Disorders of carbohydrate metabolism are one of the most important problems of modern medicine. Diabetes mellitus is defined by WHO as an epidemic of non-communicable disease. Today there are about 130 million people with diabetes in the world , every 5 years the number of patients doubles, and thus, by 2025 there will be 300 million patients on the planet With acharial diabetes . In the Russian Federation, there is the same trend: currently there are about 8 million people with diabetes .
Medico-social severity of diabetes is determined solely by the early development of disability and high mortality from this disease. Diabetes mellitus is an independent risk factor for atherosclerosis, which accounts for almost half of deaths. In 86% of diabetes is the cause of blindness, in 30% of chronic renal failure . Diabetes mellitus accounts for 50% of all nontraumatic limb amputations performed in the world .
With aharny diabetes – the most common cause of neuropathy in developed countries (a little less than a third of all cases). In diabetes mellitus , any part of the nervous system can suffer, both somatic and vegetative, and therefore diabetic polyneuropathy (DPN) is heterogeneous and includes various clinical forms that have features of pathogenesis, clinical development and require specific approaches to therapy.
According to various studies, the incidence of neuropathy among patients with C diabetes mellitus varies widely – from 10 to 90%, depending on the research methodology and the applied diagnostic criteria ( Zeigler D. et. al ., 2009). In 5% of patients, neurological disorders are the first symptoms of the disease and make it possible to diagnose diabetes later . On average, the incidence of neuropathy among patients with C acharic diabetes is about 25%, with in-depth neurological research, it increases to 50%, and with the use of electrophysiological methods of research and quantitative sensitivity assessment – up to 90%. At the same time, it should be noted that diabetic polyneuropathy with severe manifestations is less common – about 5-10%.
With an increase in the duration of the disease, the frequency of diabetic polyneuropathy is steadily increasing. If at the time of diagnosis of C diabetes diabetic, clinical signs of polyneuropathy are detected in 8-12% of patients, then after 20 years, on average 50% of patients. The likelihood of developing polyneuropathy in type 1 and type 2 diabetes is about the same, but since type 2 diabetes can develop subclinically , polyneuropathy can be detected in a larger proportion of patients with newly diagnosed type 2 diabetes.
The incidence of diabetic polyneuropathy depends not only on the duration of diabetes, but also on the effectiveness of its treatment. With satisfactory control of the blood glucose level, the frequency of neuropathy after 15 years from the moment of the development of the disease does not exceed 10%, whereas with poor glycemic control it increases to 40-50%.
On the other hand, a direct relationship between the severity of diabetes and the likelihood of polyneuropathy is not always traced (severe forms of poly neuropathy are sometimes found in people with relatively mild diabetes — more often in middle-aged and elderly men, in type 2 diabetes).
According to EURODIAB IDDM Complication Study (2001), risk factors for diabetic polyneuropathy were older age, duration of diabetes aharny C, the level of glycosylated hemoglobin, huts ytochnaya body weight, the presence of about liferativnoy diabetic retinopa TII, high lipoprotei rows of low density (LDL), presence of cardiovascular pathologies. According to Seattle Prospective Diabetic Foot Study (1996), new associations were found, including increased diastolic blood pressure, the presence of moderate ketoacidosis , increased triglycerides , the presence of microalbuminuria .
Diabetic polyneuropathy manifests itself:
- pains in feet, legs,
- paresthesias (burning sensation, goosebumps, tingling),
- cramps calves at night,
- reduced sensitivity.
When there is no treatment for polyneuropathy due to diabetes, ulcers appear on the feet, leading to gangrene .
The reason that leads to polyneuropathy is blood sugar levels above normal. When diabetes is not controlled there is no compensation, which leads to complications. To slow the development of polyneuropathy in diabetes will help only means – careful control of glucose levels, proper insulin therapy for the first type of diabetes, or treatment of hypoglycemic drugs for the second type. Only compensation of diabetes helps to slow down the process of destruction of nerves until it stops. At the same time, the clinical manifestations of polyneuropathy cannot be quickly removed; an integrated approach is required.
Non-narcotic analgesics and NSAIDs for the elimination of pain, seizures, and other symptoms of polyneuropathy are almost ineffective. However, patients continue to try to eliminate the symptoms with these drugs, as they are available. With such a long-term “treatment”, the patient gets a minimal effect, but the side effects make themselves felt very soon with severe gastrointestinal diseases, disorders in the hematopoietic system and the liver.
The use of alpha- lipoic acid is justified. ( octolipen , thiogamma , berlinale , thiolipon ) in diabetic polyneuropathy . Preparations containing this substance exhibit a powerful antioxidant effect, reduce low-density cholesterol in the blood, and improve capillary blood flow. Initially, intravenous drip is prescribed for about 10 days, then transferred to oral forms for about 2 months.
In combination with lipoic acid it is necessary to apply vitamins of group B , which are neurotropic – B1, B6, B12. B 1 – improves the nutrition of nerve cells, B6 – improves nutrition and regenerates nerve tissue, B12 – restores the myelin sheaths of nerve fibers, thereby improving the transmission of nerve impulses. The course of simultaneous therapy with these vitamins for 4-6 weeks according to the prescribed regimen facilitates the manifestations of diabetic polyneuropathy . Combined with good blood sugar control, this can stop the progression of nerve damage.
When choosing drugs in group B, one should take into account the fact that lidocaine influences the body. In recent years, lidocaine provokes anaphylactic reactions even in those who have previously been administered this drug. This is associated with lethal outcomes. Patients with diabetes mellitus especially need to be protected from anaphylaxis, because they are considered to be weakened. The vitamins themselves without lidocaine combination are effective , but unfortunately, the combined drugs ( milgamma , combinationiline ) contain this substance in the composition. Therefore, it is advisable to administer monopreparations according to the scheme indicated by the doctor, even if this is not as convenient as using a combined preparation. Safety and efficiency – beyond convenience.
Vitamins are recommended intramuscularly, because when taking oral forms of absorption is about 30%. If the pain is very severe, the doctor prescribes anticonvulsants and anti-depressants.
In some cases, polyneuropathy develops rapidly despite the hypoglycemic discipline. But these are exceptions due to genetic factors and even if they are present, one cannot blame the diet and correct glucose control for inefficiency (it is not known how quickly polyneuropathy would develop without sugar control). Even in the early stages of complications, everything is in the hands of the patient.