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Diabetic neuropathy
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Definition
Common complication of diabetes, is damageto the nerves that allow you to feel sensations
such as pain.
There are a number of ways that diabetesdamages 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.
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Risk factors
Glucose control
Duration of diabetes
Damage to blood vessels
Mechanical injury to nerves
Autoimmune factors
Genetic susceptibility
Lifestyle factors Smoking
Diet
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Nerves of the Foot
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Causes
Lifestyle factors
Metabolic factors
Autoimmune factors Nerve and blood vessel factors
Nerve injury
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Pathophysiology
Metabolic factors
High blood glucose
Advanced glycation end products
Sorbitol
Abnormal blood fat levels
Ischemia
Nerve fiber repair mechanisms
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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.
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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.
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Classification of DN
Classified based on the affected nerves:-
Peripheral neuropathy
Autonomic neuropathyFocal neuropathy
Proximal neuropathy
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Peripheral Neuropathy
The areas of the body most commonly affected are thefeet and legs.
Nerve damage in the feet ;result in a loss of footsensation (foot problem).
Injuries and sores on the feet may go unrecognized dueto lack of sensation.
Should practice proper skin and foot care.
Symptoms may include: Tingling
Numbness (severe or long-term numbness can becomepermanent)
Burning (especially in the evening)
Pain
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Regions of the body
affected by peripheralneuropathy
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Autonomic neuropathy
Affects the autonomic nerves controlling
internal organs
Peripheral
Genitourinary
Gastrointestinal
Cardiovascular
To prevent, continuously keep your blood
sugar levels well controlled.
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Regions of the body
affected by autonomic
neuropathy
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Symptoms may include:-
Bloating
Diarrheal Constipation
Heartburn
Nausea
Vomiting Feeling full after small
meals
Blacking out when youstand up quickly
Increased heart rate
Dizziness
Low blood pressure
Decrease in vaginallubrication
Decrease in number oforgasms or lack of orgasm
Unable to completely emptybladder
Incontinence (leaking urine)
Increased urination at night
Nausea
Vomiting
Early fullness
erectile dysfunction
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Focal neuropathy
Appear suddenly and affect specific nerves, mostoften in the head, torso, or leg, causing muscleweakness 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 backor leg(s)
chest or abdominal pain that is sometimes mistakenfor another condition such as heart attack orappendicitis
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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 usuallyneeded and may include medication andphysical therapy.
The recovery varies, depending on the type of
nerve damage.
Prevention consists of keeping blood sugarunder tight control.
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Diagnosis
GTT/OGTT Foot examto assess sensation in the foot
Nerve conduction studiesto test nerve activity
Electromyographyto determine how muscles respond tonerve signals
Quantitative sensory testingthe use of stimuli (eg,vibration) to check for neuropathy
QSART (quantitative sudomotor axon reflex test) a testwhich evaluates the inervation of sweat glands.
Heart rate teststo determine how the heart responds tochanges
Ultrasoundto view internal organs
Biopsyto remove a sample of nerve or skin tissue forexamination
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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
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Prevention
Well controlled diabetes.
Patient education about foot care.
Inspect their feet regularly by physician. Avoid smoking.
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Complication
Cardiovascular autonomic neuropathy can causedeath.
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 tohyperosmolar nonketotic diabetic coma ordiabetic ketoacidosis and, hence, to death.
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