Diabetic neuropathy
Contents:
Description:
The hyperglycemia is the main reason for diabetic neuropathy.
Symptoms of Diabetic neuropathy:
Sensomotor diabetic neuropathy is shown by a complex of motive and sensitive disturbances. A frequent symptom of a distal form of diabetic neuropathy are paresthesias which are shown by feeling of "crawling of goosebumps", numbness. Patients often complain of a chill of legs though they remain warm to the touch that is the sign allowing to distinguish polyneuropathy from ischemic changes when legs to the touch cold. Early display of touch neuropathy is disturbance of vibration sensitivity. The syndrome of "uneasy legs" representing a combination night paresthesia and hypersensitivity is characteristic. Onychalgias disturb at night more often, at the same time the patient cannot sometimes take out blanket touches. In a typical case of pain contrary to those at obliterating diseases of arteries can decrease when walking. Years later pain can spontaneously stop owing to death of the small nerve fibrils which are responsible for painful sensitivity. Gipoesteziya is shown by loss of sensitivity as "stockings" and "gloves". Disturbance of deep, proprioceptive sensitivity leads to a lack of coordination and difficulty of movements (a touch ataxy). The patient complains of "others legs", feeling of "standing on cotton wool". Disturbance of a trophic innervation leads to degenerative changes of skin, bones and sinews. Disturbance of painful sensitivity leads to the frequent, not noticed by the patient microtraumas of feet which are easily infected. The lack of coordination and walking leads to not physiological redistribution of load of foot joints. Anatomic relationship in a leg musculoskeletal system is as a result broken.
The foot arch is deformed, puffiness, fractures, chronic purulent processes develop.
Allocate several forms of autonomous diabetic neuropathy.
The reason of a cardiovascular form - disturbance of an innervation of a cardiopulmonary complex and large vessels. The vagus nerve is the longest nerve in this connection is surprised before others. As a result of dominance of sympathetic influences rest tachycardia develops. Inadequate reaction on ортостаз is shown by orthostatic hypotension and syncopal states. Vegetative denervation of a pulmonary and cordial complex results in lack of variability of a cordial rhythm. Connect the increased prevalence among patients with a diabetes mellitus of bezbolevy myocardial infarctions with autonomous neuropathy.
Symptoms of a gastrointestinal form of diabetic neuropathy are гастропарез with slowed down or, on the contrary, bystry gastric emptying that can create difficulties in insulin therapy selection as time and volume of absorption of carbohydrates vaguely vary; gullet atony, reflux esophagitis, dysphagy; watery diarrhea.
Are characteristic of an urogenital form of diabetic neuropathy the atony of ureters and a bladder resulting in tendency to uric infections; erectile dysfunction (about 50% of patients with a diabetes mellitus); retrograde ejaculation.
Other possible displays of vegetative diabetic neuropathy - disturbance of ability to distinguish a hypoglycemia, dysfunction of a pupil, dysfunction of sweat glands (anhidrosis), diabetic amyotrophy.
Reasons of Diabetic neuropathy:
Diabetic neuropathy represents a combination of syndromes of defeat of a nervous system.
Treatment of Diabetic neuropathy:
1. Optimization of antihyperglycemic therapy.
2. Care of legs.
3. Efficiency of neurotropic drugs (and - lipoic acid) is confirmed not in all researches.
4. Symptomatic therapy (anesthesia, sildenafit at erectile dysfunction, флудрокортизон at orthostatic hypotonia, etc.).
