Diabetic polyneuropathy of the eye. Neuropathy is divided into. Symptoms of Diabetic Polyneuropathy

Diabetic polyneuropathy- a complex of symptoms indicating dysfunction and damage to nerve fibers that develop against the background of hyperglycemia (high blood glucose levels). Disorders of all types of metabolism, which are formed in diabetes mellitus, lead to gradual death nerve cells, and decrease in sensitivity, up to its complete loss.

Peripheral neuropathy by itself does not lead to the development of trophic ulcers. lower extremities and syndrome diabetic foot, however, is a very significant indirect factor that increases the risk of purulent-necrotic complications and foot deformity.

Diabetic neuropathy, like diabetes itself, leads to significant changes in the life and health of patients. The variety of symptoms, and often its absence on initial stage, often does not allow timely detection of pathology and start of specific therapy, while the reverse development of the process is possible only at the stage when anatomical and structural changes in the musculoskeletal apparatus of the foot have not yet begun.

Statistics

Polyneuropathy is the most common complication of diabetes mellitus, developing in patients with type I diabetes in 54% of cases, in patients with type II diabetes in 45% of cases.
AT overall structure polyneuropathy diabetic variant occupies 30%.

Diabetic polyneuropathy is detected in 10% of patients who are first diagnosed with diabetes mellitus ( we are talking about type II).

Often there is an asymptomatic form, so almost 50% of patients diagnosed with diabetes mellitus do not notice symptoms of polyneuropathy, which is detected only during instrumental studies or routine medical examinations.

Diabetic polyneuropathy in 20% of cases is manifested by a pronounced pain syndrome, which is recognized as one of the most excruciating types of pain.
It is the diabetic variant of polyneuropathy that is an indirect (indirect) cause of more than 50% of cases of non-traumatic amputations.

Causes and development

In diabetes mellitus, all types of metabolism (not only carbohydrate metabolism) are disturbed, the starting factor for the onset of damage to tissues and organs is a persistent increase in the concentration of glucose in the blood - hyperglycemia.

Due to constant high content glucose inside the cell significantly changes the processing of this substance in the tissues: many toxic metabolic products accumulate in the cells, and the mechanism of oxidative stress is triggered. Gradually nerve fibers lose the ability to grow and recover, lose their functions. At the same time, the synthesis of own substances that support normal condition peripheral nerves. The listed nerve damage is a direct cause of the development of neuropathic pain, as well as loss of tactile and pain sensitivity of the foot.

Symptoms

Diabetic neuropathy is characterized by extensive symptoms that are not specific to initial stages which creates diagnostic difficulties.

In the acute variant of the course, polyneuropathy is manifested by sudden sharp pains(“knife blow”, “knife puncture”) and an unbearable burning sensation in the hands and feet, the occurrence pain under normal influences - touch, massage movements, application of external preparations.

Chronic diabetic neuropathy is often completely asymptomatic and can be diagnosed by screening studies. Patients rank as the most bright symptoms numbness of the feet and significant loss of sensation, due to which stability is impaired and the risk of sudden falls is increased.

Sleep disturbances often develop due to pain syndrome, depressive states patients are unable to work fully. Without treatment, the patient may be completely isolated from social life, he is threatened by a change in status - the loss of a profession, an irreversible deterioration in the quality of life.

Treatment

Drug therapy for diabetic polyneuropathy

The most important and main condition for the treatment of polyneuropathy in diabetes mellitus is the achievement of normal blood glucose levels using appropriate medicines- hypoglycemic oral medication or insulin. The general therapy of diabetes mellitus prescribed by the attending physician should remain unchanged! Maintenance normal level glucose is the most an important factor prevention of further development of polyneuropathy.

Neuropathic pain that develops with diabetic neuropathy is of a different nature (nerve damage), so the standard painkillers are NSAIDs and simple analgesics in this case will not be effective. Apply a wide range prescription drugs different groups that help reduce the severity and intensity of pain. These medicines prescribed by a doctor, they must be taken under the strict supervision of a medical specialist!

Symptom-modifying drugs(does not affect flow) pathological process)

Anticonvulsants more effective in acute and severe pain, they stabilize the state of nerve fibers and reduce neurological pain. Some of the drugs of the group have a pronounced analgesic effect in neurological problems and are widely prescribed for diabetic neuropathy as first-line drugs for the treatment of neuropathic pain).

Pain relief effect antidepressants due to the main mechanism of action: they reduce the content of serotonin in the central nervous system, and also presumably affect the body's own opioid systems.

Local anesthetics are used in the form of external forms - transdermal therapeutic systems, this is a modified patch that sticks to the skin, when used, a sufficient analgesic effect develops.

Narcotic analgesics have a pronounced effect in neuropathic pain, however, for obvious reasons, they are used to a limited extent, mainly in hospitals.

It should be noted that the analgesic effect of these drugs (except for the last group, the use of which in diabetic polyneuropathy is currently considered controversial) develops gradually. At the beginning of treatment, one cannot expect complete elimination of the pain syndrome.

These drugs do not affect the course of the disease, they only help to reduce symptoms and improve the quality of life of patients with diabetic polyneuropathy.

Disease-modifying drugs

Doctors have at their disposal several agents that affect the mechanisms of development (pathogenesis) of diabetic neuropathy, and the earlier treatment is started, the more pronounced the result. For these purposes, apply lipoic acid preparations, which has a complex effect, primarily antioxidant and neuroprotective. Certain other agents (aldoreductase inhibitors, growth factors nervous tissue, linoleic acid and carnitine preparations) are currently under clinical trials and have not yet entered into widespread practice.

Fibrates(fenofibrate), representing lipid-lowering agents, interfere with lipid metabolism, normalize the indicators of cholesterol fractions, also reduce the concentration of glucose. Reduce the risk of further development of diabetic neuropathy and contribute to the regression of pathology (in some cases).

Vitamin products (group B), pentoxifylline and some others traditional means that affect the metabolism of nervous tissue - are widely used in Russia, are means of additional maintenance therapy.

Non-drug treatments

Physiotherapy used in diabetic polyneuropathy different stages diseases in order to achieve analgesic, neuroprotective, regenerative effects, as well as improving blood circulation and returning sensitivity (improving conductivity) of nerves, and nourishing nerve fibers and surrounding tissues.
Electrotherapy, in particular sinusoidal, diadynamic, interference, stochastic currents, transcutaneous electrical nerve stimulation (TENS), darsonvalization are prescribed for pain relief, improving tissue nutrition.

It also has a good analgesic effect. electrophoresis- introduction medicinal substances under the influence of direct current. For diabetic polyneuropathy, the following drugs: a nicotinic acid, sodium thiosulfate, prozerin, B vitamins, etc.

Combined physiotherapy methods are used - light-laser and magneto-laser therapy. In the first case, exposure to blue polarized light in combination with an infrared laser, the second therapeutic factor is a combination of an infrared laser and a constant magnetic field. The listed methods (light, laser and magnetotherapy) are also prescribed according to isolated schemes. Leading place in treatment in recent times given magnetotherapy.

Magnetotherapy in diabetic polyneuropathy, it has analgesic, angioprotective and neuroprotective effects, helps to restore nerve fibers and improve blood supply and nutrition to adjacent tissues. Already at the beginning of the course of therapy, pain is significantly reduced, the convulsive component is eliminated, the sensitivity of the foot improves, and muscle activity increases. It is possible to achieve a significant improvement in the condition of nerve fibers, stimulation of recovery processes.
Magnetotherapy is used in various options: alternating magnetic field, low-frequency pulsed or running pulsed magnetic field, general magnetotherapy.
In addition to the effectiveness of the method, its high safety can also be noted: magnetotherapy is used in complex treatment diabetic polyneuropathy in patients different ages, including in children and adolescents, in elderly patients with multiple diagnoses.

Among the others non-drug methods spread electrostatic and pneumomassage lower limbs, balneotherapy, acupuncture.

Diabetes mellitus and its complications (diabetic polyneuropathy and angiopathy, diabetic foot syndrome, retinopathy - damage to the retina) are considered the most dangerous diseases modernity, which can not only reduce the quality of life, but also pose a direct threat to it. With the help of modern drugs and methods of non-drug correction, it is possible to achieve good results, control the disease and avoid severe consequences.

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Diabetic polyneuropathy is a condition that is a complication of diabetes mellitus and is characterized by progressive degeneration of peripheral sensory and motor nerve fibers. The disease wears chronic, its manifestations slowly increase over many years, the rate of development depends on the adequacy of the treatment of diabetes and the maintenance of normal blood sugar levels. Nerve pathology is one of the factors in the formation of neurocirculatory disorders in diabetes mellitus - diabetic foot, trophic ulcers, etc.

Timely detection of pathology in combination with the correct selected therapy can significantly slow down its progression.

Source: cf.ppt-online.org

Causes and risk factors

The immediate cause of diabetic polyneuropathy is the persistent increase in blood sugar that occurs in diabetes mellitus due to reduced insulin production. At the same time, the mechanism of damage to nerve fibers in this condition is multifactorial and is caused by several pathological processes. Several factors play a leading role.

Metabolic disorders in the nervous tissue. The lack of insulin leads to the fact that glucose from the blood does not penetrate into the cells, which is manifested by hyperglycemia. At the same time, this carbohydrate is the main and practically the only source energy for nervous tissue. Lack of energy leads to fiber degeneration and the development of diabetic polyneuropathy.
General metabolic disorders . Due to the lack of glucose in the tissues, metabolic bypasses are turned on to make up for the energy deficit. This leads to the formation of ketone bodies (a breakdown product of fats) and other toxic substances capable of damaging nervous tissue.
ischemic disorders. In diabetes mellitus, the development of angiopathy (vascular damage) associated with pathological processes in vascular wall. This reduces the blood supply to tissues and organs, especially at the microcirculatory level. Insufficient blood circulation exacerbates the energy deficit in nerve fibers and accelerates their degeneration.

Source: myshared.ru

The likelihood of developing diabetic polyneuropathy is higher in diabetic patients who often violate the diet and intake of hypoglycemic drugs. In some cases, peripheral nerve disorders may be the first sign of insufficient insulin production, but more often neuropathy occurs many years after the onset of diabetes. Pathological changes in the nervous system are irreversible.

Forms of the disease

Diabetic polyneuropathy is characterized by a variety of clinical forms, depending on which group of nerves is affected to a greater extent. There is some discussion about the classification in the scientific community.

With the development of nerve damage pathological changes, as a rule, are irreversible, so it is important not to allow the progression of the condition.

According to some researchers, true diabetic polyneuropathy should be considered only one of the forms of damage to the nervous system in diabetes mellitus - distal symmetric sensorimotor neuropathy. From this point of view, the condition has the following clinical course options:

violation of vibration sensitivity and individual tendon reflexes (for example, Achilles). This is a mild form, for many years it proceeds without noticeable progression;
damage to individual nerves, acquiring an acute or subacute character. Most often affects the nerve trunks of the limbs (ulnar, femoral, median nerves) and head (facial, trigeminal, oculomotor);
inflammation and degeneration of the nerves of the lower extremities, affecting the autonomic innervation. It is characterized by significant pain and is often complicated by trophic ulcers of the feet and legs, gangrene.

Another point of view is that diabetic polyneuropathy includes all types of peripheral nerve damage in diabetes mellitus. In this case, it distinguishes symmetrical sensorimotor neuropathy and autonomic neuropathy. The latter includes pupillary, gastrointestinal, sweat, cardiovascular forms- depending on which system or organ is most affected as a result of pathology. Separately, diabetic neuropathic cachexia is distinguished - a severe syndrome that includes both sensorimotor and autonomic neuropathy in combination with significant decline body weight.

Stages of the disease

Well defined criteria clinical stages diabetic polyneuropathy does not exist today. However, the pathology has a pronounced progressive character, the rate of increase in symptoms depends on the degree of hyperglycemia, the type of neuropathy, and the patient's lifestyle. In general, the course of the disease can be divided into stages:

Nonspecific neurogenic manifestations. These include sensitivity disorders, a feeling of "goosebumps" on the skin, in some cases - soreness along the nerve trunks and in the zone of their innervation. This state may persist long years and not go into more severe forms.
Movement disorders. Occur when motor fibers are involved in the pathological process, including the autonomic nervous system. Muscle twitching, paresis, and extremely rarely, convulsions may develop. When the nerves of the autonomic nervous system are affected, disturbances of accommodation occur, pupillary reflexes, sweating, the work of the cardiovascular and digestive systems.
trophic disorders. Most severe consequences diabetic polyneuropathy, develop as a result of a combination of autonomic innervation pathology and microcirculatory disorders. Can be worn as a local ( trophic ulcers, gangrene of the feet), and general character(neuropathic cachexia).

Another common outcome of diabetic polyneuropathy is damage to the 3rd and 4th pairs of cranial nerves responsible for the movements of the eyeballs. This is accompanied by a significant deterioration in vision due to a violation of the processes of accommodation, convergence, pupillary reflexes, the development of anisocoria and strabismus. Most often, this picture develops in diabetic patients over 50 years of age who have long suffered from other manifestations of neuropathy.

Source: ytimg.com

Diabetic polyneuropathy is characterized by a significant variety of manifestations, the clinical picture depends on the form of the pathology, the degree of its progression, the type of nerve fibers (motor, sensory, vegetative), which were affected more than others. Most often, sensitivity disorders (mainly temperature and vibration) appear first. Later they can join movement disorders(weakness of the muscles of the extremities, paresis). If the nerves were affected eyeball, anisocoria and strabismus occur.

The disease is chronic, its manifestations slowly increase over many years, the rate of development depends on the adequacy of diabetes treatment and the maintenance of normal blood sugar levels.

Diabetic polyneuropathy is almost always accompanied by vegetocirculatory disorders, mainly in the lower extremities. Initially, the temperature of the skin of the feet and legs decreases, violations of the skin are possible - peeling, keratinization. Injuries and injuries of the legs heal for a long time and hard. As the pathology progresses, pronounced pain in the legs occurs (both at rest and during exercise), trophic ulcers develop. Over time, necrosis of individual sections of the feet often develops, which then turn into gangrene.

Source: feedmed.ru

Diagnostics

In the diagnosis of diabetic polyneuropathy, a number of instrumental and laboratory techniques are used to study the functions of the peripheral nervous system, the condition of muscles, and skin. The choice of diagnostic technique depends on the form of pathology and the severity of its symptoms. Besides, diagnostic measures should include methods for determining diabetes mellitus and the severity of hyperglycemia - blood and urine tests for glucose levels, glycated hemoglobin levels and other studies. The definition of diabetic polyneuropathy itself includes:

examination by a neurologist– study of complaints and subjective symptoms, study of the history of the underlying disease, determination of skin sensitivity, activity of tendon reflexes and other neurological functions;
electromyography - allows you to assess the relationship between the nervous and muscular systems and thereby indirectly determine the degree of damage to nerve fibers;
nerve conduction study (NIP)- studies the speed of passage nerve impulses on fibers to assess the degree of their damage, often performed together with electromyography.

Other medical specialists can also participate in the diagnosis of diabetic polyneuropathy - an endocrinologist, an ophthalmologist, a urologist, a gastroenterologist. This is necessary in cases where damage to the nerves leads to disruption of the work of certain organs and systems.

Treatment

The main principle of the treatment of diabetic polyneuropathy is to reduce negative impact hyperglycemia in the peripheral nervous system. This is achieved by a properly selected diet and hypoglycemic therapy, the rules of which the patient must strictly observe. With the development of nerve damage, pathological changes are usually irreversible, so it is important to prevent the progression of the condition.

The most severe complication of diabetic polyneuropathy is neuropathic cachexia, accompanied by weight loss, sensorimotor disorders and numerous pathologies. internal organs.

In addition to the treatment of the underlying disease, drugs are prescribed that improve trophism and metabolism in nerve tissues and enhance microcirculation. For local effects (for example, to improve the trophism of the tissues of the feet), massages, electrophoresis and other physiotherapeutic procedures can be used.

In the treatment of diabetic polyneuropathy, symptomatic measures are also used - for example, in case of soreness and inflammation of the nerves, analgesics from the NSAID group are prescribed. With the development of trophic ulcers, their careful treatment is necessary to prevent infection. AT severe cases(for extensive ulcers or gangrene) surgery up to amputation.

Possible complications and consequences

The progression of diabetic polyneuropathy can cause paresis and muscle weakness, which limits mobility. Damage to the cranial nerves leads to paralysis of the facial muscles and visual disturbances. Vegetocirculatory disorders accompanying polyneuropathy of the extremities are often complicated by trophic ulcers and gangrene, which is an indication for amputation of the legs.

The likelihood of developing diabetic polyneuropathy is higher in diabetic patients who often violate the diet and intake of hypoglycemic drugs.

The most severe complication of diabetic polyneuropathy is neuropathic cachexia, accompanied by weight loss, sensorimotor disorders and numerous pathologies of internal organs.

Forecast

The prognosis is conditionally unfavorable, since the developed disorders are irreversible. However timely detection pathology in combination with the right selected therapy can significantly slow down its progression.

Video from YouTube on the topic of the article:

is perhaps the most common complication of diabetes. In addition, diabetic polyneuropathy is the first to develop of all the complications. Hello, dear readers of the blog "Sugar is normal!". For those new to the blog, let me introduce myself. My name is Dilyara Lebedeva, I am the author of this blog, the mother of a little man with diabetes. You can find out more about me on the About the Author page.

So, after a short introduction, you already understood that this article will focus on diabetic polyneuropathy - damage to peripheral (not the brain or spinal cord) nerves or nerve endings. Of course, there are other types of complications that I talked about in my introductory previous article, but about them in the following articles. And since not everyone can, although it is possible (follow the link to find out), I will tell you how to prevent the development of this complication in the future.

The fact that I decided to talk about polyneuropathy in the first place is not accidental. There are at least three reasons for this:

Signs of this complication may appear already in the early stages of diabetes mellitus, and possibly even at the time of the diagnosis of diabetes mellitus. In other words, polyneuropathy may even be.
Neuropathy can cause other chronic complications such as osteoarthropathy (joint damage) and foot ulcers (diabetic foot).
Diabetic neuropathy can worsen the course of diabetes.

That is why it is necessary to identify this complication as early as possible and begin timely treatment of the second type of diabetes, as well as do everything so that it does not occur, i.e., carry out primary prevention.

The development of peripheral polyneuropathy depends on age, duration of diabetes mellitus and the degree of compensation for the disease (blood glucose, glycated hemoglobin). According to statistics, with a duration of diabetes mellitus of more than 5 years, the prevalence does not exceed 15%, and with a duration of more than 30 years it reaches 50-90%.

With good compensation, the prevalence of polyneuropathy does not exceed 10%. If you look at the types of diabetes, then in type 1 diabetes, the prevalence of this complication is no more than 1.4%, and in type 2 - about 14.1%. And all because type 1 diabetes is detected much earlier than type 2, when there are also no hints of complications.

Most often involved in the process nerve endings lower extremities, but lesions also occur upper limbs. A little later I will tell you how this disease manifests itself. Depending on the involvement of certain nerve bundles, polyneuropathy is also divided into forms:

sensory (various sensitivity is disturbed)
motor (impaired motor function of muscles)
sensorimotor (mixed lesion)

How does diabetic polyneuropathy develop?

Currently, there are several theories of the development of this complication, and each contributes. There are the following theories:

metabolic
vascular
immune

At the very beginning, it was believed that the cause of development is chronic hyperglycemia, i.e., constantly chronically elevated level blood glucose. The fact is that with an increase in blood sugar, the polyol pathway of glucose utilization is activated, as a result of which sorbitol and fructose are formed in excess, which in turn increases the permeability cell membranes and edema, followed by the death of the Schwann cells of the nerve (a kind of insulating sheath of the nerve itself). As a result of "exposure" neural pathways the conduction of nerve impulses is sharply reduced.

The metabolic theory also includes glycosylation of nerve cells, oxidative stress (influence of free radicals on nerve cells), blockade of protein kinase C, which stimulates the synthesis of nitric oxide (a powerful vasodilator), and a decrease in myoinositol transport, which leads to demyelination ("exposure") of nerve fibers.

A little later it turned out that such violations cannot be fully caused only by metabolic processes. Therefore, a vascular theory of the development of diabetic polyneuropathy has been put forward and proven. It lies in the fact that in diabetes mellitus there is a so-called endothelial dysfunction, i.e., a lesion chronic hyperglycemiainner shell(basement membrane)capillaries that feed the nerve fiber. As a result, microangiopathy develops, i.e., a violation of the trophism of the nerve and pathways, which leads to their death and impaired nerve conduction.

The immune theory involves the production of specific anti-neuronal autoantibodies, antibodies to nerve growth factor, etc. The production of antibodies to vagus nerve(n. vagus) and spinal ganglia.

How does diabetic polyneuropathy manifest?

The main part of the identified polyneuropathy is a mixed form (sensomotor), when both sensory and motor fibers are affected nerve fibers . Sensory fibers are affected first, then, if no action is taken, motor fibers are affected. The complication begins with the nerve endings of the lower extremities, starting with the feet. Further, the signs of neuropathy spread upward to the shins and pass to the hands, and from there to the forearm (see figure).

A similar disorder in neurology is called a violation of sensitivity by the type of socks and gloves. As I said, nerve damage begins long before the first symptoms of diabetic polyneuropathy appear, and in some cases long before the diagnosis of diabetes mellitus is made. These violations can be detected using special study(electromyography), which will make it clear that there is a violation of nerve conduction. But for the most part, this is not done, and the diagnosis is made on the basis of the patient's complaints.

What complaints can the patient present? First of all, it is pain in the legs, less often in the hands. Pain more often at rest, mostly at night, poorly relieved by analgesics. Pain can be different in nature: cutting, tearing or dull, aching. Pain is often accompanied by a burning sensation or "pin tingle". In addition, a violation of sensitivity is often found - numbness or, conversely, hypersensitivity, a feeling of crawling "goosebumps", as well as convulsions.

A person has several types of sensitivity:

temperature
painful
tactile
vibrating
proprioceptive (sensation of the body in space)

So, with diabetic polyneuropathy, these types of sensitivity do not all fall out at the same time, they begin to disappear one after another in a certain sequence, which is characteristic of each person individually. The dominance of one or another symptom depends on the loss of which sensitivity prevails.

For example, if the bundles of pain pathways are more involved, then the clinic will be dominated by pain syndrome if tactile and temperature sensitivity Decreased or absent sensation of touch and temperature fluctuations. In the latter case, the situation is dangerous in that a person can inflict injury, which can subsequently develop into a diabetic foot.

The defeat of motor fibers leads to the development of deformities of the feet, characteristic of this disease(Charcot foot, hammer toes). In addition, weakness and atrophy of the muscles of the feet and hands are observed, but already in the later stages. Also, the loss of tendon reflexes (especially the Achilles tendon) indicates the neglect of the process.

In this article I talk about polyneuropathy, and in the next I will talk about mononeuropathy, a kind that affects not the hands and feet, but individual cranial nerves, spinal ganglia, as well as tunnel syndromes. So I advise you not to miss it.

How to detect diabetic polyneuropathy

Of course, every person wants to live long, happily and without problems for every person, but a person with diabetes needs to spend a little on this. more funds, psychic energy and patience. Each person with diabetes should visit narrow specialists every year in order to identify certain complications in order to start treatment on time.

Detection of polyneuropathy should begin at your endocrinologist's office. It is here that you should carry out a series of simple manipulations that will allow you to suspect or refute diabetic neuropathy. Namely:

Inspection of the legs for injuries, ulcers, and other defects.
Assessment of tactile sensitivity using a monofilament (in the figure above).
Temperature sensitivity assessment.
Assessment of vibration sensitivity using a tuning fork or biotensiometer.
Assessment of pain sensitivity with a needle.
Assessment of tendon reflexes with a neurological hammer.

If the doctor has suspicions about the development of neuropathy, then he should immediately refer you to a neurologist who will examine you more carefully and, if necessary, prescribe hardware research methods, for example, electromyography.

Ideally, electromyography should be recommended to detect early preclinical diabetic polyneuropathy, but this study is not included in the algorithm. primary care, so you can consult your doctor and go through it yourself. Because studies have shown that electromyography can diagnose slow conduction nervous excitement in 12% of patients with diabetes mellitus with a disease duration of 2-3 years.

Treatment of diabetic polyneuropathy

How to prevent complications of diabetes, I have already told in a previous article. So now we will talk about the treatment of an already developed complication.

Treatment of polyneuropathy should begin with the normalization of blood glucose levels. It has been reliably proven that the normalization of sugar and maintenance in the range of 6.5-7.0% reduces the severity clinical manifestations neuropathy.

But not always the normalization of glycemia can cope alone. There are drugs that restore normal structure nerve cell, leading to improved conduction and sometimes reversal of the symptoms of this complication.

Drugs include alpha-lipoic (thioctic) acid. In pharmacies, you may see trade names such as:

Espa lipon
Thiogamma
Thioctacid
Thiolepta

Alpha Lipoic Acid is a powerful antioxidant that reduces free radicals, which normalizes the blood supply to nerve cells, thereby restoring the normal concentration of nitric oxide, and also improves endothelial function.

Courses of therapy should be carried out 1-2 times a year. First, intravenous injections of alpha-lipoic acid at a dose of 600 mg / day for 15-21 days are prescribed, followed by administration in tablets of 600 mg per day 30 minutes before meals for 2-4 months.

In the comments, I was asked a question about Thioctacid, or rather, about its evidence base. In addition, I remembered that I had not told about Thioctacid BV. Therefore, the following information is an addition to the article. In fact, among all alpha-lipoic acid preparations, it was Thioctacid that was involved in multicenter studies. On the this moment conducted 9 placebo-controlled double-blind studies and one meta-analysis. As a result of these studies, its effectiveness has been proven. Thioctacid is the single most proven neuropathic drug, while Milgamma has only one multicenter, placebo-controlled, double-blind study for tablets, and no placebo-controlled, double-blind studies for injectables.

I did not find any information on treatment recommendations in the US, so I cannot say for sure if they use this drug. In our country, this drug is included in the treatment algorithm. Separately, I want to say about Thioctacid BV. This is a tablet version of alpha-lipoic acid, which has a unique structure that allows the drug to be absorbed as much as possible.

It is believed that this form of alpha-lipoic acid can be used instead of intravenous injections if the latter cannot be carried out. Tiktacid BV is prescribed at a dose of 600 mg 3 times a day for 3 weeks, then a maintenance dose of 600 mg 1 time per day for 2-4 months is taken.

Considering that some believe that there is not enough evidence for the effectiveness of Thioctacid and Milgamma, at the moment these are the only drugs in the world that have any effect on the pathogenesis of neuropathy. All other drugs eliminate only the symptoms (pain symptom). Therefore, it is up to you, dear readers, whether or not to use these drugs to improve the course of diabetic polyneuropathy. Of course, people have different sensitivities to any drugs (who will help and who will not). I'm just stating a fact, but in no case is this information the ultimate truth.

In addition to the appointment of alpha-lipoic acid, the course of treatment includes a complex of B vitamins (B1, B6 and B12). Vitamins B1 and B6 are available in a preparation called Milgamma. It is better to give preference to this particular drug, because, unlike vitamin preparations, in the form in which we are accustomed to seeing them, these vitamins are in a special form that allows them to be absorbed as efficiently as possible.

As in the case of alpha-lipoic acid, Milgamma is recommended to be taken initially as an IM injection of 2 ml per day for 2 weeks, and then in tablets 2-3 per day for 1-2 months. In addition to Milgamma, you can use others vitamin complexes, for example, neuromultivit, which contains B1, B6, B12.

A particular problem is the treatment of pain in diabetic polyneuropathy. For this, the following groups of drugs are used:

Tricyclic antidepressants (amitriptyline)
Anticonvulsants (Neurontin and Lyrica)
Opioids (tramadol)
The combination of these drugs

The use of non-narcotic analgesics, as well as non-steroidal anti-inflammatory drugs (diclofenac, aspirin, ibuprofen, etc.) is ineffective in this case.

This is where I end my story. If you have any questions, you can ask them in the comments. I understand that it turned out to read a lot and for a long time, but I didn’t want to divide it into several articles so that the thread would not be lost. In the next article, I will discuss what a patient with diabetic neuropathy should pay attention to. See you soon!

Diabetic polyneuropathy is one of the complications that accompany the course of diabetes mellitus. This state arises as a result of damage to the nervous tissue of the body by pathological agents produced in violation of carbohydrate metabolism.

Statistics on diabetes mellitus shows that the appearance of complications usually occurs 15-20 years after the onset of the pathological process. After the disease has developed, a long period of time must pass, since diabetes mellitus progresses rather slowly.

The prevalence of diabetic polyneuropathy in Moscow in patients is about 50-60%. The complication is typical for both type 1 diabetes mellitus and the second. Treatment of the disease is recommended to be carried out in specialized clinics, the phone number and address of which can be found on the website.

The diagnosis of diabetic polyneuropathy was included in international classification diseases - ICD. This disease code G63.2 is assigned in the system.

The human nervous system is made up of central department, represented by the brain and spinal cord, as well as nerve fibers extending from them, which form the peripheral nervous system. It includes two main types of nerves:

Somatic;
Vegetative.

Somatic nerve fibers are responsible for the innervation of striated muscles. These anatomical formations provide free, arbitrary human movements.

The autonomic system gives off many nerve trunks that go to all internal organs. It controls the operation of the following systems:

digestive tract;
blood vessels;
Respiratory system;
urinary tract, etc.

The autonomic nervous system works autonomously, that is, it does not obey the arbitrary desires of a person.

Diabetic polyneuropathy affects all peripheral nerves, which are part of both the vegetative and somatic systems. The symptoms that a person will experience depend on the location of the damage.

If the functioning of somatic nerves is disturbed, the functional activity of skeletal muscles decreases. Outwardly, this is manifested by severe pain in the limbs and other areas where large accumulations of muscles are located (abdominal pressure, back).

Damage to the nerves that make up the autonomic nervous system leads to disruption of the internal organs. This process is very dangerous for the human body, as it leads to the development of functional insufficiency of organs and body systems.

The change in the functioning of the nervous system in diabetes is due to an increase in blood glucose. With constantly elevated sugar levels, metabolism in tissues and cells is disrupted. Glucose leaves the bloodstream and settles in various anatomical formations, including the nervous system.

The defeat of the nerve trunks leads to a violation of the innervation of certain organs. Great importance in the development of the pathological process has another factor - oxygen starvation(hypoxia). If the general metabolism of a person with diabetes mellitus is disturbed, the speed of transporting blood through the vessels decreases. As a result, the nerve trunks do not receive enough of the necessary oxygen, which leads to a decrease in their functional activity.

Classification

Depending on the system in which the damage is located, the following types of polyneuropathy are distinguished:

Autonomous (peripheral);
Somatic.

The pathological process can spread to the sensory fibers that lead from the receptors, as well as damage the motor nerves that provide physical activity. Depending on the prevalence of the process, there are:

Sensory type - the sensitivity of the receptor fields of the body is disturbed;
Motor type - the activity of voluntary and involuntary movements decreases;
Sensorimotor type - there are both sensory disturbances and changes in the motor sphere.

In accordance with another classification, polyneuropathy is divided into types depending on the activity of the process. There are acute, chronic and painless (latent) forms of the disease.

Clinical picture of the disease

Symptoms of polyneuropathy in most cases extend to the lower extremities. AT rare cases pathological changes develop in the nerves of the hands.

Depending on the stage of development of the process and the severity of clinical symptoms, the main stages of diabetic polyneuropathy are distinguished. These include:

preclinical stage;
clinical stage;
stage of complications.

The stage of preclinical changes is characterized by the complete absence of complaints in a sick person. The first signs of damage to the nervous tissue appear - the sensitivity on the limbs decreases. First of all, the perception of vibration, temperature changes and pain is disturbed.

At the stage of clinical symptoms, the patient has a pronounced clinical picture of the disease. There is a strong pain syndrome, which can be located in any part of the body. The intensity of pain varies from mild to severe, combined with a decrease in sensitivity. To others clinical symptoms diseases include:

Numbness of the limbs;
Severe loss of sensation;
Severe night pains that can migrate from one area to another;
tingling feeling;
Skin burning.

Separately, it is worth mentioning the specific forms of diabetic polyneuropathy. The clinical picture of the painless form manifests itself neurological symptoms- numbness of the legs and tingling sensations. Amyotrophic polyneuropathy, in addition to loss of sensitivity, is characterized by the appearance of weakness in the muscles and the accompanying decrease in human motor activity.

The course of the disease may be accompanied by the appearance of general non-specific symptoms. These include:

Headache;
convulsions;
dizziness;
Decreased sensitivity;
diarrhea and nausea;
Urinary incontinence;
Hearing and vision impairment;
In women - anorgasmia;
Speech disorders.

The next stage in the development of the disease is the stage of complications. With the progression of diabetic polyneuropathy, severe consequences of nerve damage develop. At this stage, the patient has a group of "negative" signs of the disease, which include:

stiffness;
Severe numbness of the legs and arms;
Unsteadiness when walking, accompanied by sharp pain;
"Death" of the skin.

The occurrence of these symptoms indicates poor prognosis for the patient. Over time, trophic ulcers begin to form on the limbs of the patient, damaging the integrity skin.

With the progression of the process, the symptoms intensify, which can lead to a complete violation of the function of the lower extremities. The running course of the process is a threat to the life of the patient, therefore, on last stage the patient may require amputation of the affected limb.

Diagnostics

If diabetic polyneuropathy is suspected, urgently consult with your physician and full examination. The appearance of symptoms of the disease indicates the presence of serious disorders in the nervous system, so they cannot be ignored.

The patient should visit a therapist who, if necessary, will refer him to other, more highly specialized doctors - an endocrinologist, a neurologist, a surgeon.

Diagnosis of the disease begins with an analysis of the patient's complaints. It is necessary to tell the doctor if the patient has symptoms, describe in detail each of them, tell at what time and in connection with what they occur. The anamnesis of the patient's life is also of great importance - a characteristic of previous diseases, dietary habits, and physical activity.

After collecting an anamnesis, the doctor conducts a general examination. He appreciates:

Appearance, shape of the lower extremities, degree of development of muscle tissue;
Activity of tendon and superficial reflexes;
The nature and frequency of the pulse;
The level of blood pressure in the upper and lower extremities;
The degree of skin sensitivity on the legs and arms.

Survey results and neurological examination lower extremities allow us to suspect that he has a violation of the peripheral nervous system. The doctor establishes a preliminary diagnosis - diabetic polyneuropathy. To confirm it, the doctor prescribes a series of diagnostic procedures to the patient.

Laboratory tests that are performed when polyneuropathy is suspected include:

General and biochemical analysis blood;
Determination of glucose levels in urine and blood;
Serum insulin content;
Determination of the level of C-peptide;
Analysis of the content of lipoproteins, triglycerides and cholesterol;
Determination of the content of glycosylated hemoglobin in erythrocytes.

The results of these studies confirm that the patient has complicated diabetes mellitus with a long course.

Of great importance for the diagnosis of diabetic polyneuropathy is also instrumental examination patient. It includes the following procedures;

Electrocardiogram;
Ultrasound examination of cardiac activity;
Electroneuromyography;
Magnetic resonance imaging;
tissue biopsy.

To diagnose the disease, the doctor must full complex laboratory and instrumental research. Timely and complete examination will confirm the diagnosis of diabetic polyneuropathy. This allows the doctor to select the best options to treat a patient.

Treatment of the disease

For the treatment of diabetic polyneuropathy, a complex drug treatment, which is aimed at stopping the influence of pathological factors that stimulate the development of the disease.

An important component in the treatment of the disease is the normalization of blood glucose. Since polyneuropathy is a complication of diabetes mellitus, the first step towards the patient's recovery is the normalization of the course of this disease. The patient should consult with an endocrinologist who will select the optimal dosage of insulin. This will quickly normalize the sugar content in the patient's blood serum.

Treatment of diabetic polyneuropathy involves the use of drugs that normalize the state of the patient's nervous system. The doctor prescribes the following drugs:

Vitamin complexes, primarily B vitamins, restoring functional activity nerve fibers;
Antioxidant drugs (vitamins C and E);
inhibitory agents;
Actovegin;
Antibiotics in the presence of concomitant infectious diseases;
Painkillers to relieve severe symptoms.

With regular use of drugs included in medicinal complex, the patient's condition improves rapidly, the severity of symptoms decreases. For achievement quick effect it is recommended to combine the listed funds with each other, as this will allow you to influence several pathological factors at once, causing development diseases. Thanks to this, therapy will be much more effective.

Of great importance in the recovery and rehabilitation of a patient after diabetic polyneuropathy are non-drug methods of treatment. The patient is assigned the following procedures:

Physiotherapy treatment;
Treatment skin wounds and defects on the extremities with antiseptics to prevent concomitant infection;
The use of special orthopedic insoles;
Foot and leg massage;
Warming the lower extremities with warm socks (it is forbidden to use heating pads and hot baths for these purposes);
Therapeutic exercise to restore muscle function.

Gymnastics for diabetic polyneuropathy of the lower extremities involves regular exercises that can be performed in a sitting position.

When recovering from an illness, methods can be used traditional medicine. These include:

Dates;
Clay;
Decoctions of herbs (calendula, burdock root);
Honey and lemon;
Goat milk;
Nutmeg;
Mummy.

Alternative methods can not be used instead of medicines, as this can lead to complications in the course of the disease. It is necessary to follow the doctor's recommendations. In this case, traditional medicine can be used to relieve the symptoms of the disease.

Forecast and prevention

The life prognosis of a person with diabetic polyneuropathy of the extremities depends on the stage at which the complication was detected. If the disease is diagnosed at the preclinical stage, then it is possible full recovery patient. If it is revealed advanced stage pathology with severe complications, the prognosis is less favorable.

Prevention of the disease plays an important role for patients with diabetes. They must strictly follow the recommendations of the attending physician, eat right, take medicines on time. It's important to lead healthy lifestyle life, give up bad habits and control your body weight.

Thus, diabetic polyneuropathy of the extremities is severe complication diabetes mellitus. If you suspect this disease, you must urgently find out the phone number and address of the specialized doctor in order to make an appointment with him.

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Diabetic neuropathy is a disease of the human nervous system that is a complication of diabetes mellitus. This disease progresses gradually. For a long time a person may not suspect that he has this disease, and do not attach importance initial symptoms. However, with the development of diabetic polyneuropathy, performance is significantly reduced, up to its complete loss.

This disease affects both the somatic and autonomic nervous systems. Failure of the somatic nervous system leads to severe pain in the lower extremities and loss of their sensitivity. This makes it difficult to walk and makes the patient practically disabled. Autonomic neuropathy can be fatal, for example, due to impaired heartbeat or breathing.

The main cause of diabetic neuropathy is increased content sugar in the body. To achieve improvement in the work of the nervous system, you can lower the level of glucose in the blood.

Characteristic symptoms of the disease

Symptoms of diabetic neuropathy are divided into two types: active and passive.

Active symptoms:

burning sensation and tingling in the muscles of the lower extremities. Sometimes the pain becomes so severe that it resembles "electric shocks";
muscle cramps;
high sensitivity to pain.

Often, patients with neuropathy have difficulty moving, there is a feeling of numbness or stiffness of the limbs.

Passive symptoms

diarrhea;
violations of the functions of the reproductive system, both in women and men;
decreased elasticity of the skin of the face;
decreased visual acuity;
problems with urination;
frequent dizziness;
difficulty swallowing and chewing food;
speech disorder.

Sensorimotor neuropathy

This type of disease damages the nerve fibers that go to the limbs. Especially, sensorimotor neuropathy affects the sensitivity of the lower extremities.

Symptoms are manifested in a decrease in the patient's ability to feel signals from the lower extremities. He ceases to feel pain, environmental temperature, pressure and its fluctuation. With a complete or partial loss of sensation in the limbs, a person can injure his leg or get burned and not even notice it. As a result, wounds and ulcers form on the skin of the legs through which infections can penetrate. This can lead to suppuration or the development of gangrene, and with the development of the disease - to amputation of the limb.

Similar symptoms indicate that diabetic polyneuropathy is developing and you should immediately consult a doctor and pass the appropriate tests. Even if the patient does not complain of pain in the legs, this does not indicate the absence of neuropathy. It is necessary to examine the skin of the lower extremities and feet and the spaces between the fingers daily for damage to the skin. This attitude will help prevent complications.

The nerves that control the functioning of internal organs form the autonomic nervous system. Diabetic polyneuropathy can lead to a malfunction of its work. The first signs of this are frequent dizziness, especially when changing body position, and fainting. The risk of death due to a violation of the rhythm of the heart increases almost 4 times.

Also, this disease affects the work gastrointestinal tract. Food from the stomach moves more slowly, which leads to the development of gastroparesis. With the development of gastroporesis, there are difficulties with controlling the level of glucose in the blood, as well as maintaining its level in the norm.

Autonomic neuropathy affects bladder. The main symptom is urinary incontinence or incomplete emptying of the urine. Incomplete emptying leads to the development of an infection in this organ, which after some time affects the kidneys.

Causes of the disease

The main cause of polyneuropathy in humans is elevated blood sugar levels. Moreover, diabetes is chronic. The content of glucose in the human body depends on high level for several years now. Diabetic neuropathy is comorbidity caused by diabetes.

There are two main mechanisms for the course of the disease. At first, glucose damages the small blood vessels and capillaries that supply nutrients to nerve endings. As a result of damage to the capillaries, the nerves begin to feel a lack of oxygen, nerve impulses decrease or completely disappear.

In the second case of the development of the disease, the process of combining glucose with proteins occurs. This process is called glycation. The higher the blood glucose level, the more protein compounds will be formed. Such a connection leads to a violation of the function of proteins, including the nervous system.

Diagnosis of the disease

If diabetic polyneuropathy is diagnosed, then, first of all, the doctor is guided by the patient's complaints. If a patient with diabetes does not have obvious signs of neuropathy, this does not mean that he does not have this disease.

In order to determine the disease, specialists use a number of laboratory research patient's blood, as well as diagnostics of the nervous system. The most reliable methods for determining the functioning of the nervous system are electromyography and quantitative sensory testing.

For patients with diabetes, without symptoms of neuropathy, the doctor prescribes a mandatory examination at least once a year. If the symptoms are pronounced and there are complaints from the patient, then the examination is scheduled once every six months. Timely diagnosis disease makes it possible to identify early stage and avoid further complications.

Treatment of diabetic polyneuropathy

Treatment for neuropathy is aimed at lowering and maintaining blood sugar levels. With the normalization of sugar, the patient's condition will noticeably improve and, over time, the sensitivity of the limbs will return. However, it should be noted that the later treatment is started, the more difficult it is to restore sensitivity, because the nerve endings are not restored.

During treatment, it is necessary to adhere to a strict diet, forget about sweets, starchy foods, alcohol and smoking. You also need to avoid injuries and cuts, especially the lower extremities. Shoes in such cases should be as comfortable as possible, even microtraumas should be treated antibacterial agent, all this diabetic polyneuropathy requires to strictly comply.

The skin of the feet must be lubricated daily nourishing cream in order to avoid cracks and peeling of the skin. By strictly following all the recommendations of the doctor, there is a chance to return to a full life.