Polyneuropathy. Dysmetabolic (autonomous, hereditary, distal, sensorimotor, amyloid) polyneuropathy
A prolonged excess of glucose in the blood, having a destructive effect on blood vessels, is no less destructive for nervous system. Polyneuropathy is a severe complication of diabetes mellitus, which can affect several large plexuses of peripheral nerves that control the functions of the lower extremities.
What is diabetic polyneuropathy
Multiple lesions of nerve fibers are observed in patients suffering from diabetes mellitus for more than one decade, in 45-54% of cases. The role of peripheral nervous regulation of the body is extremely important. This system of neurons controls the brain, heartbeat, breathing, digestion, and muscle contraction. Diabetic polyneuropathy of the lower extremities (DPN) is a pathology that begins in the feet and then spreads higher and higher.
Pathogenetic mechanism The disease is very complex and is not fully understood by scientists. Disorders of the functions of the peripheral nervous system are diverse. Each type of DPN has its own clinical picture. However, all forms of this complication are dangerous and require patient treatment, otherwise a problem with legs can turn a person into a disabled person. Diabetic polyneuropathy is encrypted by doctors under the code G63.2 according to ICD-10, indicating the variant of the disease.
Types of neuropathy
Since the peripheral nervous system is divided into somatic and autonomic (vegetative), two types of diabetic polyneuropathy are also called. The first gives rise to multiple non-healing trophic ulcers of the lower extremities, the second - problems with urination, impotence and cardiovascular accidents, often with fatal outcomes.
Another classification is based on the functions of the nervous system that are disrupted as a result of the development of pathology:
- sensory polyneuropathy associated with increased painful sensations in the leg area, or, conversely, with loss of tactile sensitivity;
- motor polyneuropathy, which is characterized by muscular dystrophy and loss of the ability to move;
- sensorimotor polyneuropathy, combining the features of both of these complications.
A manifestation of the latter, mixed pathology is neuropathy of the peroneal nerve. Diabetics with this disease do not feel pain in certain places of the foot and lower leg. These same parts of the surfaces of the legs do not react to either cold or heat. In addition, patients lose the ability to control their feet. Patients are forced to walk, raising their legs unnaturally high ("rooster" gait).
Diabetic distal polyneuropathy
This is a pathology that causes the death of nerve fibers. The disease leads to a complete loss of tactile sensitivity and ulceration of the farthest part of the lower extremities - the feet. The typical condition for diabetics with distal DPN is dull, It's a dull pain, which is often so strong that a person cannot sleep. In addition, sometimes my shoulders begin to ache. Polyneuropathy progresses, and this leads to muscle atrophy, bone deformation, flat feet, and foot amputation.
Peripheral
With this type of disease, severe disorders sensorimotor functions of the legs. Diabetics suffer from pain and numbness not only in their feet, ankles, lower legs, but also in their hands. Peripheral polyneuropathy occurs mainly when doctors prescribe potent antiviral drugs with serious side effects: Stavudine, Didanosine, Saquinavir, Zalcitabine. It is important to diagnose this pathology in a timely manner in order to immediately discontinue the drug.
Sensory polyneuropathy
The main feature of the pathology is loss of sensation in the legs, the degree of which can vary significantly. From minor tingling to complete numbness, accompanied by the formation of ulcers and deformation of the feet. At the same time, the lack of sensitivity is paradoxically combined with unbearable severe pain that arise spontaneously. The disease first affects one leg, then often moves to the second, rising higher and higher, affecting the fingers and hands, torso, and head.
Dysmetabolic
The occurrence of this type of complication is often provoked, in addition to diabetes, by diseases of the stomach, intestines, kidneys, and liver. Many nerve plexuses of the extremities may be affected. When the sciatic and femoral neurons are disturbed, pain, trophic ulcers, difficulties with movement appear, knee and tendon reflexes disappear. The elbow, trigeminal, and optic nerves. Dysmetabolic polyneuropathy can occur without pain.
Why do people with diabetes develop neuropathy?
main reason– high blood glucose levels and prolonged insulin deficiency. The deterioration of cellular metabolism has a detrimental effect on peripheral nerve fibers. In addition, diabetic leg polyneuropathy can be caused by:
- endocrine disorders;
- severe liver or kidney diseases;
- depression, weakened immunity;
- infections;
- alcohol abuse;
- poisoning with toxic chemicals;
- tumors.
Symptoms
The main manifestations of the disease of all types:
- Sensitive symptoms – pain, weakening or worsening of the perception of temperature changes, vibration.
- Motor symptoms - convulsions, tremors, muscle atrophy limbs.
- Autonomic symptoms - edema, hypotension, tachycardia, stool disorders, impotence.
Burning and tingling in the legs
The feeling that the soles of the feet are on fire occurs when the peripheral nerve fibers that run from the spine to the feet are damaged. Burning feet are not a disease, but a symptom that manifests itself in polyneuropathy in diabetes mellitus. Damaged neurons are activated and send false pain signals to the brain, although the soles of the feet are intact and there is no fire.
Loss of sensation in the foot
At first, the diabetic experiences weakness and numbness in the feet. Then these sensations arise in the legs and hands. As lower extremity polyneuropathy progresses, muscle atrophy increases and tactile sensitivity decreases. The feet become difficult to control and droop. The hands become numb, starting from the fingertips. With a long-term pathological process, loss of sensitivity affects part of the body in the chest and abdomen.
Diagnosis of the disease
Polyneuropathy of the lower extremities is detected using the following methods of examining the patient:
- testing unconditioned reflexes;
- pain sensitivity test;
- checking response to vibration;
- thermal test;
- cutaneous nerve biopsy;
- Electroneuromyography (ENMG), which can show whether nerve impulses travel along muscle fibers.
Treatment of diabetic polyneuropathy of the lower extremities
Such complications cannot be completely cured, but their development can be slowed down. How to treat neuropathy of the lower extremities? The main condition is the normalization of blood glucose. Analgesics, spacious shoes, minimal walking help reduce pain, cool baths. Cold and hot shower relieves burning feet. It is necessary to use drugs that expand peripheral vessels affecting the transmission of nerve impulses. Treatment of polyneuropathy of the lower extremities becomes more effective when taking B vitamins. It is also important to correct carbohydrate metabolism with diet.
Drug therapy
Fixed assets for complex treatment patients diagnosed with polyneuropathy of the lower extremities:
- antidepressants Amitriptyline, Imipramine, Duloxetine, blocking the reuptake of the hormones norepinephrine and serotonin;
- anticonvulsants Pregabalin, Carbamazepine, Lamotrigine;
- analgesics Targin, Tramadol (doses are strictly limited - drugs!);
- vitamin complex Milgamma;
- Berlition (thioctic or alpha lipoic acid), which has the ability to restore damaged nerves;
- Actovegin, which improves blood circulation nerve endings;
- Isodibut, Olrestatin, Sorbinil, protecting nerves from glucose;
- antibiotics - if there is a threat of gangrene development.
Treatment without drugs
The hope of being cured with the help of homemade or folk remedies alone is a utopia. It is necessary to take medications and actively use:
- magnetic therapy;
- electrical stimulation;
- hyperbaric oxygen therapy;
- acupuncture;
- massage;
- Exercise therapy (physical therapy).
Video
Diabetic polyneuropathy (distal type, sensory form) is one of the most common complications of diabetes mellitus. In type II diabetes mellitus, by the time of diagnosis, clinical manifestations of distal sensory polyneuropathy are detected in 20–25%, and with a disease duration of more than 10 years - in almost 50% of patients. Unlike diabetic retinopathy and nephropathy, diabetic polyneuropathy can be accompanied by active clinical symptoms. Neurologists at the Yusupov Hospital use modern methods diagnostics The latest equipment from leading European and American manufacturers is used to examine patients.
Innovative techniques are used to treat patients. Complex therapy for diabetic distal polyneuropathy at the Yusupov Hospital includes:
- control of blood glucose levels and compensation of diabetes mellitus;
- normalization of blood pressure;
- dietary food;
- patient education;
- lifestyle change.
Neurologists prescribe the most effective drugs with a minimal spectrum to patients suffering from diabetic polyneuropathy. side effects. Rehabilitation specialists restore impaired motor puncture using modern physiotherapy therapeutic methods. Chefs cooking dietary dishes, the quality of which does not differ from home cooking. During treatment, patients stay in wards with a European level of comfort.
Mechanisms of development of distal diabetic polyneuropathy
The pathogenesis of diabetes mellitus is based on toxic effect high content blood glucose. It develops due to insufficient production of insulin or a defect in its action, or a combination of both. The aggressive effect of hyperglycemia leads to the development of diabetic angiopathy. The pathological process affects small vessels (microangiopathy) and medium and large vessels (macroangiopathy).
The toxic effect of high glucose concentrations is also realized in other ways, in particular by activation of protein glycosylation processes. As a result of the non-enzymatic attachment of glucose molecules to the amino groups of proteins, structural protein components are damaged cell membranes, proteins of the circulation system. This leads to disruption of exchange, transport and other vital important processes in organism.
With a high concentration of glucose in the blood, ketoaldehydes of free radicals begin to form, and oxidative or metabolic stress develops. The balance between pro-oxidants and components of the antioxidant defense system is disrupted in the body. It is accompanied by insulin deficiency or insulin resistance of varying severity.
Insufficient activity of antioxidant enzymes in diabetes mellitus is determined by genetic factors. Ischemia (insufficient blood supply), hypoxia (oxygen starvation) and tissue pseudohypoxia, which are observed in diabetes mellitus, are additional factors. They increase the formation of reactive oxidants in various organs and fabrics.
Diabetic polyneuropathy is a consequence of widespread damage to neurons and their processes in the central and peripheral nervous system. Due to the disruption of regeneration processes in diabetes mellitus, progressive death of neurons occurs.
All parts of the peripheral nervous system are affected:
- the number of axons in the trunks of peripheral nerves decreases (with a predominance of defects in the distal sections of neurons);
- the number of cells in the dorsal ganglia and anterior horns decreases spinal cord;
- foci of segmental demyelination and remyelination appear;
- degenerative changes develop in the cells of the sympathetic ganglia and autonomic nerves.
Typically, this results in degeneration of both myelin and axial cylinders. The pathological process spreads from distal to proximal parts. Axonal degeneration causes muscle atrophy and denervation changes in myography, in contrast to purely demyelinating lesions. Products such as amyloid, ceramide, sulfatide, and galactocerebroside accumulate in the cytoplasm and axoplasm of Schwann cells. Characteristic changes occur in blood vessels and connective tissue formations of nerve trunks:
- proliferation and hypertrophy of endothelial cells;
- thinning and doubling basement membrane capillaries;
- an increase in the number of empty capillaries;
- a decrease in the density of the endoneurial capillary bed with the presence of many aggregates of blood cells;
- increased interfascicular spaces and collagen deposits.
Risk factors for the development of diabetic polyneuropathy include the duration of the disease, the degree of hyperglycemia, male gender, patient age, and tall stature.
Symptoms of diabetic distal polyneuropathy
Diabetic polyneuropathy (sensorimotor form, distal type) is a complication of diabetes mellitus, in which multiple lesions of peripheral nerves develop. It is expressed by peripheral paralysis, vegetative-vascular disorders in remote parts of the extremities. The first sign of the disease is a violation normal functioning fingers and toes. Over time, if left untreated, it covers increasingly larger areas of the arms and legs. One of the characteristic symptoms of diabetic polyneuropathy is the symmetrical appearance discomfort in all limbs.
The main signs of the disease include:
- muscle atrophy, which begins as muscle weakness that progresses with high speed;
- imbalance in sensitivity;
- dysfunction of tactile sensation;
- increased pain;
- constant sensation of goosebumps on the skin, tingling throughout the body.
At the first stage of the disease, the patient does not experience pain. Neurologists notice certain changes in nervous tissue using special devices - electroneuromyographs. At this stage, it is difficult to diagnose the disease.
The second stage of the disease is characterized by the occurrence of pain, burning or numbness in the extremities, and a change in the sensitivity threshold. At the third stage of diabetic distal sensory polyneuropathy of the lower extremities, ulcers form on the skin of the feet and legs. They are practically painless and develop in 75% of patients if left untreated. Ulcers in 15% of patients lead to the need for limb amputation.
When a patient is admitted to the neurology clinic, doctors at the Yusupov Hospital determine temperature, pain, tactile and vibration sensitivity in the extremities for a comprehensive assessment of distal peripheral neuropathy. Temperature sensitivity is considered reduced if there is an error in determining the warm and cold sides of the sensor. A sign of missing sensitivity is the patient’s inability to determine the difference when touching the warm and cold sides of the device. Tactile sensitivity is assessed as normal, reduced (the patient does not feel the touch of the cotton wool) or absent (the patient does not feel the touch of either the cotton wool or the hand).
Vibration sensitivity is assessed using biothesiometry as normal (up to 9 V), reduced (from 10 to 25 V), absent (from 25 V and above). Pain sensitivity is assessed using an injection needle. It is considered reduced if the patient makes a mistake in determining the sharp and blunt sides of the needle or sensitivity is reduced compared to proximal parts limbs. If the patient does not feel the injection, they speak of lack of sensitivity.
Using the method of stimulation electroneuromyography, neurophysiologists at the Yusupov Hospital determine the functional state of the motor fibers of the peripheral nerve and the severity of peripheral distal diabetic polyneuropathy, the speed of impulse conduction along the motor fibers of the mixed nerve and the parameters of the M-response to a single irritation from the extensor muscle thumb. Doctors functional diagnostics analyze the following electroneuromyographic parameters: impulse conduction velocity (ICV) and M-response amplitude. M-response is the total electrical potential of a muscle in response to a single electrical stimulation of a motor or mixed nerve. The amplitude of the M response reflects the timing and amount of activation of the muscle's motor units. The death of some motor neurons leads to a decrease in the amplitude of the M-response.
SPI is the speed of action potential propagation along nerve fibers. This is a calculated indicator based on the latencies of two M-responses (for motor fibers). The SPI calculated in this way reflects the conduction velocity along the most highly conductive fibers. In patients suffering from peripheral sensory diabetic polyneuropathy, electroneuromyography is used to detect dysfunction of the motor fibers of the peripheral nerve, impaired temperature sensitivity, absence or decrease in pain, vibration and tactile sensitivity.
Treatment of diabetic sensory distal polyneuropathy
There are no approved and fail-safe standards for the treatment of diabetic polyneuropathy. Doctors at the Yusupov Hospital pay special attention to preventing the onset of the disease and progression of symptoms. Patients treated in the neurology clinic are monitored by an endocrinologist. Doctors carefully monitor blood glucose levels. It is maintained at a level close to the target and to normal level glycosylated hemoglobin. To maintain optimal glucose concentrations, both insulin injections and a complex of antidiabetic drugs are used.
Patients are recommended dietary nutrition and the required amount of physical activity, which will ensure normal work the body, keeping it in good shape. When trophic disorders occur on the skin medical staff provides care for the affected areas: applies ointments that relieve pain or normalize the sensitivity of the limbs.
Widely used for the treatment of diabetic polyneuropathy alpha lipoic acid and preparations containing benfotiamine. One of the effective therapeutic methods is also the use of tricyclic antidepressants, which block pain syndrome. Neurologists take into account contraindications to the use of these drugs, begin therapy with minimal doses, increasing to optimal doses. Doctors carefully monitor the side effects of tricyclic antidepressants (dry mouth, drowsiness, weakness), adjust the dosage and change medications.
The leading element of treatment that affects the mechanisms of development of diabetic distal sensory polyneuropathy of the lower extremities is the use of antioxidants. This is due to the fact that in diabetes mellitus the activity of one’s own antioxidant systems is decreasing, free radicals are formed in excess quantities. Reducing the severity of oxidative stress with the introduction of drugs with antioxidant effects is accompanied by the following positive changes:
- improvement of endoneurial blood flow;
- reduction in the level of lipid peroxidation;
- normalization of endothelial nitrous oxide levels;
- an increase in the content of protective proteins of heat stress.
The leading place among antioxidants is occupied by α-lipoic or thioctic acid, a natural lipophilic antioxidant. This drug reduces both neuropathic symptoms and neuropathic deficits. Doctors at the neurology clinic begin treatment with a course of intravenous drips (thioctacid, 600 mg per 200 ml of saline) for 15 days, and then prescribe the patient 600 mg thioctacid BV tablets, which he takes on a regular basis.
In order to undergo a course of adequate treatment for diabetic distal sensory polyneuropathy of the lower extremities, make an appointment with a neurologist by calling the Yusupov Hospital. Neurologists at the Yusupov Hospital individually select doses of drugs and carry out complex therapy diabetic angiopathy, aimed at preventing amputation of the lower extremities. Complete treatment disease helps stabilize the condition and improves the patient’s quality of life.
Bibliography
- ICD-10 (International Classification of Diseases)
- Yusupov Hospital
- Batueva E.A., Kaygorodova N.B., Karakulova Yu.V. The influence of neurotrophic therapy on neuropathic pain and the psycho-vegetative status of patients with diabetic neuropathy // Russian magazine pain. 2011. No. 2. P. 46.
- Boyko A.N., Batysheva T.T., Kostenko E.V., Pivovarchik E.M., Ganzhula P.A., Ismailov A.M., Lisinker L.N., Khozova A.A., Otcheskaya O .V., Kamchatnov P.R. Neurodiclovit: possibility of use in patients with back pain // Farmateka. 2010. No. 7. pp. 63–68.
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In this article we will consider in detail the most common form of late neurological complication of diabetes mellitus - distal, symmetrical, sensory or sensorimotor polyneuropathy.
The main symptoms of diabetic neuropathy are paresthesia, numbness, chilliness and pain in the lower extremities, as well as in the hands. There are symmetrical disturbances of all types of sensitivity (pain, temperature, tactile and vibration) in the so-called "socks" and "gloves" area. In some patients, these manifestations may be mild. IN severe cases characterized by paresthesia, pain, and burning sensation in the feet and hands that worsen at night. If left untreated, the pathology worsens.
Initial symptoms of neuropathy are determined in the toes; with proximal progression of the process, signs of decreased sensitivity appear in the fingers. Distal sections upper limbs It’s quite rare to be the first to get involved.
In distal, symmetrical, sensorimotor polyneuropathy, thin unmyelinated (C), weakly myelinated (Aσ) and thick myelinated nerve fibers (Aα, Aβ) are affected. Neuropathy predominantly affecting small fibers is characterized by loss of pain and temperature (heat and cold) sensitivity. When predominantly thick fibers are involved in the process, the speed of nerve impulse conduction is disrupted and tactile and vibration sensitivity is reduced or lost, which in severe cases can lead to sensory ataxia. But it should be noted that signs of damage to thin nerve fibers are observed earlier than thick ones.
Symptoms of diabetic neuropathy are recorded in more than 40% of people with diabetes and about half of them have pain. The period of occurrence of pain is characteristic: at rest, during overwork, during stress and mainly at night; when walking, the pain intensity decreases, while changing the position of the limb has no effect. Acute pain syndrome due to neuropathy is described as an independent clinical entity. It is characterized by hypersensitivity and hyperalgesia. In this case, motor nerve fibers are preserved, and sensory functions are slightly affected. A similar phenomenon was called “diabetic cachexia” by Ellenberg. Acute neuropathic pain syndrome is observed with insulin therapy and normalization of glycemia, which Caravati describes as “insulin neuritis.” IN in this case pain symptoms are associated with nerve regeneration.
The progression of diabetic polyneuropathy leads to damage to motor fibers - muscle atrophy and weakness in the distal lower extremities. When autonomic nerve fibers are involved, sweating decreases, the skin becomes dry and prone to hyperkeratosis. A so-called “risk stop” is formed. The knee and Achilles reflexes are reduced, and typical bone deformities appear: protruding heads of the metatarsal bones, hammertoes and hooked toes. The skin color is bright pink or red, and symmetrical areas of hyperpigmentation are often observed on the lower leg and dorsum of the foot (the so-called “spotted shin”). The nail plates can atrophy or, on the contrary, thicken and deform, which predetermines the development of onychomycosis. Ultimately, osteoarthropathy or Charcot's foot is formed (increase in the transverse size of the foot, transverse and longitudinal flatfoot, increased deformity ankle joint); changes in the configuration of the foot can be unilateral or bilateral, and the appearance of neuropathic edema is also possible. An important differential diagnostic feature is the persistence of pulsation in the arteries of the foot.
Prolonged pressure in areas of bone deformation leads to inflammatory autolysis of the underlying tissues and the formation of neuropathic ulcers, most often on the plantar surface of the foot and in the interdigital spaces. These ulcers may be painless for a certain period of time due to decreased sensitivity, and often only become infected and inflammatory process draw attention to the ulcerative defect. That's why early detection of signs of diabetic polyneuropathy is extremely important to reduce the risk of ulceration and subsequent possible amputation of the limb.
Unfortunately, there is no “gold standard” for identifying neuropathic disorders in diabetes mellitus. In 1998, San Antonio proposed consensus of standardized methods for diagnosing diabetic polyneuropathy, which recommends the following activities:
- Identification of clinical symptoms.
- Clinical examination: morphological and biochemical analysis.
- Electrodiagnostic study: determination of the speed of impulse transmission along the nerve.
- Quantitative sensory tests.
- Autonomous functional tests.
Often used to detect diabetic neuropathy symptom scale - NSS(Neuropathy Symptom Score) and scale of characteristics - VAT(Neuropathy Dysability Score). For clinical practice, this system was adapted by M. Young et al.
NSS assessment:
- burning, numbness (numbness) or crawling sensation = 2
- fatigue, cramping or soreness = 1
- spreading:
feet = 1
calf muscles = 1
other = 0 - gain:
at night = 2
day or night = 1
daytime = 0
awakening from sleep = 1 - reduction:
when walking = 2
standing = 1
sitting or lying down = 0
Sum of points is the scale value:
3-4 - minor symptoms,
5-6 - moderate symptoms,
7-9 - severe symptoms.
VAT assessment:
- knee reflex
- vibration sensitivity
- pain sensitivity
- temperature sensitivity
- reflexes:
normal = 0
amplify = 1
none = 2 on each side - touch (tactile) sensitivity:
present = 0
reduced or absent = 1 on each side
Sum of points:
3-5 - minor signs
6-8 - moderate symptoms
9-10 - severe symptoms
The minimum criteria for diagnosing diabetic neuropathy according to the NSS and VAT are:
- moderate signs with or without symptoms (VAT = 6-8 + NSS ≥ 0)
- minor signs with moderate symptoms (VAT = 3-5 + NSS = 5-6)
To determine the severity of clinical manifestations it is necessary neurological examination of sensorimotor disorders. It includes the study of all types of sensitivity and reflexes.
Tactile sensitivity assessed using 10 g monofilament (5.07 Semmes-Weinstein). The places where the study needs to be carried out are the plantar surface distal phalanx big toe, plantar surface of the distal head and V metatarsal bone. There must be at least 2 touches at one point. The vibration sensitivity threshold is determined using a neurological tuning fork or biothesiometer. The examination is carried out at standard points: the base of the big toe and the inner ankle. Vibration sensitivity is not reduced if the patient stops feeling vibration when the tuning fork scale value corresponds to 7 UE and above. A decrease in the vibration sensitivity threshold is assessed by many researchers as the most unfavorable prognostic sign. Temperature sensitivity is determined by alternating touches of a warm and cold object to adjacent areas of the big toe, dorsum of the foot, inner ankle, shin and knee. Pain sensitivity is studied using a blunt needle or special devices (Neuropen, Pin-wheel). To analyze the state of the motor part of the nervous system, the Achilles and knee reflexes are determined using a neurological hammer. To identify autonomic neuropathy, the most accessible method V routine practice is orthostatic test.
Based on clinical manifestations, the following are distinguished: stages of distal diabetic neuropathy(International Guidelines for the Outpatient Management of Diabetic Neuropathy, 1995):
- 0 - no neuropathy, no symptoms or signs
- 1 - asymptomatic neuropathy
- 1 A - NSS = 0, normal knee reflex
- 1 B - NSS = 0, reduced knee reflex
- 2 - symptomatic neuropathy
- 2 A - NSS ≥ 1, normal knee reflex
- 2 B - NSS ≥ 1, decreased knee reflex
- 3 - severe neuropathy.
With diabetes mellitus, a person develops numerous complications that negatively affect work internal organs. The peripheral nervous system is also often affected - if individual nerve fibers are damaged, the doctor diagnoses diabetic neuropathy, in case of mass damage, diabetic polyneuropathy is detected.
This disease develops in diabetics with the first and second types of diabetes mellitus; the risk of the disease is 15-50 percent of cases. Typically, diabetic polyneuropathy is diagnosed if a person has had a lack of insulin for a long time and has increased level blood glucose.
Peripheral nerves are damaged as a result of changes in the mechanism of the metabolic process in tissues. Nerve fibers are exposed to oxygen starvation, the concentration of nitric oxide decreases, due to which blood supply deteriorates and the functioning of the nervous system is disrupted.
What is diabetic polyneuropathy
Pathological disorders are divided into several types, depending on the type of lesion and the severity of the disease. As is known, the peripheral nervous system is somatic and autonomic. Based on this, there is somatic and autonomic polyneuropathy in diabetes mellitus.
In the first case, diabetic polyneuropathy of the lower extremities is provoked in the form of numerous ulcers. The second type of disease often leads to fatal outcome patient.
The disease is also classified according to the type of damage to the functions of the nervous system. In particular, the sensory form of diabetic polyneuropathy manifests itself in the form of loss of sensitivity to temperature changes.
With the motor form, muscle weakness appears, with the somatic form, the signs of manifestations of both forms are combined.
Diabetic distal polyneuropathy
Sugar level
This pathology, which can be seen in the photo, is classified as a type of disease. It is accompanied by the death of nerve fibers, due to which a person loses all sensitivity, and numerous ulcers develop on the feet.
The reason for the genesis of this type of complication is most often diabetes, while the person’s performance decreases. The disease itself is very dangerous both for the health and life of a diabetic.
Distal polyneuropathy usually affects the lower extremities, but can sometimes affect the arms. A person feels a pulling and dull ache, which can be so strong that the patient cannot sleep normally at night. The pain intensifies at rest and can worsen during long walking.
Additionally, paresthesia makes itself felt, which is manifested by numbness, “crawling goose bumps,” tingling, chilliness or burning, heaviness and weakness of the legs, and sometimes pain is felt in the shoulders, forearms, and thighs. The feeling of pain during palpation of the lower leg is considered the main symptom by which pathology is diagnosed.
- On initial stage The disease noticeably reduces sensitivity in the toes; after some time, symptoms may spread to the upper extremities. If treatment for diabetic polyneuropathy of the lower extremities is not started in time, a person may develop serious complications, life-threatening.
- The disease is accompanied by disruption of thin and sometimes thick nerve fibers. When thin fibers are damaged, the patient's temperature and pain sensitivity in the legs decrease. If the pathology affects thick nerve fibers, the diabetic partially or completely loses tactile sensitivity.
- With further development of the disease, work is disrupted musculoskeletal system, a person feels weakness in the legs, muscle atrophy develops, sweating worsens, the skin dries out, and the bones become noticeably deformed. The skin acquires a pink or reddish tint, symmetrical pigmentation appears in the area of the lower leg and the back of the feet, the lower limbs atrophy or become deformed.
- As a result, osteoarthropathy develops, which is characterized by transverse and longitudinal flat feet, increased by deformation of the ankles, an increase in the size of the feet on the transverse side. Such foot disorders can be either unilateral or bilateral.
- Because of long-term pressure In response to the deformed area of the bone, neuropathic ulcers appear on the outer sides of the feet and between the toes. Such wounds initially do not cause pain due to decreased sensitivity, but after a while, when the inflammatory process begins, the diabetic pays attention to the skin defect.
In order to prevent the development of serious complications that lead to amputation of the lower limb, it is important to carry out timely diagnosis and know how to treat such a pathology. For precise definition After diagnosis, a neurological examination is performed to study the degree of sensitivity and reflexes of the patient.
The main reason for the progression of the pathology is elevated blood sugar levels, therefore, in children and adults, therapy is carried out with hypoglycemic agents.
It is important to regularly monitor glucose levels; if necessary, the diabetic takes painkillers.
Diabetic polyneuropathy: symptoms
On different stages The symptoms of the disease can differ significantly - at stage zero, symptoms are completely absent. The first stage has no characteristic signs, but the doctor can diagnose the disease by examining ready-made blood tests and the results of diagnostic testing in the neurophysiology department.
On the second clinical stage distinguish between chronic pain, acute pain, amyotrophy and painless form. In the chronic painful form, diabetics experience a burning sensation and pain in the legs, while sensitivity is noticeably reduced, as a result of which polyneuropathy of the lower extremities is diagnosed. Symptoms may especially intensify at night.
When an acute painful form develops, pain begins to spread throughout the body, in some cases increased sensitivity is observed in the lower extremities. Amyotrophy is accompanied by muscle weakness and severe pain at night. In the painless form, a person does not completely feel pain or temperature changes.
The doctor diagnoses the third stage of the disease, when serious complications are observed. Numerous wounds and ulcers can be seen in the foot area; Charcot's foot may develop; in this case, the disease often leads to amputation of the foot.
All possible signs of the disease can be divided into three main groups:
- Sensitive symptoms include disturbances in the form of aching, cutting, shooting, burning pain. In a diabetic, sensitivity decreases or, conversely, increases, arms and legs go numb. Also, the patient may not feel vibration or temperature changes.
- Symptoms of motor activity are accompanied by weakness or atrophy of the muscle tissue of the legs, lack of reflexion, trembling of the limbs, and cramps of the calf muscles.
- Including the work of a diabetic is disrupted autonomic system, this is manifested by tachycardia, decreased blood pressure when a person changes body position, constipation, diarrhea, impotence, impaired sweating, and edema.
Diagnosis and treatment of polyneuropathy
The disease is diagnosed based on the diabetic’s complaints, existing symptoms and certain factors. The disease is quite difficult to detect, since older people may experience similar Clinical signs due to age-related changes.
In addition, sometimes the symptoms do not manifest themselves at all, so the disorder can only be identified by undergoing a special examination.
Most often, this disease is detected in older men; there is also a risk of developing diabetic polyneuropathy in diabetes mellitus with prolonged hyperglycemia, high patient stature, the presence of diabetic retinopathy and nephropathy, decreased sensitivity to vibrations, and weakened tendon reflexes.
- If a person has a sensory form of the disease, vibration sensitivity is measured for diagnostic purposes using a tuning fork, the degree of sensitivity to temperature changes is determined, pain sensitivity detected by pricking the legs with a special needle. This includes testing tactile sensitivity and the diabetic’s ability to sense the position of body parts.
- If a motor form of the disease is suspected, tendon reflexes are assessed and electromyography is performed, which consists of studying the bioelectrical activity of muscle tissue.
- When autonomous form polyneuropathy, the frequency of heart contractions during inhalation and exhalation is measured, a gastroenterological and urological examination is carried out, and it is checked how prone a person is to orthostatic hypotension.
During the examination, the doctor checks whether the diabetic feels touch, pain, heat, cold, vibration and pressure. Various devices are used for this, but the patient, if necessary, can check sensitivity himself using any warm or cold objects. Tactile sensations can be detected with cotton swabs that are moved over the skin.
If a diabetic is diagnosed with diabetic polyneuropathy, treatment must be comprehensive, all causes that provoke the disease must be eliminated. To do this, on the recommendation of the attending physician, various drugs are prescribed to relieve symptoms and alleviate the patient’s condition.
- To lower blood sugar levels, take antihyperglycemic medications.
- To normalize the functioning of the nervous system, the doctor prescribes B vitamins, small dosages of antidepressants, and drugs containing thioctic acid.
- Anti-cramp effective means is Gabapentin, analgesics and anesthetics are also required. A magnesium supplement helps relieve muscle cramps, and muscle relaxants relieve spasms.
- To increase the energy resources of neurons, it is recommended to take the drug Actovegin.
- If a person has tachycardia, take Nebivolol or Metoprolol.
- To eliminate skin irritation, Capsicam, Apizartron, and Finalgon are used.
Among non-drug remedies, special physiotherapy procedures, relaxing massage, acupuncture, magnetic therapy, and electrical stimulation can cure pathology.
Tested products help very well in getting rid of wounds and ulcers on the skin due to diabetic polyneuropathy. traditional methods, for this they are used herbal infusions, healing oils, healthy decoctions.
Be sure to exclude any alcoholic drinks from your diet to keep your body strong and healthy.
Preventive measures
At timely diagnosis, proper therapy, carrying out prevention can stop the development of the disease in time. For these purposes, it is important for diabetics to consult a doctor five years after the discovery of diabetes mellitus and undergo an examination for the presence or absence of diabetic polyneuropathy in a child or adult. After this, you need to undergo control every year.
Diseases of the nervous system manifest themselves in the form of neurological symptoms. A person may experience contracture (tightening of a joint), trembling of the limbs, paresis (weakening) and paralysis of muscle tissue, decreased or deepening of reflexes, and signs of paresthesia. The last point includes the feeling of goosebumps running across the skin, numbness and tingling in a certain area of the body.
The symptoms are localized mainly at the site of innervation of the affected nerve; for example, if the facial branch is damaged, the entire face suffers. Sometimes the causes are hidden in pathological processes that arise in the spinal cord and brain. Separately, it is necessary to highlight a disease such as polyneuropathy (polyneuropathy). It represents damage to several nerves at once, mainly due to external factors. This process may also be preceded by other reasons, for example, infection or diabetes, which are important to know before carrying out a course of treatment.
With multiple nerve damage, doctors often diagnose polyneuropathy, but few people know what it is. The lesion is localized mainly in peripheral part central nervous system and precede this process mainly external factors, which for a long time disrupted their work.
Toxic polyneuropathy is the main type multiple lesions. For it, a preceding factor may also be diseases in which substances toxic to humans accumulate. Among them are endocrine disruptions, for example, diabetes. This disease is characterized distal polyneuropathy and it occurs in more than half of the cases. This process occurs due to long-term exposure high level blood sugar at . In medicine, this type of pathology is called dismetabolic polyneuropathy due to characteristic metabolic failures.
Toxic neuropathy can occur not only due to high blood sugar, but also due to other substances that destroy nerve fibers.
For example, a substance may not be inside the body, but constantly enter it from the outside. Basically, such a toxin is alcoholic beverages and this type of disease is called alcoholic polyneuropathy of the lower extremities. As the pathology develops, the patient’s hands are gradually affected. The disease is also included in the group of dysmetabolic disorders and primarily affects motor-sensory symptoms.
Oncological diseases of a malignant nature are not uncommon in neuropathy. They poison the entire body and it is extremely difficult to get rid of them, so the prognosis for recovery is mostly negative. Neoplasms belong to the paraneoplastic type of the disease.
In more in rare cases infection, for example, diphtheria bacillus, causes the development of the disease. Its waste products harm the nerve fibers and malfunctions gradually begin to occur. A disease of this form is considered infectious and toxic at the same time.
Polyneuropathy causes are not always related to the toxic effects of various substances. The disease sometimes occurs due to immune failures in which antibodies destroy the myelin sheath nerve cells. This type of disease is called demyelinating and belongs to the group of autoimmune pathological processes. Often this type of neuropathy has a genetic development factor, and hereditary motor sensory pathology manifests itself in the form of damage to motor muscles.
Forms of the disease
Polyneuropathy of the upper and lower extremities manifests itself in the form of pronounced neurological symptoms and the degree of its manifestation depends on the form of the disease and the types of damage.
According to the type of damage to nerve fibers, pathology is of the following types:
- Demyelinating polyneuropathy (axonal demyelinating disease). This pathological process represents the destruction of the myelin sheath on the processes (axons) coming from neurons;
- Axonal polyneuropathy. It occurs due to malfunctions of axons;
- Neuropathic polyneuropathy. This pathology appears due to damage to the body of the neuron (nerve cell).
Pathology can be divided into certain types impacts, namely:
- Sensory polyneuropathy. Its symptoms include disturbances in the sensitivity of nerve endings, such as pain, burning and numbness;
- Motor polyneuropathy. Muscle damage is observed. This occurs in the form of weakness, atrophy, paralysis, etc.;
- Sensorimotor polyneuropathy. This type of damage combines sensory and motor disorders;
- Autonomic polyneuropathy. In this case, failures occur in vegetative department nervous system, which is responsible for the functioning of internal organs. These nerve fibers are also responsible for other systems that a person cannot consciously control, namely heartbeat, secretion of saliva, sweat, etc.;
- Mixed look. It includes various signs violations common to all groups.
By etiological factor the disease is divided into the following groups:
- Idiopathic form (polyneuropathy of unknown origin). There is no specific reason for this type, but immune failures are considered the main version of development;
- Hereditary form. This pathology is transmitted from parents;
- Dysmetabolic form. It occurs due to metabolic failures;
- Toxic form. The development of this variety occurs due to the influence of toxins on the body;
- Post-infectious form. This type of polyneuropathy appears due to past infections that have affected most body systems, for example, HIV infection or diphtheria;
- Paraneoplastic form. Manifests itself against the background of malignant oncological diseases;
- Systemic diseases. This type of polyneuropathy is part of another pathological process that occurs in the connective tissue, for example, scleroderma (failure in collagen production).
Symptoms
Due to polyneuropathy, it is mainly the legs and arms of a person that suffer, or more precisely, the feet and hands. This happens due to the fact that predominantly small nerves are damaged, since they are easiest for toxins to destroy. Sometimes polyneuritic syndrome occurs and is characterized by the same symptoms in the upper and lower extremities. Damage often occurs symmetrically as toxins are carried through the bloodstream.
With polyneuropathy, the symptoms of nerve damage are as follows:
- Painful sensations of various nature manifestations with a burning element;
- Tremor (shaking) in the lower and upper extremities, manifesting mainly in the fingers;
- Uncontrollable fasciculations, which are muscle twitching;
- Sensory disturbances, which include impaired perception of temperature, pain, and worse sensation of touch (numbness). With diabetes, patients may not even notice that a glass or pebble gets into a shoe due to polyneuropathy of the leg;
- Muscle paresis (weakness), which makes it harder for a person to walk long distances and perform daily tasks. This symptom is often combined with low muscle tone and loss of strength in the patient, and occurs mainly with polyneuropathy of the lower extremities.
The main danger is vegetative signs of the disease and among them the following symptoms can be distinguished:
- Temperature surges;
- Intensive work of the sebaceous glands;
- Pale skin;
- Disruptions in blood circulation;
- Heart arythmy.
With polyneuropathy of the lower extremities, the most pronounced symptoms are usually the following:
- Decreased sensitivity;
- Muscle paresis;
- Decreased Achilles reflexes;
- Trophic changes.
Polyneuropathy of the upper extremities manifests itself in virtually the same way, but the skin color becomes paler and the tremor is much stronger. However, the disease does not always develop over years. In some cases, it appears after 2-3 hours, for example, after irradiation or severe poisoning toxic substances.
In more rare cases, due to a critical lack of vitamin B12, it occurs. It is characterized by damage to the posterior columns of the spinal cord. They contain nerve branches responsible for the perception of joints and muscles. This pathological process has its own characteristics, because with ataxia a person cannot move in the dark, because he does not understand where his legs and arms are. However, with good lighting, the problem disappears by itself and the patient does not feel any changes.
With autonomic polyneuropathy, a person may die suddenly from cardiac arrest, which occurs due to serious arrhythmia or disturbances in the functioning of the ventricles.
This form of pathology belongs to the cardiac type of polyneuropathy.
Diagnostics Polyneuropathy of the lower extremities, as well as the upper ones, is determined by a neurologist. The attending physician focuses on interviewing and examining the patient and, in general, making a diagnosis does not cause any difficulties. If you still have questions, you will have to use instrumental method examinations. In the case of polyneuropathy, diagnosis using ultrasound examination , as well as computed tomography and magnetic resonance imaging will not bring results. Doctors for staging correct diagnosis
Electroneuromyography is used. It serves to identify any slightest disruptions during the passage of an impulse along the nerve fibers. Based on the results of the examination, the neurologist can accurately determine where the disorder occurred, namely in the axon, its sheath or the body of the neuron. To make a diagnosis, it is sometimes necessary to take general analysis blood, for example, with diabetes, it will show increased concentration
Sahara. In rare cases, doctors take a biopsy of nerve tissue.
nervous system rather than functional.
First you need to determine the cause of the disease and eliminate it. You can understand how to treat polyneuropathy using the example of diabetics. They should monitor their blood sugar levels more closely to ensure they remain within normal range. If it comes to alcoholics, then they need to give up alcoholic beverages. Otherwise, neither the first nor the second group will be helped by medications. In case of cancer, before treating the pathology, it is necessary to eliminate the neoplasms that have arisen in the body.
- For polyneuropathy, treatment is carried out using the following drugs:
- Vitamin complexes, for example, Milgamma;
- Antioxidants like Berlition;
- Drugs with a metabolic effect to stimulate microcirculation like Trental;
Anesthetics like Versatis anesthetic ointment. It is recommended to use ointment and tablets in the treatment of polyneuropathy in combination with. It is necessary to add more vegetables and fruits to your diet and, if possible, avoid fried, smoked and canned foods. It is advisable to boil or steam food.
Physiotherapy can speed up the healing process and the following procedures are most often used:
- Electropharis based on Dibazol and thiamine;
- Treatment with foil (joint wrapping);
- Therapeutic baths;
- Acupuncture.
Massage is especially beneficial for polyneuropathy. It should be performed by an experienced specialist so as not to aggravate the course of the disease.
Treatment of polyneuropathy of the lower extremities usually involves not only the use of drugs, but also gymnastics. It allows you to maintain tone muscle tissue and improves general state sick. Physiotherapy(physical therapy) should be prescribed depending on the person’s condition, because in most cases physical overload is not recommended.
Forecast
Usually the prognosis for polyneuropathy is not good. The disease is difficult to treat and tends to progress. Over time, a person may become disabled and even die due to heart failure. Some types of disease have no treatment at all, for example, those caused by autoimmune disorders. If it comes to alcohol poisoning or diabetes, then the prognosis is generally positive, but provided that the patient normalizes sugar concentration and gives up alcoholic beverages.
Polyneuropathy is severe damage to nerve tissue and must be treated when the first symptoms occur, otherwise the pathology will progress. This development of events often leads to disability and death.