DIABETIC NEUROPATHY

DIABETIC NERVE DAMAGES

We have already seen in our first post that what is diabetes mellitus (DM) and how it is developing and all other basics of its pathology and therapeutics.

Here we will see one of the DM's major complications the Diabetic Neuropathy which affects almost all parts of our body that are innervated.

Our entire body system needs energy for its daily activities. Our body gets its energy 100% from the burning of glucose a carbohydrate within each cell of all tissues including neuronal tissues of our body.

Glucose metabolism is basically regulated and maintained by a hormone known as insulin from the pancreatic beta islets of our body.

Lack of insulin impairs glucose metabolism and the cells would become depleted of energy, tired, and die. The tissues would be damaged and become ischemic.

These complications mostly happened in nerve tissues during DM and the result is Diabetic Neuropathy, the nerve damages of diabetes.

Normally the peripheral nerves are blood supplied by very small arteries known as vasa-nervorum. Diabetes damages and narrowing these arteries and thereby block the blood supply to the nerves.

Types of Conditions Associated With DN

1.Third nerve palsy

The third cranial nerve and its branches are supplied to our oculomotor system (Eye system)

Any damage to these third cranial nerves will affect the eye movements. The affected individual will feel difficult to move his eyes.

2.Mononeuropathy

In this condition, anyone nerve supply to the peripheral organ or part of our body is affected and that will result in loss of movement, sensation, and other functions of that nerve. The nerve is mostly supplied to outside the brain and spinal cord and hence it is known as peripheral neuropathy.

Mononeuropathy may affect any part of the peripheral organs or parts of the body leads to loss of sensations, weakness, paralysis, tingling, burning pain, and abnormal sensations.

3.Mononeuropathy multiplex 

In this condition as in mononeuropathy there instead of one nerve, there are two or three nerves are damaged.

4.Diabetic Amyotrophy

 Also known as lumbosacral-radiculoplexes-neuropathy, or femoral neuropathy. It is a polyneuropathy involved by many nerves supplied to the peripheral parts. This is the most common type among the other diabetic neuropathies which affects thighs, hips, buttocks, and legs. The symptoms are painful muscles, muscle wasting, and muscle weakness. It commonly occurs in type-2 DM patients.

The common symptoms start all of the sudden onsets with mild pain in the buttocks, hip, and thighs first on one side of the body followed by increased severity and then affect both sides. These symptoms develop and finally affect the lower limbs so that the patient cannot sit to stand or stand to sit without assistance.

5.Autonomic Neuropathy

In this, the nerve damages are extended to the Autonomic Nervous System (ANS) which controls our body's vital organs such as heart, lungs, liver, kidneys, and various other involuntary organs.

The symptoms are similar to autonomic deficiencies such as orthostatic hypotension or postural hypotension in which you feel the lower tension during when you change the position from sitting to standing.

Other symptoms are Dry mouth, Tachycardia, Tunnel vision, Difficulty swallowing, Bowel incontinence, Blurred vision, Urinary incontinence, Constipation, Anhydrosis, Sexual problems. In simple, there is adrenergic hyperactivity.

General Symptoms of DN

1.The trouble with balance while standing or walking

2.Numbness and tingling of extremities

3.Desensthesia, abnormal sensation to a body part.

4.Diarrhea

5.Erectile problems

6.Urinary incontinence

7.Facial and eye movement difficulties

8.Vision changes

9.Dizziness

10.Muscle weakness

11.Difficulty in swallowing

12.Speech difficulties

13.Retrograde ejaculation(ejaculation into the bladder instead of the urethra)

14. Face muscle twitching.

Treatments

Treatments are primarily the treatment for the DM-Type-2 followed by other symptoms control by 

1.Tricyclic antidepressants to releive pain,e.g.Amitryptylin;imipramin 

2.Selective Serotonin-Norepinephrin Reuptake Inhibitors(SSNRI) for pain releiving,e.g.venlafaxine,duloxetine

3.Selective Serotonin Reuptake Inhibitors SSRI),e.g.fluoxetin,paroxetin

4.Anti epileptic drugs,e.g.Pregabalin,and Gabapentin