Diabetic Neuropathy As A Long Term Complications Of Diabetes Mellitus And Management In Insulin Therapy
Examining For Nephropathy
Most common neurological complication is peripheral neuropathy. Metabolic neuropathy may develop because of hyperglycemia and this subsides with proper control of diabetes. The other type is mononeuritis multiplex which is produced by occlusion of the vasa nervorum of the nerve trunks. This does not clear up promptly with treatment. Clinical presentation may be varied. Symmetrical distal sensory neuropathy with pain, numbness, paresthesia, gloves and stocking, sensory loss and areflexia is a common pattern seen in diabetics.
Motor paralysis leads to foot drop, weakness and wasting of the quadriceps, wasting of small muscles of the hands and feet and clawing of the feet. Entrapment neuropathies are also not uncommon. Patients may develop carpal tunnel syndrome. As a result of sensorimotor neuropathy pressure, sores may develop over the metatarsal heads.
In chronic cases, with loss of sensations, the midtarsal and ankle joints may undergo degeneration (Charcot’s joints). The ulnar, femoral, common peroneal and sciatic nerve trunks may be affected in mononeuritis multiplex. The third or sixth cranial nerves may be paralysed (cranial neuritis). Pupillary abnormalities and disturbances of accommodation may also occur.
Sometimes, diabetics develop lancinating pains, motor weakness, sensory ataxia and bladder derangements as in the case of tabes dorsalis (diabetes pseudotabes).
Objective Analysis Of Neuropathy
Other Forms Of Diabetic Neuropathy
Diabetic amyotrophy consists of gross weakness and wasting of the proximal group of muscles- pelvic girdle, quadriceps, and iliopsoas. Clinical features are pain, paraesthesiae, and loss of tendon jerks, without any objective sensory loss. This is seen more commonly in elderly subjects. Diabetic amyotrophy has to be differentiated from a primary myopathy and neuropathy. With proper control of the diabetic state, amyotrophy clears up completelt unlike myopathy and neuropathy.
Autonomic neuropathy is common in diabetes. Presence of autonomic neuropathy should be looked for since the warning signs of hypoglycemia disappear in such patients. Common manifestations of autonomic neuropathy are impotence in males, orthostatic hypotension, nocturnal diarrhea, disorders of sweating such as anhidrosis or gustatory sweating, and atonia of the bladder. There is impairment of autonomic control of the heart. Absence of sinus arrhythmia and loss of normal response to Valsalva’s maneuvers clinically indicate autonomic dysfunction of heart. Subjects with cardiac autonomic neuropathy are under high risk of sudden death.
Once established, diabetic neuropathy tends to persist. Meticulous control of diabetes is of definite benefit. Analgesic, antidepressants, and hypnotics help to relieve pain and insomnia. Paraesthesiae can be relieved by phenytoin or carbamazepine. Empirically high dose of vitamin B1, B12 and B6 have been widely used based on clinical impression without much objective evidence. Electrical stimulation at the site of pain using a cutaneous nerve stimulator helps in relieving pain in some cases.
Continuous Insulin Therapy: Long term complications of diabetes can be minimized by more meticulous control of blood sugar levels. Insulin pumps which can be worn by the patient, and which are capable of delivering fixed or variable quantities of insulin are available at present. These are being used more and more.
© 2014 Funom Theophilus Makama