DIABETIC

NEUROPATHIES
Prepared by:
Marlon M. Legarda
BSN IV – 17
 Family of nerve disorders caused by diabetes. 
Whatarediabeticneuropathies?

About 60 to 70 percent of people with diabetes have some

form of neuropathy.
The highest rates of neuropathy are among people who
have had diabetes for at least 25 years.
Diabetic neuropathies also appear to be more common in
people who have problems controlling their blood
glucose, also called blood sugar, as well as those with high
levels of blood fat and blood pressure and those who are
overweight.
These conditions are thought to result from diabetic 
microvascular injury involving small blood vessels that
supply nerves (vasa nervorum) in addition to
macrovascular conditions that can culminate in diabetic
neuropathy.
Relatively common conditions which may be associated
with diabetic neuropathy include third nerve palsy;
mononeuropathy; mononeuropathy multiplex; diabetic 
amyotrophy; a painful polyneuropathy; autonomic
neuropathy; and thoracoabdominal neuropathy.
What causes diabetic neuropathies?
The causes are probably different for different types of diabetic
neuropathy. Researchers are studying how prolonged exposure
to high blood glucose causes nerve damage. Nerve damage is
likely due to a combination of factors:
metabolic factors, such as high blood glucose, long duration of
diabetes, abnormal blood fat levels, and possibly low levels of
insulin
neurovascular factors, leading to damage to the blood vessels
that carry oxygen and nutrients to nerves
autoimmune factors that cause inflammation in nerves
mechanical injury to nerves, such as carpal tunnel syndrome
inherited traits that increase susceptibility to nerve disease
lifestyle factors, such as smoking or alcohol use
What are the symptoms of diabetic neuropathies?
Symptoms depend on the type of neuropathy and which
nerves are affected. Some people with nerve damage have
no symptoms at all. For others, the first symptom is often
numbness, tingling, or pain in the feet. Symptoms are
often minor at first, and because most nerve damage
occurs over several years, mild cases may go unnoticed
for a long time. Symptoms can involve the sensory, motor,
and autonomic—or involuntary—nervous systems. In
some people, mainly those with focal neuropathy, the
onset of pain may be sudden and severe.
Symptoms of nerve damage may include:
numbness, tingling, or pain in the toes, feet, legs, hands, arms, and fingers
wasting of the muscles of the feet or hands
indigestion, nausea, or vomiting
diarrhea or constipation
dizziness or faintness due to a drop in blood pressure after standing or
sitting up
problems with urination
erectile dysfunction in men or vaginal dryness in women
Weakness

Symptoms that are not due to neuropathy, but often accompany it, include
weight loss and depression.
What are the types of diabetic neuropathy?
Diabetic neuropathy can be classified as peripheral, autonomic, proximal,
or focal. Each affects different parts of the body in various ways.
Peripheral neuropathy, the most common type of diabetic neuropathy,
causes pain or loss of feeling in the toes, feet, legs, hands, and arms.
Autonomic neuropathy causes changes in digestion, bowel and bladder
function, sexual response, and perspiration. It can also affect the nerves
that serve the heart and control blood pressure, as well as nerves in the
lungs and eyes. Autonomic neuropathy can also cause hypoglycemia
unawareness, a condition in which people no longer experience the
warning symptoms of low blood glucose levels.
Proximal neuropathy causes pain in the thighs, hips, or buttocks and leads
to weakness in the legs.
Focal neuropathy results in the sudden weakness of one nerve or a group
of nerves, causing muscle weakness or pain. Any nerve in the body can be
affected.
Peripheral neuropathy
affects
toes
feet
legs
hands
arms
Autonomic neuropathy affects
heart and blood vessels
digestive system
urinary tract
sex organs
sweat glands
eyes
lungs
Proximal neuropathy
affects
 thighs
 hips
 buttocks
 legs
Focal neuropathy affects
eyes
facial muscles
ears
pelvis and lower back
chest
abdomen
thighs
legs
feet
What is peripheral neuropathy?
Peripheral neuropathy, also called distal symmetric
neuropathy or sensorimotor neuropathy, is nerve
damage in the arms and legs. Your feet and legs are likely
to be affected before your hands and arms. Many people
with diabetes have signs of neuropathy that a doctor could
note but feel no symptoms themselves. Symptoms of
peripheral neuropathy may include
numbness or insensitivity to pain or temperature
a tingling, burning, or prickling sensation
sharp pains or cramps
extreme sensitivity to touch, even light touch
loss of balance and coordination
These symptoms are often worse at night.
What is autonomic neuropathy?
Autonomic neuropathy affects the nerves that control the
heart, regulate blood pressure, and control blood glucose
levels. Autonomic neuropathy also affects other internal
organs, causing problems with digestion, respiratory
function, urination, sexual response, and vision. In
addition, the system that restores blood glucose levels to
normal after a hypoglycemic episode may be affected,
resulting in loss of the warning symptoms of
hypoglycemia.
What is proximal neuropathy?
Proximal neuropathy, sometimes called lumbosacral
plexus neuropathy, femoral neuropathy, or diabetic
amyotrophy, starts with pain in the thighs, hips, buttocks,
or legs, usually on one side of the body. This type of
neuropathy is more common in those with type 2 diabetes
and in older adults with diabetes. Proximal neuropathy
causes weakness in the legs and the inability to go from a
sitting to a standing position without help. Treatment for
weakness or pain is usually needed. The length of the
recovery period varies, depending on the type of nerve
damage.
What is focal neuropathy?
Focal neuropathy appears suddenly and affects specific nerves,
most often in the head, torso, or leg. Focal neuropathy may cause
inability to focus the eye
double vision
aching behind one eye
paralysis on one side of the face, called Bell’s palsy
severe pain in the lower back or pelvis
pain in the front of a thigh
pain in the chest, stomach, or side
pain on the outside of the shin or inside of the foot
chest or abdominal pain that is sometimes mistaken for heart
disease, a heart attack, or appendicitis
Focal neuropathy is painful and unpredictable and occurs
most often in older adults with diabetes. However, it tends
to improve by itself over weeks or months and does not
cause long-term damage.
People with diabetes also tend to develop nerve
compressions, also called entrapment syndromes. One of
the most common is carpal tunnel syndrome, which
causes numbness and tingling of the hand and sometimes
muscle weakness or pain. Other nerves susceptible to
entrapment may cause pain on the outside of the shin or
the inside of the foot.
How can I prevent diabetic neuropathies?
The best way to prevent neuropathy is to keep your blood
glucose levels as close to the normal range as possible.
Maintaining safe blood glucose levels protects nerves
throughout your body.
How are diabetic neuropathies diagnosed?
Foot Exams
Experts recommend that people with diabetes have a comprehensive
foot exam each year to check for peripheral neuropathy. People
diagnosed with peripheral neuropathy need more frequent foot
exams. A comprehensive foot exam assesses the skin, muscles,
bones, circulation, and sensation of the feet. Your doctor may assess
protective sensation or feeling in your feet by touching your foot
with a nylon monofilament—similar to a bristle on a hairbrush—
attached to a wand or by pricking your foot with a pin. People who
cannot sense pressure from a pinprick or monofilament have lost
protective sensation and are at risk for developing foot sores that may
not heal properly. The doctor may also check temperature perception
or use a tuning fork, which is more sensitive than touch pressure, to
assess vibration perception.
The doctor may perform other tests as part of your diagnosis.
Nerve conduction studies or electromyography are sometimes
used to help determine the type and extent of nerve damage.
Nerve conduction studies check the transmission of electrical
current through a nerve. Electromyography shows how well
muscles respond to electrical signals transmitted by nearby
nerves. These tests are rarely needed to diagnose neuropathy.
A check of heart rate variability shows how the heart responds
to deep breathing and to changes in blood pressure and posture.
Ultrasound uses sound waves to produce an image of internal
organs. An ultrasound of the bladder and other parts of the
urinary tract, for example, can show how these organs preserve a
normal structure and whether the bladder empties completely
after urination.
How are diabetic neuropathies treated?
The first treatment step is to bring blood glucose levels
within the normal range to help prevent further nerve
damage.
Blood glucose monitoring, meal planning, physical
activity, and diabetes medicines or insulin will help
control blood glucose levels.
Good blood glucose control may also help prevent or
delay the onset of further problems.
Medications used to help relieve diabetic
nerve pain include
tricyclic antidepressants, such as amitriptyline,
imipramine, and desipramine (Norpramin, Pertofrane)
other types of antidepressants, such as duloxetine
(Cymbalta), venlafaxine, bupropion (Wellbutrin),
paroxetine (Paxil), and citalopram (Celexa)
anticonvulsants, such as pregabalin (Lyrica), gabapentin
(Gabarone, Neurontin), carbamazepine, and lamotrigine
(Lamictal)
opioids and opioid-like drugs, such as controlled-release
oxycodone, an opioid; and tramadol (Ultram), an opioid
that also acts as an antidepressant
Follow these steps to take care of your feet:
Clean your feet daily, using warm—not hot—water and a mild soap. Avoid soaking
your feet. Dry them with a soft towel and dry carefully between your toes.
Inspect your feet and toes every day for cuts, blisters, redness, swelling, calluses, or
other problems. Use a mirror—laying a mirror on the floor works well—or get help
from someone else if you cannot see the bottoms of your feet. Notify your health
care provider of any problems.
Moisturize your feet with lotion, but avoid getting the lotion between your toes.
After a bath or shower, file corns and calluses gently with a pumice stone.
Each week or when needed, cut your toenails to the shape of your toes and file the
edges with an emery board.
Always wear shoes or slippers to protect your feet from injuries. Prevent skin
irritation by wearing thick, soft, seamless socks.
Wear shoes that fit well and allow your toes to move. Break in new shoes gradually
by first wearing them for only an hour at a time.
Before putting your shoes on, look them over carefully and feel the insides with
your hand to make sure they have no tears, sharp edges, or objects in them that
might injure your feet.
If you need help taking care of your feet, make an appointment to see a foot doctor,
KEY POINTS..
Diabetic neuropathies are nerve disorders caused by many of the abnormalities
common to diabetes, such as high blood glucose.
Neuropathy can affect nerves throughout the body, causing numbness and
sometimes pain in the hands, arms, feet, or legs, and problems with the
digestive tract, heart, sex organs, and other body systems.
Treatment first involves bringing blood glucose levels within the normal
range. Good blood glucose control may help prevent or delay the onset of
further problems.
Foot care is an important part of treatment. People with neuropathy need to
inspect their feet daily for any injuries. Untreated injuries increase the risk of
infected foot sores and amputation.
Treatment also includes pain relief and other medications as needed,
depending on the type of nerve damage.
Smoking significantly increases the risk of foot problems and amputation. If
you smoke, ask your health care provider for help with quitting.