Neuropathy is the most common neurological complication in diabetic patients and is also the most common cause of neuropathy in general. The disease has different clinical presentations depending on the location of the lesion, but all cause disability to the patient.
Causes and mechanisms of disease
This neurodegeneration is believed to have multiple causes, but the most commonly cited is microvascular injury from oxygen free radicals in combination with other mechanisms, including an increase in sorbitol from the enzyme aldose reductase induced by elevated blood glucose levels. This increase affects neuronal function and is accompanied by increased oxygen free radical generation, activation of protein kinase C, accumulation of advanced glycation endproducts, accumulation of immunologic and inflammatory compounds, and associated neuronal dysfunction.
Diagnosis and differential diagnosis
In general, the diagnosis of diabetic neuropathy is mainly based on medical characteristics. Since diabetic patients often have other comorbidities, neuropathy should be differentiated from other causes, such as renal failure, malnutrition, immune system diseases, blood diseases, drug or other toxin poisoning. Diseases in other systems that may have similar symptoms include spinal canal stenosis, which causes compression of nerve roots or spinal cord, and plantar fasciitis. In patients with small neuropathy, sugar tolerance should be tested.
Treatment
It can be divided into 3 groups: disease prevention, symptom relief, and prevention of complications.
1. Prevention or delay of disease
The most important factor is strict control of diabetes. From long-term studies, it has been found that this neuropathy can be prevented or slowed down considerably. As for the treatment that targets the pathophysiology of the disease, there is still no clear information on the medical benefits, whether it is an Aldose reductase inhibitor, vasodilator, Protein kinase C inhibitor, nerve growth factor, etc. There is some data supporting the effectiveness of drugs in relieving nerve pain from this disease, such as alpha lipoic acid.
2. Symptom relief
Patients with neuropathic pain, also known https://ufabet999.app as neuropathic pain, often suffer from the disease, which affects the patient’s quality of life. Therefore, pain relief is very important. Patients often have various types of pain and do not respond to general pain relievers. Instead, they respond to drugs that directly affect the nervous system, such as antidepressants and anticonvulsants. In addition, other drugs are often used as supplementary drugs, such as 0.075% capsaicin cream. These drugs can use together. When using a single drug is ineffective. The selection of different drugs should be based on the characteristics of each patient, comorbidities, and possible side effects.
3. Prevention of complications
Patients should have their feet and shoes examined regularly to prevent and treat early sores. Special shoes or orthotics may consider, if necessary. Preventing accidents resulting from loss of sensation, such as accidental contact with hot objects, should prevent. If walking is difficult, balance training and fall prevention should be provided. The skin in the limbs with small nerve problems is often dry and crack. So frequent moisturizing creams should use and scratching should be avoided.