Diabetic neuropathy: an overview of information

Diabetic neuropathy is a combination of syndromes of the nervous system that are pathogenetically associated with diabetes mellitus, classified according to the primary involvement of the spinal cord nerves (distal or peripheral, diabetic neuropathy) and / or the autonomic nervous system (visceral or autonomic, diabetic neuropathy with the exclusion of other causes of their defeat.

According to this definition, only the type of damage to the peripheral nervous system can be considered diabetic, in which other etiological factors of polyneuropathy development, for example, toxic etiology (alcoholic) or other endocrine system diseases (hypothyroidism), are excluded.

[1], [2], [3]

The causes and pathogenesis of diabetic neuropathy

The pathogenesis of diabetic neuropathy is not fully understood. The main initial pathogenetic factor of diabetic neuropathy is chronic hyperglycemia, which ultimately leads to a change in the structure and function of nerve cells. Probably, the most important role is played by microangiopathy (changes in vasa nervorum with disturbed blood supply of nerve fibers) and metabolic disorders, which include:

• Activation of the polyol shunt (impaired fructose metabolism) is an alternative way of glucose metabolism, as a result of which it is converted to sorbitol by aldose reductase, then into fructose, the accumulation of sorbitol and fructose leads to hyperosmolarity of the intercellular space and edema of the nerve tissue;
• a decrease in the synthesis of the components of nerve cell membranes, leading to a disruption of the nerve impulse. In this regard, effective in diabetic neuropathy is the use of cyanocobalamin involved in the synthesis of the myelin sheath of the nerve, which reduces pain sensations associated with damage to the peripheral nervous system that stimulates nucleic acid metabolism through the activation of folic acid;

The causes and pathogenesis of diabetic neuropathy

Symptoms of diabetic neuropathy

Clinical manifestations of diabetic neuropathy in the initial stages are absent. 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;

Symptoms of diabetic neuropathy

Diagnosis of diabetic neuropathy

The diagnosis of diabetic neuropathy is based on the corresponding complaints, anamnesis of type 1 or type 2 diabetes, data from a standardized clinical examination and instrumental research methods (including quantitative sensory, electrophysiological (electromyography) and autofunctional tests).

[4], [5], [6], [7], [8], [9]

Complaints and standardized clinical examination

To measure the intensity of pain, special scales are used (TSS - general scale of symptoms, VAS - visual analog scale, McGill scale, HPAL - Hamburg symptom questionnaire).

Diagnosis of diabetic neuropathy

[10], [11], [12], [13], [14], [15], [16],

Treatment of diabetic neuropathy

The main measure of prevention and treatment of diabetic neuropathy is the achievement and maintenance of target values of glycemic values.

Recommendations for the pathogenetic therapy of diabetic neuropathy (benfotiamine, aldolazoreductase inhibitors, thioctic acid, nerve growth factor, aminoguanidine, protein kinase C inhibitor) are being developed. In some cases, these drugs alleviate neuropathic pain. Treatment of diffuse and focal neuropathies is mostly symptomatic.

Thioctic acid - intravenously drip (for 30 minutes) 600 mg in 100-250 ml of 0.9% sodium chloride solution once a day, the course of 10-12 injections, then inside 600-1800 mg / day, in 1-3 reception, 2-3 months.

Treatment of diabetic neuropathy