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                        Diabetic Neuropathy

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[Up] [Hypoglycemia] [Diabetic Eye complications] [Diabetes and Kidney damage] [Diabetic Neuropathy] [Macrovascular complications] [Lipid disorder in diabetics] [Hypertension in diabetics] [Diabetic Ketoacidosis] [Diabetic Foot]

 

Diabetic Neuropathy. 

 

(Nerve involvement)

 

                                                                                                 

 

           Facial nerve damage                                    Wasting of muscles & joint deformities 

        (causing asymmetry of face)                           (due to damage to nerves supplying them)

 

Nerve damage.

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High glucose levels can damage nerve cells by making the nerve cells swell and scar and by preventing the nerves from sending signals properly. This can cause numbness and diminish your ability to feel in your feet.

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Commonest complication associated with diabetes.

 

Cause 

Poor glycemic control (sugar control) is the main factor in a diabetic.

Other contributory factors associated with an increasing prevalence of diabetic nerve disease are:
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Increasing age of patient,

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Increasing duration of diabetes,

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Presence of cardiovascular disease,

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Hypertension, 

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Dyslipidemias and a 

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Positive smoking history                                         

                                                                    

                                                            

Sensation loss in stocking and gloves areas

(marked red)

 

 

Nerve involvement.

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Most commonly distal nerves are affected (sensation loss in stocking and gloves areas), but motor nerves (responsible for movement of different body parts) and the autonomic nervous system (responsible for blood pressure control etc.) are also often involved.

 

Presentation:

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Sensation loss, numbness, sensation of pin prick, tingling sensation.

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"Burning feet syndrome" in which patient continuously experience burning sensation  in feet Severe pain in foot can also develop..

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Wasting of muscles due to damage to nerves supplying them.

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In severe cases of nerve damage, movement of body parts affected, joint deformities can develop, ulcers can form especially in limbs which can become infected and lead to gangrene and loss of limb. 

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Erectile sexual dysfunction is also common .

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Damage to cardiovascular nerves (supplying heart and blood vessels) can lead to sudden death.

 

Clinical presentations.   

Diabetic neuropathy has a varied clinical presentation.

 

Two of presentations associated with significant debility are:
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Distal Symmetrical Sensorimotor Polyneuropathy.

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Cardiovascular autonomic neuropathy.

 

Distal Symmetrical Sensorimotor Polyneuropathy.

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Commonest form of diabetic neuropathy.

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Manifests in three stages: Early, Symptomatic, Late.

 

Stages

 

Early. 

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Usually asymptomatic (without symptoms), but sensory loss may be detectable.

 

Symptomatic:

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Manifested by sensory loss, often with frank numbness and accompanied by paraesthesias (increased sensations), most commonly tingling or a sensation of pin prick; may also be accompanied by pain which in some cases may be severe enough to present as "Burning Feet Syndrome"

 

Severe:

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It is usually associated with motor involvement and accompanied by disabling symptoms; high potential for ulceration which may lead to infection, necrosis, gangrene and loss of limb.

 

Cardiovascular autonomic neuropathy.

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Possibly, a leading cause of sudden death.

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Parasympathetic damage (failure of heart rate , abnormal ECG)

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Followed later by sympathetic damage (marked fall in blood pressure with posture or failure to increase with exercise)

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Screening for the presence of cardiovascular autonomic neuropathy can be done by testing for heart rate control in response to deep breathing, or after standing from the lying position and / or circulatory response to the valsalva maneuver.

 

Management neuropathy

 

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