Diabetic neuropathy is one of the late complications of diabetes and encounters several disorders regarding somatic (peripheral) and / or autonomic nervous system.
Eliciting factors are deposits of glucose alcohols (polyols) alongside of nervous membranes, disorders of the circulation in the nerves due to damaged small blood vessels and changes of factors which are responsible for the growth of the nerves.
Diagnostic checks have to distinguish other types of neuropathy (excessive alcohol consumption, lack of vitamins, virus infections, effect of chemotherapy, exposition to heavy metals, other metabolic diseases). About 30% of type 1 and type 2 diabetics develop a diabetic neuropathy. The risk is influenced by metabolic control, duration of diabetes, age of patient, hypertension, metabolic fat disorders or more diabetic late complications (retinopathy, nephropathy).
After a duration of diabetes of 10 years half of all diabetics show symptoms of a diabetic neuropathy. Sometimes diabetic neuropathy does not lead to any symptoms (subclinical) or shows multiple symptoms. Main types of diabetic neuropathy are the peripheric sensomotoric neuropathy and the autonomic neuropathy.
Periperic sensomotoric neuropathy
The peripheric sensomotoric neuropathy (80% of all cases of neuropathy) leads to nervous disorders at the limbs, which occur typically symmetric (both sides) and mostly the lower limbs are concerned (feet and legs). It is very common that symptoms progress from the toes or hands to lower leg or forearm.
Diabetics with neuropathy feel paraestesia (prickle, burning pain especially during the night), unawareness of sensations (touch, pain, temperature, vibration), disordered function of the nerves nourishing the muscles of the feet, deficits in reflexes.
A dramatic consequence of the diabetic neuropathy is the Diabetic Foot Syndrome (DFS). People are not aware of injuries due to reduced pain perception. Infections can complicate the situation.
Diabetics have to be trained accordingly by their diabetes health care team to achieve good metabolic control. Regular checks can help to avoid Diabetic Foot Syndrome and its complications.
Easy checks like the test with a tuning fork for perception of vibration, the test for distinguishing cold/warm or sharp/blunt help the physician to detect nervous damage in time even when the patients does not feel any symptoms.
Autonomic diabetic neuropathy concerns the so-called vegetative nervous system and can lead to functional disorders in several organ systems.
This encounters reduced awareness of hypoglycemia due to a deficit of counterregulation, pain-free heart attack, disordered regulation of heart frequency, cardiac arrhythmia, disordered regulation of blood pressure and circulation, disordered sweat secretion (dry skin which can be injured easily), disorders in stomach/intestinal function, disordered function of the bladder and erectile dysfunction.
In terms of prevention and therapy optimized blood glucose control plays an important role. Normalization of blood pressure is important as well.
Other therapeutical options care for the symptoms of the disease (pain-reducing medication, antiepileptics). Some studies show some positive proof for a therapy with alpha-Lipon acid.
The most important goal is to diagnose patients at risk in time especially to prevent Diabetic Foot Syndrome.