Disorders of sensation are the most common and bothersome nerve disorders associated with diabetes. A number of different conditions break down into diffuse neuropathies involving many nerves and focal neuropathies involving one or a few nerves.
Distal polyneuropathy is the most frequently occurring form of diabetic neuropathy. "Distal" means "far away from the center of the body," like the feet and hands. "Poly" means "many," and neuropathy is disease in nerves. So this is a disease of many nerves noticed in the hands and feet.
The signs and symptoms of distal polyneuropathy include:
i Diminished ability to feel light touch (numbness) or feel the position of a foot, whether bent backward or forward, resulting from the loss of large fibers i Diminished ability to feel pain and temperature, resulting from the loss of small fibers i Minimal weakness i Tingling and burning i Extreme sensitivity to touch i Loss of balance and coordination i Worsening of symptoms at night
The danger of this kind of neuropathy is that the patient doesn't know, without looking, whether he has trauma to his feet, such as a burn or a puncture. When the small nerve fibers are lost, the symptoms aren't as serious. The majority of patients with distal polyneuropathy are unaware of the loss of nerve fibers, and the disease is detected by nerve conduction studies.
The most serious complication of loss of sensation in the feet is the neuropathic foot ulcer. A person with normal nerve function feels pain when pressure mounts on an area of the foot. However, a person with diabetic neuropathy doesn't feel this pressure. A callus forms, and with continued pressure, the callus softens and liquefies, finally falling off to leave an ulcer. This ulcer becomes infected. If it isn't promptly treated, it spreads, and amputation may be the only way to save the patient. In this situation, loss of blood supply to the feet isn't an important contributing factor to the ulceration; in fact, the blood supply may be good, but an ulcer still develops.
A less common complication in distal polyneuropathy is neuroarthropathy, or Charcot's joint. In this condition, trauma occurs to the joints of the foot and ankle without the patient feeling it. The bones in the foot go out of line, and many painless fractures occur. The patient has redness and painless swelling of the foot and ankle. The foot becomes unusable and is described as a "bag of bones."
¿jjjMjlEft Treatment of distal polyneuropathy starts with the best possible glucose control and extremely good foot care. Your doctor should look at your feet during each visit, particularly if you have evidence of loss of feeling. Chapter 7 has more information on checking your feet.
Some drugs, such as the non-steroidal anti-inflammatory agents ibuprofen and sulindac, can reduce the inflammation associated with the unfelt trauma. Other drugs, such as the antidepressants amitryptiline or imipramine, reduce the pain and other discomfort that becomes worse as distal polyneuropathy continues. A drug called capsacin that's applied to the skin reduces pain as well. The results of these treatments are variable and seem to work only 60 percent of the time. However, the longer the pain has been present, and the worse the pain is, the less likely the drugs are to work.
Other drugs called gabapentin and pregabalin have been found to work more often than many of the older drugs in treating distal neuropathy, but they cause sleepiness and dizziness, which may make treatment more complicated. New drugs continue to be developed, but perhaps because so many factors cause the neuropathy, no one drug has proven to be successful all the time.
Polyradiculopathy-diabetic amyotrophy is a mixture of pain and loss of muscle strength in the muscles of the upper leg so that the patient can't straighten the knee. Pain extends from the hip to the thigh. This is the second most common diabetic nerve condition after polyneuropathy. Time may heal the problem; it usually lasts weeks to months, but it may last years. Tight glucose control doesn't seem to have as much of an effect on this condition as it does on others. Painkillers may help.
Sometimes a severe pain along the location of a specific nerve suggests that the root of the nerve is damaged as it leaves the spinal column. The usual clinical picture for this condition known as radiculopathy is pain distributed in a horizontal line around one side of the chest or abdomen. The pain may be so severe that it's mistaken for an internal abdominal emergency. Fortunately, the pain goes away in 6 to 24 months. In the meantime, good glucose control and pain management with various painkillers are helpful.
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This guide will help millions of people understand this condition so that they can take control of their lives and make informed decisions. The ebook covers information on a vast number of different types of neuropathy. In addition, it will be a useful resource for their families, caregivers, and health care providers.