Diabetic neuropathy

     Diabetes mellitus is a common chronic condition that can lead to numerous complications. Diabetic neuropathy is one of the major complications and a leading cause of disability that adversely affects patients’ quality of life, especially in individuals with long-standing and poorly controlled diabetes, whether type 1 or type 2.

These complications may occur in both types of diabetes

     In some cases, diabetic neuropathy may already be present at the time of diagnosis of type 2 diabetes, as the patient may have had the disease for some time without prominent symptoms. Pain is a key symptom of this condition, although it is not present in all patients, and the pathogenesis remains unclear. However, recent research over the past decade suggests that immune system mechanisms and abnormal nervous system adaptation play significant roles in disease progression.

Most patients experience chronic pain that is difficult to treat and significantly impairs their quality of life. This may further lead to additional complications.

Image source: East Coast Podiatry

Diabetic Neuropathy

     Diabetic neuropathy is a complication caused by the degeneration of nerves, which can occur from the pre-diabetic stage through to the advanced stages of the disease. Strict blood sugar control is therefore essential. Current treatment focuses on symptom relief through pain management and the prevention of further complications. Advances in modern medical science have improved understanding of the disease mechanisms, aiding in the development of more effective treatments.

Types of Diabetic Neuropathy

     A distinctive form of diabetic neuropathy is Diabetic Lumbosacral Radiculoplexus Neuropathy (DLRPN), also known by other names such as Diabetic Amyotrophy, Bruns-Garland Syndrome, or Femoral-Sciatic Neuropathy.

Symptoms of Diabetic Neuropathy

     Patients often experience sudden numbness or pain in the thigh, accompanied by weakness in the quadriceps or iliopsoas muscles, resulting in difficulty walking. Physical examination may reveal reduced or absent patellar reflexes. These symptoms may persist for several months before gradually improving, though some disability may remain.

Abnormal Immune Responses

     Currently, it is believed that this condition results from abnormal immune responses, leading to inflammation and blockage of the small blood vessels supplying the affected nerves. Neuropathological studies have shown inflammatory responses and lymphocyte infiltration around the blood vessels, leading to nerve damage.

Treatment often involves the use of high-dose corticosteroids or intravenous immunoglobulin (IVIG), which have shown promising results. However, large-scale studies confirming their efficacy are still lacking.

Diabetes Mellitus and Nervous System Complications

     Diabetes is a major cause of many serious complications. Poor control of the disease increases the risk of these complications, which can affect any part of the body, with the nervous system being one of the most commonly impacted.

1. Peripheral Nervous System Complications

Patients may experience sensory loss, typically starting as numbness in the fingers and progressing to other body parts. Even when in contact with heat, cold, or injury, the patient may not feel anything.

• Damage may also occur to the cranial nerves, especially those controlling eye muscles, resulting in symptoms such as double vision, restricted eye movement, and headache.
• The feet are particularly vulnerable to injury in diabetic patients, as they are constantly in use. If sensory nerves in the feet are impaired, the patient may not notice injuries caused by stepping on sharp objects. Furthermore, due to poor blood circulation and high blood sugar, wounds heal more slowly and are more prone to infection.
• If wounds are not properly managed, they may become infected. In cases where microvascular complications reduce blood flow to the feet, patients may experience burning pain, nerve pain, or a sensation similar to ants crawling on the feet.

2. Autonomic Nervous System Complications

• When the autonomic nervous system affecting the gastrointestinal tract is involved, it can lead to symptoms such as poor gastric motility, reduced appetite, vomiting, abdominal bloating, and impaired nutrient absorption.
• If the autonomic nerves responsible for the reproductive or urinary systems are affected, symptoms may include urinary incontinence, bladder dysfunction with urine retention, urinary tract infections, and sexual dysfunction, including erectile dysfunction in men.

Conclusion

     Diabetes damages the small blood vessels that supply the peripheral nerves, especially in the hands and feet. This results in nerve dysfunction, leading to numbness or burning pain. If patients develop wounds, they may not notice or treat them due to sensory loss. High blood sugar further promotes infection, and untreated wounds may become gangrenous, potentially leading to amputation. In men, this may also result in erectile dysfunction.

Diabetic neuropathy causes numbness in the hands and feet, making it difficult for patients to notice wounds, which can become necrotic if left untreated.