. Most often, patients complain of a decrease or absolute loss of sensitivity, numbness, pain in the lower extremities.

The factors leading to the development of such a complication are distinguished: a high concentration of glucose in the patient’s body, arterial hypertension, a genetic factor, bad habits (alcohol abuse, tobacco smoking).

It is necessary to find out the pathogenesis of diabetic neuropathy, to find out the symptoms that indicate such a pathology. And also consider how the disease is classified, and how to cure the patient?

Classification and Symptoms of Diabetic Neuropathy

Knowing what diabetic neuropathy is, you need to consider the signs and symptoms that signal the disease.

The symptomatology of pathology is based on the part of the nervous system that is most affected. In other words, the signs of the disease can differ significantly, and it all depends on the damage in the patient’s body.

When the peripheral region is affected, the symptoms make themselves felt after two months. This circumstance is associated with the fact that in the human body there is a huge number of nerve endings, and at first the viable nerves take over the functionality of the damaged ones.

Diabetic peripheral neuropathy is characterized by the initial involvement of the hands and feet.

Classification of diabetic neuropathy:

  • Symmetrically generalized polyneuropathy syndrome: sensory neuropathy, motor neuropathy, sensorimotor disease, hyperglycemic pathology.
  • Diabetic autonomic neuropathy: urogenital, respiratory, sudomotor, cardiovascular.
  • Focal neuropathy: tunnel, cranial, plexopathy, amyotrophy.

Sensory neuropathy is called the defeat of the susceptibility of nerve endings, to a symmetrical distortion of human sensations. For example, one leg will be more sensitive than the other. Due to the fact that nerves are affected during the pathology, incorrect transmission of signals from skin receptors to the brain occurs.

The following symptoms are observed:

  1. High susceptibility to stimuli (“goosebumps” crawl along the limbs, burning sensation, itching, periodic sharp pains for no reason).
  2. A negative reaction to any stimulus. “Mild irritant” can be the result of severe pain syndrome. For example, a patient may wake up at night in pain due to the touch of a blanket.
  3. Decrease or absolute loss of susceptibility. Initially, there is a loss of sensitivity of the upper limbs, then the lower limbs suffer (or vice versa).

Diabetic motor neuropathy is characterized by damage to the nerves responsible for movement, which regulate the transmission of signals from the brain to the muscles. Symptoms develop rather slowly, a characteristic sign of this condition is an increase in symptoms during sleep and rest.

The clinical picture of such a pathology is characterized by loss of stability when walking, disruption of the musculoskeletal system, limitation of joint mobility (edema and deformation), muscle weakness.

Autonomic diabetic neuropathy (also called autonomic neuropathy) is a consequence of a violation of the functionality of the nerves of the autonomic part of the nervous system, which is responsible for the functioning of internal organs.

Symptoms of autonomic neuropathy in type 2 diabetes:

  • Disruption of the digestive tract (hard to swallow, pain in the stomach, bouts of vomiting).
  • Dysfunction of the pelvic organs.
  • Dysfunction of the heart.
  • Changes in the skin.
  • Visual impairment.

Optical neuropathy is a pathology that can lead to a loss of visual perception of a long-term or temporary nature.

The urogenital form of diabetic neuropathy is characterized by impaired bladder tone, as well as damage to the ureters, which may be accompanied by urinary retention or incontinence thereof.

Distal neuropathy occurs in almost half of patients with diabetes mellitus. The danger of pathology lies in the irreversibility of damage. Distal neuropathy of the lower extremities is characterized by loss of sensitivity of the legs, pain syndrome and various sensations of discomfort – tingling, burning, itching.

Diagnosis of pathology

Diabetic neuropathy has many branches, each of which has a characteristic characteristic of it. To diagnose diabetic neuropathy, the doctor first takes a history of the patient.

To obtain the most complete clinical picture, a special scale and questionnaires are used. For example, a scale of signs of a neuralgic nature, a general scale of symptoms, and others are used.

During a visual examination, the doctor examines the joints, looks at the condition of the foot, foot and palms, the deformation of which indicates neuropathy. Determines whether there is redness, dryness and other manifestations of the disease on the skin.

During an objective examination of the patient, such an important symptom as exhaustion and other minor signs is revealed. Diabetic cachexia can be extreme when the patient is completely devoid of subcutaneous fat and abdominal fat.

After the examination, a vibration sensitivity test is performed. By means of a special vibration device, which the doctor presents to the big toe or other areas. This study is carried out three times. If the patient does not feel the vibration frequency of 128 Hz, then this indicates a decrease in susceptibility.

To determine the type of pathology, and find out how to treat it further, the following diagnostic measures are taken to determine diabetic neuropathy:

  1. Tactile sensitivity is determined.
  2. The temperature sensitivity is determined.
  3. Pain sensitivity is determined.
  4. Reflexes are assessed.

Diabetic neuropathy is characterized by a varied course, therefore, in the overwhelming majority of cases, all diagnostic measures are carried out without exception.

Treatment of neuropathy is a complex, laborious and costly process. But with the timely start of therapy, the prognosis is favorable.

Diabetic neuropathy treatment

Treatment of diabetic neuropathy is based on three areas. Firstly, it is necessary to reduce the concentration of sugar in the blood, secondly, to make the patient feel better, to stop the pain syndrome, and, thirdly, to restore the damaged nerve fibers.

If the patient has diabetic neuropathy, treatment begins with blood sugar correction. The main task is to normalize glucose and stabilize it at the required level. For this, drugs are recommended that help reduce sugar in the patient’s body.

Blood sugar lowering pills are divided into three groups. The first category includes drugs that increase the production of insulin in the human body (Gliclazide). 

The second category includes drugs that increase the sensitivity of soft tissues to the hormone – Metformin. And the third group includes tablets that partially block the absorption of carbohydrates in the gastrointestinal tract – Miglitol.

It should be noted that with this genesis, the doctor selects drugs individually for each patient. The frequency of administration and dosage of the drug for type 1 and type 2 diabetes can differ significantly.

It so happens that it is possible to stabilize blood sugar, but the patient has an exacerbation of diabetic neuropathy. This symptom can only be removed with pain relievers, and it suggests that the changes in the human body are reversible, the nerve fibers have begun to recover.

Drugs for pain relief and restoration of nerve function:

  • Thiolepta (contains alpha lipoic acid). The medicine helps to regulate metabolic processes, protects nerve cells from the effects of toxic substances and free radicals.
  • Cocarnit is a complex of vitamins and substances that affect human metabolism. It has analgesic and neurometabolic effects. Cocarnit is injected intramuscularly, 1-2 ampoules per day. The duration of therapy always varies depending on the specific clinical picture.
  • Nimesulide (non-steroidal anti-inflammatory drug) helps relieve swelling of the nerves, relieves pain.
  • Mexiletin (an antiarrhythmic agent) provides blockages of sodium channels, as a result of which the transmission of pain impulses is impaired, and helps to normalize the heart rhythm.

In diabetic neuropathy, the symptoms are significantly different, which is why two or more medications are always used to obtain the required therapeutic effect.

It should be noted that the painful form of diabetic neuropathy requires the simultaneous administration of analgesic drugs, anticonvulsants in combination.

Any drug has its own side effects, so it is prescribed exclusively by the attending physician.

Prevention of pathology

Diabetic neuropathy is a complex disease with many consequences for the patient. But this diagnosis can be prevented. The basic rule is glucose control in the patient’s body.

It is a high glucose level that is a serious risk factor for loss of functionality by nerve cells and endings. There are certain preventive measures that will help prevent complications and serious consequences against the background of the underlying disease.

Observing the first signs of pathology, you should immediately consult a doctor. It is he who will prescribe adequate treatment. It is known that any disease is easier to treat at the initial stages of development, and the chances of controlling the pathology increase several times.

You need to control blood sugar levels, follow a low-carbohydrate diet for diabetics, and inform your doctor about the slightest changes in the body. 

It is necessary to lead an active lifestyle, play sports, daily walks in the fresh air (at least 20 minutes), morning exercises are equally important. It is recommended to engage in physiotherapy exercises.

Diabetic neuropathy is fraught with numerous complications, but with a timely visit to the doctor, success in therapy is ensured. If you stabilize glucose in the body at the required level and ensure better functioning of the nervous system, then all symptoms will disappear literally after 1-2 months.

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