Symptoms of diabetic neuropathy

Symptoms of autonomic diabetic neuropathy are determined by the localization of the lesion.

For autonomic diabetic neuropathy of the cardiovascular system are characteristic:

• painless ischemia and myocardial infarction (detect only with ECG);
• decreased heart rate variability, including the lack of an adequate increase in heart rate with exercise, no changes in heart rate with deep breathing, Valsalva, orthostatic test;
• tachycardia at rest (defeat of the vagus nerve);
• Orthostatic hypotension (sympathetic innervation).

For autonomic diabetic neuropathy of the gastrointestinal tract is characterized by:

• dysphagia (violation of esophageal motility);
• feeling of stomach overflow, sometimes nausea, possible postprandial hypoglycemia (due to violation of evacuation from the stomach);
• night and postprandial diarrhea ,. Alternating with constipation (as a result of intestinal innervation damage);
• incontinence of the stool (dysfunction of the sphincter of the rectum).

With autonomic diabetic neuropathy of the genitourinary system, it is noted:

• violation of emptying the bladder, vesicoureteral reflux and atony of the bladder, accompanied by an increased risk of urinary tract infection;
• erectile dysfunction;
• retrograde ejaculation.

With autonomous diabetic neuropathy of other organs and systems, the following are possible:

• impaired pupillary reflex;
• violation of adaptation to darkness;
• violation of sweating (increased sweating during eating, decreased sweating of distal extremities);
• absence of symptoms of hypoglycemia.

Focal neuropathies

The clinical manifestations of these rare types of neuropathies are determined by the localization of the lesion. These include focal neuropathies of ischemic etiology and tunneling neuropathies.

Diabetic amyotrophy (proximal neuropathy) is characterized by:

• sudden onset, more common in older men;
• it is often accompanied by anorexia and depression.

Clinical manifestations include:

• weakness and atrophy of the hip muscles;
• pain in the back and thigh;
• difficulty in lifting from sitting position;
• usually asymmetric nature of the lesion or onset on one side, followed by the involvement of another limb;
• improvement of the state with the normalization of glycemia.

Diabetic radiculoplexopathy is more common in type 2 diabetes mellitus.

The clinical features include:

• unilateral progressive pain in the chest;
• possible sensitivity disorders in the area of innervation of the affected nerve.
• spontaneous recovery.

Mononeuropathy usually develops in individuals older than 40-45 years. Characteristic signs of mononeuropathy include:

• acute or subacute start;
• asymmetry of the process;
• defeat of cranial nerves (diverting and oculomotor, distal departments of the facial) with the development of the corresponding symptoms (more often double vision and paresis);
• sometimes pain in the eye area, headaches,
• spontaneous recovery.

Tunneling neuropathies are primarily associated not with impaired blood supply or nerve metabolism, but with their compression in anatomically conditioned "tunnels". Tunnel syndromes with compression of the median, elbow, ray, femoral, lateral cutaneous nerve of the femur, peroneal, and also medial and lateral plantar nerves are possible. Most often, with diabetes mellitus, carpal tunnel syndrome (compression of the median nerve) occurs.

Tunnel syndromes are characterized by:

• slow start;
• gradual progression and the absence of spontaneous recovery (in contrast to typical mononeuropathies).

Clinical symptoms of carpal tunnel syndrome include:

• paresthesia of the large, index and middle fingers;
• As the disease progresses, the pain sensitivity decreases in these fingers, the atrophy of the short muscle that removes the thumb.

[1], [2], [3], [4], [5], [6]

Subclinical stage of diabetic neuropathy

There are no clinical manifestations. Neuropathy is detected only with the help of special research methods. In this case it is possible:

• change the results of electro-diagnostic tests:
  • decrease in conduction of the nerve impulse in the sensory and motor peripheral nerves;
  • a decrease in the amplitude of induced neuromuscular potentials,
• change test results for sensitivity;
  • vibration;
  • tactile;
  • temperature;
• the change in the results of functional tests characterizing the activity of the autonomic nervous system:
  • a violation of the function of the sinus node and the rhythm of the heart,
  • impaired pupillary reflex.

Clinical stage of diabetic neuropathy

Diffuse neuropathy

With distal symmetric neuropathy, patients' complaints include:

• pains (usually mild, blunt and pulling, mainly in the feet and legs, intensifying at rest, especially in the evening and night, and decreasing with physical activity);
• numbness, paresthesia (including sensations of "crawling crawling", "superficial tingling"), dysesthesia (unpleasant and painful sensations from any touch of clothing, bedding), hyperesthesia, burning sensation (more often in the soles).

At physical examination also reveal:

• sensitivity disorders (vibration - the earliest manifestations, tactile, pain, temperature, muscle-joint feeling or proprioception - in the joints of the distal phalanx of the thumbs of both feet);
• arefleksiyu (usually the fall of the Achilles reflex on both sides),
• violation of the musculo-articular feeling in the distal interphalangeal joints of the big toes;
• motor disorders are possible later.

[7], [8]