Introduction,causes,signs and symptoms and pathogenesis, prevention: Diabetes mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar (glucose) levels to be abnormally high. Urination and thirst are increased, and people may lose weight even if they are not trying to.
Now let us understand the meaning of pathy.Pathy is denoting disorder in a particular part of the body.pathy: A suffix derived from the Greek "pathos" meaning "suffering or disease".
The complications or pathies associated with Diabets are
neuropathy (nerve disease);
Cardiomyopathy (Heart muscle disease); retinopathopathy (disease of the retina); nephropathy (disease of kidney),macro vascular disease; micro-angiopathy (disease of small blood vessels) etc .
In medical terminology, the word -pathy indicates the disease state of that specific organ of human body. Some examples of this include neuropathy, myopathy, retinopathy, cardiomyopathy, and nephropathy.
Common diabetes health complications include heart disease, chronic kidney disease, nerve damage, and other problems with feet, oral health, vision, hearing, and mental health.
The peripheral nervous system is one of two components that make up the nervous system of bilateral animals, with the other part being the central nervous system. The PNS consists of the nerves and ganglia outside the brain and spinal cord.
The peripheral nervous system is divided into two main parts:
(i) Autonomic nervous system (ANS): Controls involuntary bodily functions and regulates glands.
(ii)Somatic nervous system (SNS): Controls muscle movement and relays information from ears, eyes and skin to the central nervous system.
Diabetic neuropathy refers to various types of nerve damage associated with diabetes mellitus. Symptoms depend on the site of nerve damage and can include motor changes such as weakness; sensory symptoms such as numbness, tingling, or pain; or autonomic changes such as urinary symptoms. These changes are thought to result from microvascular injury involving small blood vessels that supply nerves.
Diabetic neuropathy is a type of nerve damage that can occur if you have diabetes.It is the condition that most often affects the legs and feet. Diabetic peripheral neuropathy usually first appears in the feet and legs, and may occur in the hands and arms It is a progressive disease, and symptoms get worse over time. Neuropathy happens when high levels of fats or sugar in the blood damage the nerves in the body.High blood sugar -glucose that is hyperglycemia can injure nerves throughout the body.Neuropathy is a disease or dysfunction of one or more peripheral nerves, typically causing numbness or weakness.
For some people, symptoms are mild.Chronic symptoms can last for years or be lifelong.
For some people, symptoms are mild. For others, symptoms can be painful, debilitating and even fatal.
Symptoms include pain and numbness in the legs. In more severe cases, symptoms include issues with digestion, the bladder and controlling heart rate. Consult your local medical authority for advice.
Dr
Prevalence and incidence of diabetic peripheral neuropathy:
Prevalence is a function of disease duration, and a reasonable figure, based upon several large studies, is that approximately 50 percent of patients with diabetes will eventually develop neuropathy.
The prevalence of peripheral neuropathy in diabetic subjects approaches 70% and about 50% of these are cases of DPN. The disease usually progresses to involve cardiac autonomic nerves, and as a result it is a major factor in mortality of diabetic subjects.
More than 1 million cases per year are reported in India.The estimates of DPN prevalence in India vary widely from 9.6% to 78% in different populations.The prevalence of DPN was found to be 39.3% in the present study which is higher when compared to the other studies from India which is 19.1% and 29.2% respectively.
The peripheral neuropathy is common in India:
Peripheral neuropathy (PN) is a common disorder and presents as diagnostic and therapeutic challenge to physicians and neurologists. In epidemiological studies from India from various regions the overall prevalence of PN varied from 5 to 2400 per 10,000 population in various community studies.
Tne number of people have peripheral neuropathy in the world:
Around 425 million people worldwide are suffering from this disease, and this number is expected to rise to 628 million people by 2045 . Diabetic peripheral neuropathy (DPN) is the most prevalent complication of diabetes mellitus .
The percentage of the population has neuropathy:
Neuropathy is very common. It is estimated that about 25% to 30% of Americans will be affected by neuropathy. The condition affects people of all ages; however, older people are at increased risk. About 8% of adults over 65 years of age report some degree of neuropathy.
As many as 50 percent of diabetics have nerve damage.
Diabetic neuropathy is a one of the serious diabetes complications that may affect as many as 50% of people with diabetes. But you can often prevent diabetic neuropathy or slow its progress with consistent blood sugar management and a healthy lifestyle.
25 to 50% of all diabetics have peripheral neuropathy.
Peripheral neuropathy is a type of nerve damage that typically affects the feet and legs and sometimes affects the hands and arms. This type of neuropathy is very common. About one-third to one-half of people with diabetes have peripheral neuropathy.
Early signs and symptoms of diabetes mellitus:
(1)Frequent urination. When your blood sugar is high, your kidneys expel the excess blood sugar, causing you to urinate more frequently.
(2)Increased thirst.
(3)Fatigue.
(4)Blurred vision.
(5)Increased hunger.
(6)Unexplained weight loss.
(7)Slow healing cuts and wounds.
(8)Tingling or numbness in the hands or feet.
The warning signs of neuropathy:
(1) burning pain radiating in hands or feet.
(2) pins and needles in the extremities of body
(3) numbness and tingling.
weakness in arms and legs.
(4) knotted feeling in the soles and palms.
(5) pain from the lightest touches.
(6) difficulty in walking.
pain from the pressure of walking
.
5 main Signs and symptoms of peripheral neuropathy are often worse at night, and may include:
(1)Numbness or reduced ability to feel pain or (2)temperature changes.
(3)Tingling or burning feeling.
(4)Sharp pains or cramps.
Muscle weakness.
(5) Extreme sensitivity to touch — for some people, even a bedsheet's weight can be painful.
Diabetic neuropathy can affect any peripheral nerves including sensory neurons, motor neurons, and the autonomic nervous system. Therefore, diabetic neuropathy has the potential to affect essentially any organ system and can cause a range of symptoms. There are several distinct syndromes based on the organ systems affected.
Sensori-motor polyneuropathy is a main syndrome associated with diabetic peripheral neuropathy.
Longer nerve fibers are affected to a greater degree than shorter ones because nerve conduction velocity is slowed in proportion to a nerve's length. In this syndrome, decreased sensation and loss of reflexes occurs first in the toes on each foot, then extends upward. It is usually described as a glove-stocking distribution of numbness, sensory loss, dysesthesia and night time pain. The pain can feel like burning, pricking sensation, achy or dull. A pins and needles sensation is common. Loss of proprioception, the sense of where a limb is in space, is affected early. These patients cannot feel when they are stepping on a foreign body, like a splinter, or when they are developing a callus from an ill-fitting shoe. Consequently, they are at risk of developing ulcers and infections on the feet and legs, which can lead to amputation. Similarly, these patients can get multiple fractures of the knee, ankle or foot, and develop a Charcot joint. Loss of motor function results in dorsiflexion, contractures of the toes, loss of the interosseous muscle function that leads to contraction of the digits, so-called hammer toes. These contractures (contracture is a condition of shortening and hardening of muscles, tendons, or other tissue, often leading to deformity and rigidity of joints.)occur not only in the foot but also in the hand where the loss of the musculature makes the hand appear gaunt(excessively thin and angular) and skeletal. The loss of muscular function is progressive.
The causes for diabetic neuropathy:
Over time, high blood glucose levels, hyperglycemia and high levels of fats, such as triglycerides, in the blood(hyper triglyceridemia) from diabetes can damage your nerves. High blood glucose levels can also damage the small blood vessels that nourish your nerves with oxygen and nutrients.
Diabetic neuropathy cannot be reversed or it can't ever go away:
Diabetic neuropathy is common and can't be reversed. However, you can manage it through a variety of ways.
These include managing blood glucose levels.
Regular walking good for diabetic neuropathy:
Walking is recommended as an adjunct therapy to diet and medication in diabetic patients, with the aim of improving physical fitness, glycaemic control and body weight reduction.
One can live longer with diabetic neuropathy:
Mortality is higher in people with cardiovascular autonomic neuropathy (CAN). Diabets mellitus and Cardiovascular autonomic neuropathy detected, compared with a 5% mortality rate in those without evidence of Cardiovascular autonomic neuropathy. Morbidity results from foot ulceration and lower extremity amputation.
Pathogenesis of diabetic peripheral neuropathy:
The following processes are thought to be involved in the development of diabetic neuropathy:
(1)Microvascular disease:
(Micro-angiopathy)
Vascular and neural diseases are closely related. Blood vessels depend on normal nerve function, and nerves depend on adequate blood flow. The first pathological basement membrane thickening and endothelial hyperplasia, which contribute to diminished oxygen tension and hypoxia.
Neuronal ischemia is a well established characteristic of diabetic neuropathy. Blood vessel opening agents or drugs (e.g., ACE inhibitors, α1-antagonists) can lead to substantial improvements in neuronal blood flow, with corresponding improvements in nerve conduction velocities. Thus, small blood vessel dysfunction occurs early in diabetes, parallels the progression of neural dysfunction, and may be sufficient to support the severity of structural, functional, and clinical changes observed in diabetic neuropathy.
(2) Role of Advanced glycated end products in pathogenesis:
Elevated levels of glucose within cells cause a non-enzymatic covalent bonding with proteins, which alters their structure and inhibits their function. Some of these glycated proteins have been implicated in the pathology of diabetic neuropathy and other long-term complications of diabetes.
(3) Role of Polyol pathway in pathogenesis:
Polyol pathway is
also called the sorbitol/Aldose reductase pathway. the polyol pathway appears to be implicated in diabetic complications, especially in microvascular damage to the retina,kidney, and nerves.Activation of the polyol pathway is an early abnormality in DPN. It comprises two steps: the conversion of glucose to sorbitol by aldose reductase and the conversion of sorbitol to fructose by sorbitol dehydrogenase.
Foods that you should avoid if you have ave Peripheral Neuropathy:
(1)Gluten.
(2)Alcohol.
(3)Added Sugars.
(4)Refined Grains.
(5)Salty snacks
(6)Trans fat and saturated fat
(7)Sugary Snacks: Snacks or desserts such as ice cream, cookies, candy, and even excess fruit consumption should be avoided by neuropathy patients.
(8)produce with pesticides
High levels of blood sugar impact nerve damage especially in those with diabetic neuropathy.
Six great plant-based foods to fight nerve pain:
(1) Green and leafy vegetables. Broccoli, spinach and asparagus all contain vitamin B, a nutrient important for nerve regeneration and nerve function. .
(2)Fruits. Eat at least one fruit daily to help heal damaged nerves.
(3)Zucchini.
(4)Sweet potato.
(5)Quinoa.
(6)Avocado
Other measures:
(1)Orange juice is good for nerves:Orange juice is rich in vitamin- C, with 1 cup (240 mL) providing 93% of the Daily Value. Interestingly, vitamin-C may offer neuroprotective benefits.
(2)High blood sugar affect neuropathy:Controlling your blood sugar is the best thing you can do to prevent peripheral neuropathy and diabetic neuropathy. Sugar in your blood can also contribute to peripheral neuropathy symptoms by damaging your nerves. To improve the glycemic index of your diet, replace all of your refined grains with whole grains.
(3) Banana are good for nerves:Bananas are high in B vitamins, which help calm the nervous system. The vitamin B6 that bananas contain regulates blood glucose levels, which can affect your mood.
(4) Garlic is good for nerves:
Garlic is your friend!
Like all pain, back pain is caused by inflammation in the body which impacts nerves. Garlic does, in fact, feature anti-inflammatory properties which can be useful for back pain sufferers.
(5)Effect of honey:
Three months honey supplementation reduced participants' subjective pain scores and symptoms from diabetic neuropathy and improved their QOL.However, the nerve conduction study showed that no significant change had occurred in motor velocity.Quality of life (QOL) is defined by the World Health Organization as 'individuals' perception of their position in life in the context of the culture and value systems in which they live, and in relation to their goals, expectations, standards and concerns.
Dr Bhairavsinh Raol
