What hurts with type 1 and type 2 diabetes?

If diabetes, like endocrine pathology, is associated with disruption of the homeostasis of the most important energy substrate in the body - glucose, then the different localization of pain in diabetes occurs as a complication of it due to prolonged hyperglycemia, in which glucose has a toxic effect on many tissues.

Causes of pain in diabetes

From the standpoint of the achievements of diabetology, the causes of pain in diabetes and their pathogenesis are considered by endocrinologists as components of a multistage biochemical process that occurs when the blood glucose in the blood of diabetics is elevated and affects the whole organism.

Excess glucose leads to an acceleration of glycation of proteins, that is, nonenzymatic binding of the aldehyde glucose group to the terminal amino group of proteins. At the same time - due to the accumulation of the given products (immunoreactive carbonyl compounds) in the cells of the reaction (proteins containing lipoprotein envelopes of blood erythrocytes, connective tissue proteins (elastin and skin collagen, endothelium of vessels), myelin sheath of nerve fibers undergo structural modification. Its negative result is damage to tissues with a violation of their inherent functions.

The causes of pain in diabetes are also associated with the oxidation of excessive amounts of glucose, which brings normal interstitial oxidation processes to the degree of oxidative stress: with an increase in free radicals, an increase in oxidized lipids, LDL, isoprene and diacylglycerol. The latter initiates the expression of the intracellular enzyme protein kinase-C, as a result of which the smooth muscle and connective tissue fibers of the blood vessel walls enter the hypertension state; platelets undergo enhanced aggregation; glycosylated plasma albumin poorly delivers the cells the necessary substances and removes metabolites and exogenes.

The basal layer of the epithelium lining the capillary walls becomes thicker (the vessels become less elastic), and the endothelium itself is hypertrophied due to deposits of lipo- and glycoproteins. This reduces diffusion of oxygen and negatively affects the barrier function of the endothelium and microcirculation (capillary blood flow) - with the development of  diabetic angiopathy.

[1], [2], [3], [4]

Pathogenesis

The pathogenesis of damage to the peripheral and autonomic nervous system - with the  symptoms of diabetic neuropathy  (or polyneuropathy), including pain - is caused by glycation of the main protein and myelin phospholipids of the nerve fiber membrane. For this reason, the transmission of nerve impulses from the receptors to the brain is disrupted. For more details, see:  Pain in diabetic polyneuropathy

Statistics

Statistics of the incidence of pain in patients with diabetes mellitus associated with the development of diabetic polyneuropathy, varies from 20 to 55%, according to other data - 65% or more.

One third of patients complain of pain in the legs, of which diabetic osteoarthropathy is noted in more than 6.5% of cases, and diabetic foot syndrome after 15-20 years of the disease (most often of type 2 diabetes) - in every tenth case.

Problems with kidneys in diabetes occur in 25-40% of patients.

What hurts with diabetes?

Most often, with diabetes, legs hurt. Restriction of mobility and joint pain in diabetes can appear years after detection of the disease in patients with unstable or poorly controlled levels of hyperglycemia - due to the development of diabetic osteoarthropathy. And they can start much faster, since proteins of collagen, proteoglycans and glycoproteins of cartilaginous tissue are exposed to toxic effects of excess glucose among the first.

The defeat of metatarsophalangeal joints causes blunted pains of the toes in diabetes; tarsal joints - pulling or burning foot pains with diabetes; and when the subtalar and / or talus-calcaneus-navicular joints are affected, the heel in diabetic is sore. You can feel burning in the legs, the feet are always cold and often cyanotic, and also swell (swelling takes hold of the ankle and spreads to the lower part of the shin). Legs ache during movement, lameness (intermittent), cramping of the calf muscles, knee pain in diabetics is possible. Over time, pain is increasingly worried and at rest. This symptomatology is noted in limb ischemia - diabetic microangiopathy and insufficiency of their arterial blood supply (macroangiopathy).

When the etiology of complications is associated with nerve damage, leg pain in diabetics begins only after deformity of the joints and the apparent syndrome of the diabetic foot (Charco's osteoarthropathy), since in the initial stages of such patients the reflexes and sensitivity of the distal sections of the lower limbs are impaired (paresthesia, dysesthesia, hyperesthesia ).

In addition, if the peroneal nerve is squeezed, pain can be felt in the region of the thigh (which indicates the syndrome of the tarsal canal).

Pain in the hands of diabetes

It is often enough to worry about pain in the hands of type 2 diabetes in the presence of focal mononeuropathy of the upper limbs in the form of osteoarthritis of the joints of the fingers, inflammation of the tendons and the joint bag of the shoulder joint (humeroscapular periarthritis). And because of the compression of the nerve in the carpal tunnel, carpal (carpal) syndrome accompanied by characteristic pain can develop.

Pain in muscles with diabetes

With deficiency of endogenous insulin and inability of tissues to absorb glucose in patients with type 1 diabetes mellitus, the mechanism of its production due to cleavage of glycogen, which is available not only in the liver, but also in muscles, can be included. Moderate pulling pain in muscles with diabetes can appear for this reason.

Localized on the external surface of the thigh and in the buttock, acute muscle pains - with simultaneous muscle weakness and movement problems - are explained in endocrinology by the superhigh level of hyperglycemia and the state of diabetic ketoacidosis.

Back pain in diabetes can be caused by damage to connective tissue membranes of the spinal nerves (due to glycation of collagen and elastin proteins). Often, it is low back pain in diabetes with hip and region spread along the entire lower limb; while weakening the tone of muscle fibers and reducing their volume. The presence of these symptoms is a manifestation of the amyotrophic form of diabetic neuropathy or lumbosacral radiculopathy.

Pain in the bones with diabetes

The pains felt in the bones in diabetes, experts attribute to two main factors. First, with a decrease in bone mineral density due to the high activity of osteoclasts and the predominance of resorption processes. In this process, the formation of bone tissue - osteoblastogenesis - lags noticeably due to a lack of insulin (and associated with its synthesis of growth factors). So some patients have boneaches in diabetes due to secondary osteoporosis.

Secondly, an important role in the appearance of such pain is played by problems with joints and ligaments, since glycation of the protein compounds that make up their tissues adversely affects the entire musculoskeletal system.

Headache with diabetes mellitus

As endocrinologists emphasize, the headache in diabetes can arise not only when the blood sugar level is elevated, but also in the opposite situation, as well as with its fluctuations and sharp jumps and too high doses of insulin.

A prolonged overdose of insulin, known as Somogy's syndrome, usually begins to manifest itself with sudden weakness and a headache. And if the patient, in addition to these symptoms, suffer from nausea and thirst, these are the first signs of a dangerous condition - ketoacidosis.

Cardialgia in diabetes mellitus

Coronary heart disease, according to clinical data, develops in almost half of elderly patients with diabetes mellitus. Therefore, complaints about the fact that the heart is aching with diabetes, doctors listen often.

Cardialgia in combination with cardiac rhythm disturbances (tachycardia or bradycardia) is referred to as diabetic mononeuropathy with insufficient insulin replacement therapy.

[5], [6], [7]

Pain in the abdomen, stomach, in the pancreas with diabetes

Spontaneously occurring painful spasms in the abdomen (short, with diarrhea) or mild pains of a bursting nature (with constipation) may indicate diabetic enteropathy. But acute pain in the abdomen with diabetes, accompanied by a strong thirst, increased heart rate, increased diuresis, nausea, vomiting and diarrhea, are signs of a complication such as  diabetic ketoacidosis and diabetic ketoacidotic coma

Various problems with the gastrointestinal tract have many diabetics, and stomach pains in diabetes are not uncommon. Physicians consider this a manifestation of gastrointestinal neuropathy. In cases of damage to the innervation of the stomach, his motor skills may be disrupted and gastroparesis may develop, which causes pain, nausea and vomiting, reflux of gastric contents with heartburn.

Typically, pancreatic pains in type 1 diabetes - with autoimmune damage to the β-cells of the islets of the pancreas Langerhans.

Almost two thirds of patients this pathology leads to inflammation of these tissues - insulin with pain in the subcostal area.

Kidney Disease in Diabetes

With long-term diabetes of both types, sclerotic changes in the intima of renal vessels, the structure of nephrons, glomerulus (glomeruli) and the violation of their functions lead to the development of nephrosclerosis, nodular or diffuse sclerosis of the glomerulus (glomerulosclerosis), due to which kidneys are afflicted with diabetes

Also read the article -  Diabetic Nephropathy

Pain in the eyes of diabetes

When the eyes are aching with diabetes, pressure is felt inside the eyeballs, the spots "swim" before the eyes and vision deteriorates, ophthalmologists diagnose diabetic retinopathy, that is, the pathological change in the retina caused by the damage to its blood vessels.

Diagnosis of pain in diabetes

Given the localization of pain syndromes, the diagnosis of pain in diabetes requires a thorough examination with the involvement of doctors of various specializations - from the orthopedist and neurologist to the gastroenterologist and ophthalmologist.

And, depending on the individual patient, in each case, analyzes are assigned, instrumental and differential diagnosis is performed.

Complete information in the article -  Diagnosis of diabetic neuropathy

[8], [9], [10]

Treatment of pain in diabetes

From the point of view of etiology, the main treatment for pain in diabetes is adequate insulin substitution and hypoglycemic therapy, that is, treatment of the disease itself. All other pharmacological drugs, including pain medication - for example, carbamazepine,  gabapentin,  or pregabalin - are symptomatic.

It is customary to prescribe vitamins with shock doses: acting as a strong antioxidant thiamine (B1), which increases immunity and helps nerve cells absorb glucose pyridoxine (B6), as well as cyanocobalamin (B12), which supports the defenses of the body, blood and nervous system.

On how to get rid of pain in diabetes and what medications should be taken, how physiotherapy is carried out, and whether it is possible to treat people with pain syndromes in diabetes, and when surgical treatment is necessary - for details in the material.  Treatment of diabetic neuropathy

Consequences and complications

As practice shows, foot pains with diabetes are not the worst: the appearance of ulcers on the fingers, between the fingers, on the heels can lead to necrosis of soft tissues, and necrosis to gangrene.

With insulin, damage to the tissues of the pancreas can reach pancreatitis or lead to fibrosis and complete cessation of organ function.

When complications of diabetes affect the kidneys - with a nodular or widespread defeat of the glomerulus, the result is most often chronic renal failure.

The consequences and complications of diabetic retinopathy include not only deformity of the vitreous, but retinal detachment and irreversible loss of vision.

But even more serious consequences - a lethal outcome - has a ketoacidotic coma in diabetes, and so this condition ends in almost ten cases out of a hundred.

[11], [12], [13], [14], [15], [16], [17], [18],

Prevention

Unfortunately, to date, diabetes prevention, despite the advice to lead a healthy lifestyle, is impossible.

And the main thing in the prevention of diabetic polyneuropathy is the constant struggle with hyperglycemia and control of blood sugar level. First of all, these are the appropriate drugs, but one should also control one's diet. Read -  Diet for Type 1 Diabetes  and  Diabetes for Type 2 Diabetes

Endocrinologists say that the risk of serious complications of diabetes can be reduced by half.

Forecast

The course of pain syndromes in diabetic neuropathy can have a favorable prognosis only if the treatment is started and the glycemia is kept at a level close to normal.

[19], [20]