Diabetic neuropathy
These changes are thought to result from a microvascular injury involving small blood vessels that supply nerves (vasa nervorum).
Therefore, diabetic neuropathy has the potential to affect essentially any organ system and can cause a range of symptoms.
Similarly, these patients can get multiple fractures of the knee, ankle or foot, and develop a Charcot joint.
One commonly recognized autonomic dysfunction in diabetics is orthostatic hypotension, or becoming dizzy and possibly fainting when standing up due to a sudden drop in blood pressure.
This can lead to hypoglycemia when an oral diabetic agent is taken before a meal and does not get absorbed until hours, or sometimes days later when there is normal or low blood sugar already.
Sluggish movement of the small intestine can cause bacterial overgrowth, made worse by the presence of hyperglycemia.
The onset of a diabetic third nerve palsy is usually abrupt, beginning with frontal or pain around the eye and then double vision.
The following processes are thought to be involved in the development of diabetic neuropathy: Vascular and neural diseases are closely related.
As the disease progresses, neuronal dysfunction correlates closely with the development of blood vessel abnormalities, such as capillary basement membrane thickening and endothelial hyperplasia, which contribute to diminished oxygen tension and hypoxia.
Elevated levels of glucose within cells cause a non-enzymatic covalent bonding with proteins, which alters their structure and inhibits their function.
[7] Physical exam findings may include changes in appearance of the feet, presence of ulceration, and diminished ankle reflexes.
Capsaicin applied to the skin in a 0.075% concentration has not been found to be more effective than placebo for treating pain associated with diabetic neuropathy.
There is insufficient evidence to draw conclusions for more concentrated forms of capsaicin, clonidine, or lidocaine applied to the skin.
[20] Medication options for pain control include antiepileptic drugs (AEDs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs).
[23] The only three medications approved by the United States' Food and Drug Administration for diabetic peripheral neuropathy (DPN) are the antidepressant duloxetine, the anticonvulsant pregabalin, and the long-acting opioid tapentadol ER (extended release).
[24][25] Before trying a systemic medication, some doctors recommend treating localized diabetic peripheral neuropathy with lidocaine patches.
[9] Multiple guidelines from medical organizations such as the American Association of Clinical Endocrinologists, American Academy of Neurology, European Federation of Neurological Societies, and the National Institute for Clinical Excellence recommend AEDs, such as pregabalin, as first-line treatment for painful diabetic neuropathy.
A 2014 systematic review and network meta-analysis concluded topiramate, valproic acid, lacosamide, and lamotrigine are ineffective for pain from diabetic peripheral neuropathy.
[19] As above, the serotonin-norepinephrine reuptake inhibitors (SNRIs) duloxetine and venlafaxine are recommended in multiple medical guidelines as first or second-line therapy for DPN.
[19] At low dosages used for neuropathy, toxicity is rare,[citation needed] but if symptoms warrant higher doses, complications are more common.
In contrast, low-quality evidence supports a moderate benefit from the use of atypical opioids (e.g., tramadol and tapentadol), which also have SNRI properties.
[26] Monochromatic infrared photo energy treatment (MIRE) has been shown to be an effective therapy in reducing and often eliminating pain associated with diabetic neuropathy.
The nitric oxide in turn promotes vasodilation which results in increased blood flow that helps nourish damaged nerve cells.
[28] Gait re-training would also be beneficial for individuals who have lost limbs, due to diabetic neuropathy, and now wear a prosthesis.
[31] Aerobic exercise such as swimming and using a stationary bicycle can help peripheral neuropathy, but activities that place excessive pressure on the feet (e.g. walking long distances, running) may be contraindicated.
[37][34][35][38][39] Multiple nerve decompression surgery is unusual in that it can reverse some symptoms (e.g. lower pain and increased sensation), while also providing protection against serious foot complications (e.g. ulcers and amputations).
