Neuropathy is a microvascular complication which affects a large number of patients having diabetes mellitus. Diabetic neuropathies are the disorder of nerves which can affect any nerve in the body. These neuropathies are caused by diabetes and it is accompanied by pain that can be characterized as burning, prickling, shooting and pins and needles.
Diabetes mellitus is a serious health condition which occurs when the body does not properly process food for use as energy. It is characterized by the high blood glucose level in the body. Most of the food that we eat is turned into glucose so that the body can use it as an energy and with the help of insulin, this glucose gets into the cells of the bodies. When people have diabetes, it means that their body has either doesn’t produce enough insulin or can’t use insulin as it should. Diabetic neuropathy is one of the most common complications of diabetes mellitus and there are various factors that contribute to the development and progression of diabetic neuropathy. It is very well clear that the total amount of time nerves are exposed to high blood sugar level or uncontrolled diabetes is the key factor in the development of diabetic neuropathy. The excess sugar in the bloodstream slowly damages the nerve fibers over time. Also, an increased glucose level activates the polyol pathway which increases intracellular levels of fructose and sorbitol. In peripheral nerves, an increased sorbitol level leads to axonal edema which alters the neurologic function and as a result, the peripheral nerves become extremely sensitive to light touch and other minor sensations.
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Types of diabetic neuropathies
Peripheral neuropathy is one of the most common nerve damage due to diabetes and it is a general term that is used to describe any disorder that affects the peripheral nerves. Peripheral nerves send sensory information back to the brain and spinal cord and these nerves also carry signals from the brain and the spinal cord to the muscles to create movement. Any damage to these nerves can cause problems with the connections of these nerves. Peripheral nervous consists of sensory, motor and autonomic nerves.
- Sensory neuropathy - Sensory neuropathy is categorized into acute sensory neuropathy and chronic sensory neuropathy. Acute sensory neuropathy is rare and is characterized by the onset of severe sensory symptoms. Chronic sensory neuropathy is common in patients with diabetes and it is characterized by symptoms such as frequent electrical sensation, burning pain, and deep aching pain that become worse over time.
- Motor neuropathy- Motor neuropathy is characterized by immense weakness, and it involves extensor group of muscles rather than the flexor group of muscles.
- Autonomic dysfunction - Autonomic dysfunction is quite common and it leads to orthostatic, impotence in men and gastroparesis.
Proximal neuropathy is also known as diabetic femoral neuropathy or diabetic amyotrophy neuropathy and this type of neuropathy is more common in patients having diabetes type 2 as compared to patients having diabetes type 1. Proximal neuropathy is caused by the combinations of various factors such as autoimmunity, metabolic derangements, microvascular insufficiency, oxidative and nitrosative stress, and deficiencies in neurohormonal growth factors. Impaired blood flow and endoneurial microvasculopathy also play a critical role in the development of proximal neuropathy. Proximal neuropathy can have a gradual or acute onset and it is most common in people with age 50 or more. It is often accompanied by the pain in the hip, buttock or thigh and sometimes a diabetic patient with proximal neuropathy also experiences weight loss.
Diabetic autonomic neuropathy is one of the least recognized and the most serious complication of diabetes, affecting any part of the body and is accompanied by a large number of symptoms. The high glucose level in the body causes a number of changes such as metabolic, neurotrophic, vascular and immune changes that lead to damage and nerve fiber loss. Other than the duration of diabetes, the risk factors that are associated with the development of diabetic autonomic neuropathy include age, glycemic control, microvascular complications and other factors such as obesity, smoking, hypertension, and consumption of alcohol. Generally, the clinical symptoms of autonomic neuropathy do not occur until long after the onset of diabetes. Diabetic autonomic neuropathy is associated with various health complications such as erectile dysfunction, orthostatic hypotension, diabetic cystopathy, diabetic cardiomyopathy.
Focal neuropathy, also known as mono-neuropathy can be present in the people having diabetes mellitus. Focal neuropathy is classified into three types of neuropathies:
- Cranial Neuropathy - The elderly people are mostly affected by this type of focal neuropathy and involves third, fourth and sixth cranial nerves. It is accompanied by symptoms like eye pain, diplopia, and ptosis.
- Truncal Neuropathy - It is less common and it usually occurs in people who have diabetes for a long time and it is accompanied by other microvascular complications, especially peripheral neuropathy.
- Entrapment neuropathy - It is also known as pressure palsy and the median nerve is the most affected nerve.
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