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Diabetic neuropathies are nerve damaging disorders associated with diabetes mellitus. These conditions are thought to result from a diabetic microvascular injury involving small blood vessels that supply nerves vasa nervorum in addition to macrovascular conditions that can accumulate in diabetic neuropathy. Relatively common conditions which may be associated with diabetic neuropathy include third, fourth, or sixth cranial nerve palsy  ; mononeuropathy ; mononeuropathy multiplex; diabetic amyotrophy ; a painful polyneuropathy; autonomic neuropathy ; and thoracoabdominal neuropathy.
Diabetic neuropathy affects all peripheral nerves including sensory neuronsmotor neuronsand also affects the autonomic nervous system. Therefore, diabetic neuropathy can affect all organs and systems, as all are innervated. There are several distinct syndromes based on the organ systems and members affected, but these are by no means exclusive.
A patient can have sensorimotor and autonomic neuropathy or any other combination. Signs and Neuritis bei Diabetes vary depending on the nerve s affected and may include symptoms other than those listed. Symptoms usually develop gradually over years.
Vascular and neural diseases are closely related and intertwined. Blood vessels depend Neuritis bei Diabetes normal nerve function, and nerves depend on adequate blood flow.
The first pathological change in the small blood vessels is narrowing Neuritis bei Diabetes the blood vessels.
As the disease progresses, neuronal dysfunction correlates closely with the development of blood vessel abnormalities, such as capillary basement membrane thickening and endothelial hyperplasia, which contribute to diminished oxygen tension and Neuritis bei Diabetes. Neuronal ischemia is a well-established characteristic of diabetic neuropathy. Neuritis bei Diabetes vessel Neuritis bei Diabetes agents e. Thus, small blood vessel dysfunction occurs early in diabetes, parallels the progression of neural dysfunction, and may be sufficient to support the severity of structural, functional, and clinical changes observed in diabetic neuropathy.
Elevated levels of glucose within cells cause Neuritis bei Diabetes non-enzymatic covalent bonding with proteinswhich alters their structure and inhibits their function.
Some of these glycated proteins have been implicated in the pathology of diabetic neuropathy and other long-term complications of diabetes. Longer nerve fibers are affected to a greater degree than shorter ones because nerve conduction velocity is slowed in proportion to a nerve's length.
In this syndrome, decreased sensation and loss of reflexes occurs first in the toes on each foot, then extends upward. It is usually described as a glove-stocking distribution of numbness, sensory loss, dysesthesia and night time pain. The pain can feel like burning, pricking sensation, achy or dull. A pins and needles sensation is common. Loss of proprioceptionthe sense of where a limb is in space, is affected early. These Neuritis bei Diabetes cannot feel when they are stepping on a foreign body, like a splinter, Neuritis bei Diabetes when they are developing a callous from an ill-fitting shoe.
Consequently, they are at risk of developing ulcers and infections on the feet and legs, which can lead to amputation. Similarly, these patients can get multiple fractures of the knee, ankle or foot, and develop a Charcot joint. Loss of motor function results in dorsiflexion, contractures of the toes, loss of the interosseous muscle function that leads to contraction of the digits, so-called hammer toes. These contractures occur not only in the foot but also in the hand where the loss of the musculature makes the hand appear Neuritis bei Diabetes and skeletal.
The loss of muscular function is progressive. The autonomic nervous system is composed of nerves serving the heartlungsblood vesselsboneadipose tissuesweat glandsgastrointestinal Neuritis bei Diabetes and genitourinary system.
Autonomic neuropathy can affect any of these organ systems. The most commonly recognized autonomic dysfunction in diabetics is orthostatic hypotensionor becoming dizzy and possibly fainting when standing up due to a sudden drop in blood pressure. In the case of diabetic autonomic neuropathy, Neuritis bei Diabetes is Neuritis bei Diabetes to the failure of the heart and arteries to appropriately adjust heart rate and vascular tone to keep blood continually and fully flowing to the brain.
This symptom is Neuritis bei Diabetes accompanied by a loss of respiratory sinus arrhythmia — the usual change in heart rate seen with normal breathing. These two findings suggest autonomic neuropathy.
GI tract manifestations include gastroparesisnauseabloatingand diarrhea. Because many diabetics take oral medication Neuritis bei Diabetes their diabetes, absorption of these medicines is greatly affected by the delayed gastric emptying. This can lead to hypoglycemia when an oral diabetic agent is taken before a meal and does not get Neuritis bei Diabetes until hours, or sometimes days later when there is normal or low blood sugar already.
Sluggish movement of the small intestine can cause bacterial overgrowth, made worse by the presence of hyperglycemia. This leads to bloatinggas and diarrhea. Urinary symptoms include urinary frequency, urgency, incontinence and retention. Again, because of the retention of urineurinary tract infections are frequent. Urinary retention can lead to bladder diverticulastones, reflux nephropathy.
When cranial nerves are affected, neuropathies of the oculomotor nerve cranial nerve 3 or CNIII are most common. The oculomotor nerve controls all the muscles that move the eye except for the lateral rectus and superior oblique muscles. It also serves to constrict the pupil and open the eyelid. The onset of a diabetic third nerve palsy is usually abrupt, beginning with frontal or pain around the eye and then double vision.
All the oculomotor muscles innervated by the third nerve may be affected, but those that control pupil size are usually well-preserved early on. This is because the parasympathetic nerve fibers within CNIII that influence pupillary size are found Neuritis bei Diabetes the periphery of the nerve in terms of a cross-sectional viewwhich makes them less susceptible to ischemic damage as they are closer to the vascular supply. The sixth nerve, the abducens nervewhich innervates the lateral rectus muscle of the eye moves the eye laterallyis also commonly affected but fourth nerve, the trochlear nerveinnervates the Neuritis bei Diabetes oblique muscle, which moves the eye downward involvement is unusual.
Damage to a specific nerve of the thoracic or lumbar spinal nerves can occur and may lead to painful syndromes that mimic a heart attackgallbladder inflammationor appendicitis. Diabetics have a higher incidence of entrapment neuropathies, such as carpal Neuritis bei Diabetes syndrome. Diabetic peripheral neuropathy is the most likely diagnosis for someone with diabetes who has pain in a leg or Neuritis bei Diabetes, although it may also be caused by vitamin B 12 deficiency or osteoarthritis.
A review in the Journal of the American Medical Association 's "Rational Clinical Examination Series" evaluated the usefulness of the clinical examination in diagnosing diabetic Neuritis bei Diabetes neuropathy. Normal results on vibration testing LR range, 0. Combinations of signs do not perform better than these 2 individual findings. Diabetic neuropathy encompasses a series of different neuropathic syndromes which can be schematized Neuritis bei Diabetes the following way: .
Prevention is by good blood sugar control and exercise. A systematic review concluded that " tricyclic antidepressants and traditional anticonvulsants are better for short term pain relief than newer generation anticonvulsants. The only three medications approved by the United States' Food and Drug Administration for diabetic peripheral neuropathy DPN are the Neuritis bei Diabetes duloxetinethe anticonvulsant pregabalinand the long-acting opioid tapentadol ER.
Multiple guidelines from medical organizations such as Neuritis bei Diabetes American Association of Neuritis bei Diabetes EndocrinologistsAmerican Academy of NeurologyEuropean Federation of Neurological Societiesand the National Institute of Clinical Excellence recommend AEDssuch Neuritis bei Diabetes pregabalinas first-line treatment for painful diabetic neuropathy.
A systematic review and network meta-analysis concluded topiramatevalproic acidlacosamideand lamotrigine are ineffective for pain from diabetic peripheral neuropathy. As above, the serotonin-norepinephrine reuptake inhibitors SNRIs duloxetine and venlafaxine are recommended in multiple medical guidelines as first or second-line therapy for DPN.
SSRIs include fluoxetineparoxetinesertralineand citalopram have been found to be no more efficacious than placebo in several controlled trials and therefore are not recommended to treat painful diabetic neuropathy. Side effects are rarely serious and do not cause any permanent disabilities.
They cause sedation and weight gain, which can worsen a diabetic person's glycemic Neuritis bei Diabetes. They can be used at dosages that also relieve the symptoms of depressiona common comorbidity of diabetic neuropathy.
TCAs include imipramineamitriptylinedesipramineand nortriptyline. They are generally regarded as first or second-line treatment for DPN. Additional common side effects include dry mouthdifficulty sleepingand sedation.
Among the TCAs, amitriptyline is most widely used for this condition, but desipramine and nortriptyline have fewer side effects. Typical opioid medications, such as oxycodoneappear to be no more effective than placebo. In contrast, low-quality evidence supports a moderate benefit from the use of atypical opioids e.
Capsaicin applied to the skin in a 0. There is insufficient evidence to draw conclusions for more concentrated forms of capsaicin, clonidineor lidocaine applied to the skin. Low-quality evidence supports a moderate-large beneficial effect of botulinum toxin injections. There is insufficient evidence to draw firm conclusions for the utility Neuritis bei Diabetes the cannabinoids nabilone and nabiximols. Monochromatic infrared photo energy treatment MIRE has been shown to be an effective therapy in reducing and often eliminating pain associated with diabetic neuropathy.
The infrared light energy prompts the cytochrome C to release nitric oxide into the cells. The nitric oxide in turn promotes vasodilation which results in increased blood flow that helps nourish damaged nerve cells. Physical therapy may help reduce dependency on pain relieving drug therapies. Certain physiotherapy techniques can help alleviate symptoms brought on from diabetic neuropathy such as deep pain in the feet and legs, tingling or burning sensation in extremities, muscle crampsmuscle weaknesssexual dysfunctionand diabetic foot.
Neuritis bei Diabetes electrical nerve stimulation TENS and interferential current IFC use a painless electric current and the physiological effects from low frequency electrical stimulation to relieve stiffnessimprove mobility, relieve neuropathic pain, reduce oedemaand heal resistant foot ulcers. Exercise programs, along with manual therapywill help to prevent muscle contractures, spasms and atrophy.
Heat, therapeutic ultrasound hot wax  are also useful for treating diabetic neuropathy. Treatment of early manifestations of sensorimotor polyneuropathy involves improving glycemic control. Conversely, painful symptoms of neuropathy in uncontrolled diabetics tend to subside as the disease and numbness progress. The Neuritis bei Diabetes of diabetic neuropathy are poorly understood. At present, treatment alleviates pain and can control some associated symptoms, but the process is generally progressive.
As a complication, there is an increased risk of injury to the feet because of loss of Neuritis bei Diabetes see diabetic foot. Small infections can progress to ulceration and this may require amputation.
Diabetes is the leading known cause of neuropathy in developed countries, and neuropathy is the most common complication and greatest source of morbidity and mortality in diabetes. The main risk factor for diabetic neuropathy is hyperglycemia. The progression of neuropathy is dependent on the degree of glycemic control in both Type 1 and Type 2 diabetes.
Duration of Neuritis bei Diabetes, agecigarette smoking, hypertensionheight, and hyperlipidemia are also risk factors for diabetic neuropathy. From Wikipedia, the free encyclopedia. Diabetic neuropathy Specialty Endocrinology Diabetic neuropathies are nerve damaging disorders associated with diabetes mellitus. Main article: Microangiopathy.