Patients with diabetes have more complications from nerve damage, called neuropathy due to diabetes. High blood sugar can damage the nerve fibers of the entire body, but the lower limbs and feet are often the most vulnerable.
Depending on how the nerve injury, but symptoms can vary from pain, loss of sensation in the lower to the symptoms of the digestive system, urinary tract, blood vessels and heart. Some patients have mild symptoms but many patients also have terrible pain, incapacity and even death
Neurological disease due to diabetes is the most serious complications of diabetes. You can prevent or slow the progression of neurological disease due to diabetes by controlling blood sugar closely and have a healthy lifestyle.
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Symptoms
Neurological disease due to diabetes has four main types. Patients may have a form or a symptom of many types at once. Most of the symptoms manifest slowly as the patient did not notice until a serious injury. Some patients have symptoms even before diabetes is diagnosed.
Symptoms of neurological disease due to diabetes varies depending on what type and how nerve injury:
Peripheral neuropathy
Peripheral neuropathy is the most common neurological disease due to diabetes. It hurt the nerves in the feet, lower limbs, arms and hands, but the lower limbs and feet are usually affected most. These symptoms include:
* Numbness or decreased sensation of pain, hot and cold temperatures, especially in the feet.
* Stinging sensation, such as tingling, burning starts in your toes and gradually spread to the feet.
Pain like a knife stabbing, such as electric shocks or knives, often up at night.
* Increased sensitivity to touch, feel - a few patients, even up blanket is painful.
* Loss of balance and coordination
* Muscle weakness and difficulty walking
* Many leg problems are severe, such as ulcers, infection, deformity and painful joints.
Autonomic neuropathy
Autonomic nervous system controls the operation of the agency: heart, bladder, lung, stomach, digestive, reproductive organs and eye. Diabetes can damage the nerve fibers in any organ, causing:
* Bladder problems: recurrent urinary tract infection often does not control or primary (elementary patients not resist)
* Digestive problems: as the first breath, heartburn and abdominal pain
* Constipation, diarrhea, uncontrollable or a combination of constipation and diarrhea
* Eat slowly emptied indigestion caused by gastric (stomach paralysis), leading to nausea, vomiting or loss of appetite.
* Erectile dysfunction affects over 50% of men with diabetes> 60 years old.
* Vaginal dryness and difficulty in sexual activity in women.
* Increased or decreased sweating
* The inability to regulate blood pressure and heart rate, leading to postural hypotension when the patient changes posture to sit or sugar.
* Issues related to regulating body temperature.
* Change the way the eyes adjust from light to dark.
Neurological disease usually occurs automatically on diabetes patients control blood sugar for many years is not good.
Also known as femoral neuropathy or muscle atrophy caused by diabetes. Neurological origin often painful in the hip, thigh, buttocks, usually starting on one side, eventually leading to muscle weakness and muscle atrophy patients difficult to change positions from sitting to standing. Many patients with severe weight loss. Some patients with pain in his back. Nerve root disease usually occurs in elderly patients or patients with type 2 diabetes.
Focal neuropathy
Focal neuropathy usually appear suddenly often related to a nerve independent. Common in elderly patients. Neurological disease that can cause localized pain and may disappear after a few weeks or few thang.Nhung symptoms include:
* Difficulty focusing eyes, double vision or pain behind the eyes.
*paralyze the side face
* Pain in the lower leg or foot.
Sometimes neurological disease caused by localized pinched nerve fibers. Carpal tunnel syndrome is the most common form of focal neuropathy in patients with diabetes.
Symptoms of carpal tunnel syndrome:
* Numbness, swelling, or stinging in the fingers while driving or while holding the newspaper.
* Pain spreading from the wrist up the arm, shoulder or spread to the palms, fingers.
* Feeling of weakness in the hand and tend to drop objects.
Cause
A complex system of nerves running throughout the body, connecting the brain to the muscles, skin and other organs. Through the nerves, the brain will feel the pain and temperature, control and operation of automated tasks such as digestion.
High blood sugar can damage the nerve fibers, but the exact reason is not known how clearly rang.Co be due to a combination of many factors, including nerve and blood vessels. High blood sugar increases the ability of neural signals pure decline. High blood sugar affect the capillaries that supply blood and nutrients to the nerve fibers.
Other factors
Other factors may contribute to neurological disease caused by diabetes, including:
* Glycate protein. Glycate process of protein occurs when glucose interacts with proteins, modifying proteins. This process is thought to be related to complications of diabetes, including neuropathy due to diabetes.
* Autoimmune inflammatory response of nerve fibers. When the immune system mistakenly attacks the body's organs in the body.
* Factor gene: make patients vulnerable nerve fibers.
* Alcohol and tobacco, both nerve damage and blood vessels, increasing the risk of infection.
Risk Factors
Any diabetic patient can no neurological complications, but the following factors increase the likelihood that injured nerve fibers.
* Poor blood sugar control. This is the biggest risk factors for all diabetes complications, including neurological complications. Keeping blood sugar stable is the best way to protect the nerves and blood vessels.
* Time has diabetes. The risk of neuropathy due to diabetes increased over time with diabetes, especially if blood sugar is not well controlled. Neuropathy can automatically affect the digestive system, bladder and sexual function, which occurs mainly in patients with diabetes are not good blood sugar control or diabetes over 20 years. The rate of peripheral nerve disease occurs in most patients with diabetes> 25 years.
* Age. Older patients more at risk from diabetes nerve.
* Gender. Men prone to neurological disease due to diabetes than women.
* Increased cholesterol. Increased bad cholesterol damage the small blood vessels feeding the nerves.
* Cigarette smoking. Smoking is the arteries harden and narrow and reduces blood flow to the legs. Making slow healing wounds and hurting peripheral neuropathy.
Diagnostic tests
Neurological disease due to diabetes is usually diagnosed based on symptoms, medical history and physical examination. The doctor will examine your muscle tone, bone tendon reflexes, touch sensation, thermal sensation and vibration sense.
Usea soft nylon brush lightly over the foot. If the patient does not feel the nylon on the feet, which is a sign of loss of sensation.
Other tests
In some cases, the following tests may be screaming:
*Assessment of neurotransmitters. This test is used to evaluate the conductive speed of nerve fibers in the limbs, usually used to diagnose carpal tunnel syndrome.
American Diabetes Association recommends that all public patients with diabetic foot should be examined at least once each year. In addition, foot inspection to detect signs of inflammation, cracked skin, calluses, deformed joints each doctor visit
Complications
Neurological disease due to diabetes can cause many serious complications
* Loss of sense of truth. Because of nerve damage causing loss of sensation in the legs, so the patient does not detect the injury, swelling and pain in the leg wound infection can be severe. Very high risk of infection due to decreased blood flow to the legs. Infection can spread to the bone and tissue necrosis. It is difficult to treat, need to be amputated legs or arms.
* Charcot Joints. This occurs when the joints in the legs disfigured by nerve damage
* Primary and primary infection do not control. Neurological damage bladder control patients could not state the end, still urine in the bladder after urinating, when it is so easy to create conditions for germs to develop in the bladder and kidneys, leading to infection urinary tract. Nerve damage also affect the ability to sense when you urinate and control of urination.
* Hypoglycaemia without warning. Normally, when blood sugar dropped too low, below 70 mg / dL, or below 3.0 mmol / L patients will have symptoms such as trembling hands, sweating, heart palpitations... Here are the warning symptoms of patients. Neuropathy can automatically make the patient may not manifest symptoms of hypoglycemia and is not treated promptly, very easy to coma and even death.
* Low blood pressure.. Neurological damage control circulatory system will impact the ability to adjust the body's blood pressure. When that cause low blood pressure when changing positions from sitting to standing, causing symptoms of dizziness or shock. Called postural hypotension.
* Gastrointestinal disorders. Automatic nerve damage control digestive system will cause many digestive problems, including constipation, diarrhea or constipation interspersed diarrhea, nausea, vomiting, bloating or loss of feeling good mouth. A serious complication that is paralyzed stomach, as food from the stomach slowly cause nausea and vomiting.
* Sexual dysfunction. Neuropathy usually automated nerve damage affecting the genitals, causing erectile dysfunction in men and vaginal dryness in women.
* Increased or decreased sweating. When the sweat glands do not function normally, the body will not be able to regulate body temperature. Typically, neurological diseases causing automatic sweat more, especially at night
Drugs and treatment
Treatment of neurological diseases caused by diabetes to focus on:
* Slow progression of disease
* Reduce pain
* Treatment of complications
* Rehabilitation
Slow progression of the disease.
Keep blood sugar constant in the normal limits will help slow the progression of peripheral neuropathy and can reduce symptoms. Target blood glucose:
* Blood sugar before meals: 90 to 130 mg / dL (5 to 7 mmol / L)
* 2 hour postprandial blood glucose <180 mg / dL (10 mmol / L)
* Hemoglobin A1c <7%
Sugar HbA1c is associated with hemoglobin - substance inside red blood cells carrying oxygen. It reflects the average blood glucose of patients in 2-3 months
To help slow the nerve damage:
* As recommended by your doctor about foot care
* Keep blood pressure within limits
* The healthy diet and reasonable
* Regular physical activity that
* Maintain ideal body weight
* Stop smoking
* Absolute alcohol or stop drinking, if permitted, shall not exceed one per day for women beer or two cans, for men.
Analgesic
Treatment of pain in neurological disease caused by diabetes is very difficult. Many drugs have been used to relieve pain but not effective in all patients and many side effects.
These medications include:
* Anti-epileptic Drugs: Drugs such as gabapentin (Neurontin), pregabalin (Lyrica) and carbamazepine (Tegretol), used to treat epilepsy, but it is also used to treat neuropathic pain. Side effects include drowsiness and dizziness.
* Antidepressants, including amitriptyline, nortriptyline (Pamelor), desipramine (Norpramin) and imipramine (Tofranil), may reduce pain mild to moderate, but also has many side effects. The new antidepressants better pain relief and fewer side effects.
* Lidocaine patch. Patch containing lidocaine local anesthetic and helps relieve pain. Usually no more side effects, sometimes causing redness.
*Capsaicin is a substance extracted from chillies, when applied on the skin, capsaicin cream (ArthriCare,... Zostrix) can reduce pain..
* Other drugs. Painkillers such as codeine or central oxycodone (OxyContin) may be used to relieve pain. But the drugs can cause many adverse effects of long-term treatment.
Other types of treatment
Many non-drug treatments can help relieve pain. Can be combined with drugs to treat:
* Alpha-lipoic acid (ALA). Alpha-lipoic acid is an antioxidant found in food, can help reduce symptoms of peripheral neuropathy.
* Electrical stimulation through the skin: This method uses a small electric current stimulation to reduce pain, but this method is not effective in all patients and all types of pain.
* Acupuncture. National Institutes of Health of the United States have applied acupuncture in the treatment of chronic pain including neuropathic pain.
* Relaxation techniques. Reduce the pressure and pain. Relaxation techniques include deep breathing exercises or looking at pictures, yoga...
Treatment complications
Urinary tract complications. Anti-spasm medication (anticholinergics), changing county... to reduce urination urinary tract symptoms.
Gastrointestinal disorders. When the stomach is paralyzed, the patient should eat several meals a day, each meal should eat less, down fiber and fats in the diet.
* Postural hypotension. Patients with postural hypotension should avoid alcohol, drink plenty of water and stood up from tu.Co many drugs to treat postural hypotension, such as fludrocortisone to increase blood pressure.
* Sexual dysfunction. Sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra) may improve sexual function in men, but these drugs may not be effective and safe for everyone. Women may need substance through vaginal estrogen cream to prevent vaginal dryness.
Prevention
Patients can prevent and delay complications of neurological disease due to diabetes by keeping blood sugar within permissible limits, foot care and lifestyle changes.
Blood sugar control:
Target blood sugar
* Blood sugar before meals: 90 to 130 mg / dL (5 to 7 mmol / L)
* 2 hour postprandial blood glucose <180 mg / dL (10 mmol / L)
* Hemoglobin A1c <7%
Foot care
To protect your feet to avoid serious complications:
* Check feet every day. If patients do not see the soles of the feet, to use mirrors or inspection by a relative vacuum. Find the area swelling, boils, wounds, red...
* Retain a clean and dry. Wash your feet daily with warm water. If your feet can not feel temperature, test temperature of water by absorbent towel to touch other body areas, such as wrist, elbow or used for testing. Dry your feet gently Rub the skin can cause scratches. Dry the feet of the interstitial fluid and apply to damp skin if dry skin.
Cut nails carefully. Cut nails straight lines and careful sanding edges. Do not cut corners feet deep.
* Based calluses. Use a pumice or nail files for filing calluses or maybe surgery to remove, but patients do not voluntarily cut calluses.
* Wear clean socks and dry. Cotton socks should even go in the house.
* Wear shoes both legs. Always wear shoes to protect feet just to avoid foot injuries. Should buy shoes in the afternoon because then your feet will be larger than the morning
Lifestyle changes
* Control blood pressure. Diabetic patients are at risk of hypertension than 2 times higher than people without diabetes. If both hypertension and diabetes, patients with increased risk of complications in blood vessels and reduced blood flow information. Control blood pressure <130/85 mmHg
* Choose foods that have health benefits. Select balanced diet, especially greens, fruits, whole grain wheat. Keeping an ideal body weight.
* Physical activity daily. Daily activities to help protect the heart and improves blood flow, and which help stabilize blood sugar and blood pressure.
* Stop smoking. Diabetic patients smoking increases the risk of stroke and myocardial infarction than 2 times compared with diabetic patients not smoking. Periodic leg at the same time is also affected.
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