Peripheral neuropathy is one of the most common complications of diabetes. The longer the life expectancy with diabetes, the greater the risk of developing neuropathy.
In young patients with type 1 diabetes, the result of poor control of diabetes can be seen from the onset of the disease.
It is more common in people with type 2 diabetes, and the onset of the disease may begin with neuropathic involvement.
It is thought that there is an imbalance in nerve fiber destruction and repair in diabetic polyneuropathy. High blood sugar, oxidative stress, and disruptions in cell repair mechanisms are thought to be among the causes. In addition, ischemic factors and inflammation also contribute to the development of diabetic neuropathy. Keeping blood sugar within normal limits prevents the development of diabetic polyneuropathy.
Diabetic polyneuropathy causes different involvements from patient to patient. It can have proximal or distal, acute, subacute or chronic, symmetrical or asymmetrical, painless or painful, sensory or motor or autonomic involvement.
The most common initial symptoms are numbness, burning feet, stinging, and electric shock. Symptoms are more pronounced at night and the burning is more exacerbated by contact.
Sensory diabetic polyneuropathy is sometimes completely silent and shows symptoms such as painless trauma or burns, wounds on the foot. It starts from the feet first and progresses upwards, often extending to the arms after passing the knee level. As the spread continues, complaints are also observed in the trunk. If progression is not prevented, almost all sensory modalities such as pain and temperature disappear.
Another neuropathy seen in diabetic patients is selective fine fiber neuropathy. Thin fiber neuropathy is characterized by pain and decreased sensation of heat. Pain is defined by patients as a burning, stinging, stabbing or pressure sensation.
Another neuropathic involvement detected in diabetic patients is autonomic neuropathy. Autonomic neuropathy can be life-threatening in diabetic patients. It can be observed that the heart is affected, causing palpitations and tachycardia, silent heart attacks, and deterioration of the nutrition of the heart. Apart from this, postural hypotension, bloating in the stomach, vomiting, slowing of gastric emptying, diabetic diarrhea, urinary and stool incontinence, frequent urinary tract infections due to slowed bladder emptying, impotence (impotence) are frequently observed symptoms in diabetic autonomic involvement. When patients are left untreated, signs of autonomic involvement increase.
Diabetic polyneuropathy is diagnosed by the patient’s complaints and changes in EMG. Even in patients who do not have any complaints yet, slowdowns in conduction rate are observed with EMG.
Early diagnosis is very important in diabetic polyneuropathy and prevention of progression is of great importance.
Controlling blood sugar is the best strategy for preventing diabetic neuropathy.
Chronic foot wounds of a diabetic patient; It is often the result of unrecognized painless trauma, vascular insufficiency, and secondary infections. In order to prevent the progression of wounds, regular foot care and appropriate intervention for developing wounds are required.
Treatments for symptoms of diabetic neuropathy such as pain, autonomic disorders and loss of sensation are important. Carbamazepine, phenytoin, clonazepam and some antidepressants are used in its treatment. Alphalipoic acid, gabapentin, pregabalin treatments were found to be effective in diabetic polyneuropathy. In addition, physical therapy, ozone therapy, nerve blockages, and interventional pain methods are used in the treatment.
