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Diabetic NeuropathyDiabetic Neuropathy – General InformationDiabetic Neuropathy is considered a neuropathic condition the can be associated with the disease also known as diabetes mellitus. The disease appears after a diabetic micro vascular damage which can involve the small blood vessels that supply the nerves with blood, called vasa nervorum. There are many conditions that can cause similar signs and symptoms to those of Diabetic Neuropathy. They are known to include, mononeuropathy multiplex, diabetic amyotrophy, mononeuropathy, autonomic neuropathy, third nerve palsy, thoracoabdominal neuropathy and polyneuropathy. The main risk factor that can lead to the appearance of this kind of disease is hyperglycemia. There are also some cases in which the patients who suffer from diabetes can develop signs and symptoms similar to the peripheral neuropathy, leading to a disease also known as Glucojasinogen that is due to the excess of glucose in the patient’s blood. This type of condition can also cause erectile dysfunction and epigastric tenderness, leading to a lack of blood flow that travels to the peripheral intrapectine nerves, which are responsible with the movement of the patient’s arms and legs. The evolution of Diabetic Neuropathy depends on the degree of glycemic control in the type I and type II of the diabetes. There are many risk factors that can cause the disease and can include duration of the diabetes, age, smoking, height, hyperlipidemia and hypertension. The exact cause of the disease is still unknown, but scientists say that genetic factors, chemical agents, that can damage the metabolism, such as chemotherapy drugs, and HIV, can cause the appearance of the disease.Diabetic Neuropathy – SymptomsDiabetic Neuropathy usually affects the peripheral nerves of the patient, tissues which can include pain fibers, motor neurons and autonomic nerves. Due to this fact, all organs and systems that are innervated by these nerves are also affected. If the systems and members that are innervated by the peripheral nerves are damaged, this can lead to the appearance of many distinct syndromes based on the respective organ system. For example, a patient can suffer from a sensorimotor and autonomic neuropathy or any other disorder combination. The symptoms of Diabetic Neuropathy depend on the nerve that has been affected. These signs can develop gradually over years and can include symptoms such as numbness and tingling of extremities, dysesthesia, a decreased or loss of sensation of a specific body part, diarrhea, erectile dysfunction, urinary incontinence or loss of bladder control, impotence, facial, mouth and eyelid drooping, vision changes, dizziness, muscle weakness, dysphagia, a swallowing difficulty, speech impairment, muscle contractions, burning, especially in evenings and a stabbing pain. If the patient’s gastrointestinal system has been affected by the disease, he can experience symptoms such as delayed gastric emptying, gastro paresis, nausea, or bloating. If the patient’s urinary tract has been affected, he can complain of symptoms such as Urinary frequency, urgency, incontinence and retention. The retention of the urine can lead to more severe urinary tract infections or bladder diverticula’s, stones, reflux nephropathy, and so on. It is very important to treat the disease in an early stage because the chances of curing are increased and the risk of developing complications is much lower.Diabetic Neuropathy – TreatmentDue to Diabetic Neuropathy’s unknown cause, it is very challenging for the health care provider to apply the adequate treatment. He or she must do a set of medical exams before proceeding with a therapy. Due to the same cause, the available treatment triggers many side effects and has lack of efficacy. Its main goal is to interrupt the pathological processes that take place in the patient’s metabolism. Most of the medicines are applied to reduce the symptoms (pain, in general), and can include agents as tricyclic antidepressants (TCAs), serotonin reuptake inhibitors (SSRIs) and antiepileptic drugs (AEDs). The tricyclic antidepressants (that are in fact the traditional anticonvulsants) prove to be more efficient if they are taken for short term, and better than the newer generation of pain relievers. The tight glucose control treatment trial is also used to treat Diabetic Neuropathy, and is considered a treatment for early stages of the disease, which improves the glycemic control. This type of treatment can reverse the changes of the disease, but only if it is applied in early stages. If the treatment with glucose is administered in an advanced stage, it could worsen the symptoms, especially in uncontrolled diabetic patients. In these cases, the uncontrolled diabetics are exposed to an increased risk of developing foot ulcer and amputation. The tricyclic antidepressants are also used to treat Diabetic Neuropathy, and can be prescribed as Imipramine, Amitriptyline, Desipramine and Nortriptyline. These types of medicines decrease the disease’s painful symptoms, but can cause severe side effects and also an addiction. The main and most important side effect of the antidepressants is the cardiac toxicity, which can easily lead to fatal arrhythmias. In most cases doctors apply Amitriptyline, but the Desipramine and Nortriptyline drugs can cause fewer side effects. Serotonin reuptake inhibitors can also be used to treat Diabetic Neuropathy, and can be prescribed as fluoxetine, paroxetine, Sertraline and Citalopram. These types of medicines are less effective than the tricyclic antidepressants, but more tolerable. In most cases, these inhibitors cause side effects, but are rarely severe and can not cause any permanent disorders. There are cases in which the medicines have caused sedation and weight gain, which can worsen the patient’s medical status. They can be used to relieve symptoms of pain and depression. The main inhibitor used to treat the disease is Duloxetine, which can be prescribed as Cymbalta. It is a very good pain reliever. In most cases, the typical dose is 80 mg per day. Another way to treat Diabetic Neuropathy is the use of antiepileptic medicines that can be prescribed as Gabapentin. These medicines treat the advanced stages of the disease. However, they can also cause side effects, for example sedation which tends to get worsen over time, weight gain, worsening the glycemic control of the diabetic patient. It is usually administered in three doses per day. Carbamazepine, prescribed as Tegretol, can be also effective in treating the disease, but it is not considered safe for the patients. The medicine can cause side effects such as anorexia and weight loss. |
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