Patients
with diabetes have more complications from nerve damage, called neuropathy due
to diabetes. High blood sugar can damage the nerve fibers of the entire body,
but the lower limbs and feet are often the most vulnerable.
Depending
on how the nerve injury, but symptoms can vary from pain, loss of sensation in
the lower to the symptoms of the digestive system, urinary tract, blood vessels
and heart. Some patients have mild symptoms but many patients also have
terrible pain, incapacity and even death
Neurological
disease due to diabetes is the most serious complications of diabetes. You can
prevent or slow the progression of neurological disease due to diabetes by
controlling blood sugar closely and have a healthy lifestyle.
Symptoms
Neurological
disease due to diabetes has four main types. Patients may have a form or a symptom
of many types at once. Most of the symptoms manifest slowly as the patient did
not notice until a serious injury. Some patients have symptoms even before
diabetes is diagnosed.
Symptoms
of neurological disease due to diabetes vary depending on what type and how
nerve injury:
Peripheral
neuropathy
Peripheral
neuropathy is the most common neurological disease due to diabetes. It hurt the
nerves in the feet, lower limbs, arms and hands, but the lower limbs and feet
are usually affected most. These symptoms include:
*
Numbness or decreased sensation of pain, hot and cold temperatures, especially
in the feet.
*
Stinging sensation, such as tingling, burning starts in your toes and gradually
spread to the feet.
Pain
like a knife stabbing, such as electric shocks or knives, often up at night.
*
Increased sensitivity to touch, feel - a few patients, even up blanket is
painful.
*
Loss of balance and coordination
*
Muscle weakness and difficulty walking
*
Many leg problems are severe, such as ulcers, infection, and deformity and
painful joints.
Autonomic
neuropathy
Autonomic
nervous system controls the operation of the agency: heart, bladder, lung,
stomach, digestive, reproductive organs and eye. Diabetes can damage the nerve
fibers in any organ, causing:
*
Bladder problems: recurrent urinary tract infection often does not control or
primary (elementary patients not resist)
*
Digestive problems: as the first breath, heartburn and abdominal pain
*
Constipation, diarrhea, uncontrollable or a combination of constipation and
diarrhea
*
Eat slowly emptied indigestion caused by gastric (stomach paralysis), leading
to nausea, vomiting or loss of appetite.
*
Erectile dysfunction affects over 50% of men with diabetes> 60 years old.
*
Vaginal dryness and difficulty in sexual activity in women.
*
Increased or decreased sweating
*
The inability to regulate blood pressure and heart rate, leading to postural
hypotension when the patient changes posture to sit or sugar.
*
Issues related to regulating body temperature.
*
Change the way the eyes adjust from light to dark.
Neurological
disease usually occurs automatically on diabetes patients control blood sugar
for many years are not good.
Also
known as femoral neuropathy or muscle atrophy caused by diabetes. Neurological
origin often painful in the hip, thigh, buttocks, usually starting on one side,
eventually leading to muscle weakness and muscle atrophy patients difficult to
change positions from sitting to standing. Many patients with severe weight
loss. Some patients with pain in his back. Nerve root disease usually occurs in
elderly patients or patients with type 2 diabetes.
Focal
neuropathy
Focal
neuropathy usually appears suddenly often related to a nerve independent.
Common in elderly patients. Neurological disease that can cause localized pain
and may disappear after a few weeks or few thang.Nhung symptoms include:
*
Difficulty focusing eyes, double vision or pain behind the eyes.
*paralyze
the side face
*
Pain in the lower leg or foot.
Sometimes
neurological disease caused by localized pinched nerve fibers. Carpal tunnel
syndrome is the most common form of focal neuropathy in patients with diabetes.
Symptoms
of carpal tunnel syndrome:
*
Numbness, swelling, or stinging in the fingers while driving or while holding
the newspaper.
*
Pain spreading from the wrist up the arm, shoulder or spread to the palms,
fingers.
*
Feeling of weakness in the hand and tend to drop objects.
Cause
A
complex system of nerves running throughout the body, connecting the brain to
the muscles, skin and other organs. Through the nerves, the brain will feel the
pain and temperature, control and operation of automated tasks such as
digestion.
High
blood sugar can damage the nerve fibers, but the exact reason is not known how
clearly rang.Co is due to a combination of many factors, including nerve and
blood vessels. High blood sugar increases the ability of neural signals pure
decline. High blood sugar affects the capillaries that supply blood and
nutrients to the nerve fibers.
Other
factors
Other
factors may contribute to neurological disease caused by diabetes, including:
*
Glycate protein. Glycate process of protein occurs when glucose interacts with
proteins, modifying proteins. This process is thought to be related to
complications of diabetes, including neuropathy due to diabetes.
*
Autoimmune inflammatory response of nerve fibers. When the immune system
mistakenly attacks the body's organs in the body.
*
Factor gene: make patients vulnerable nerve fibers.
*
Alcohol and tobacco, both nerve damage and blood vessels, increasing the risk
of infection.
Risk
Factors
Any
diabetic patient cans no neurological complications, but the following factors
increase the likelihood that injured nerve fibers.
*
Poor blood sugar control. This is the biggest risk factors for all diabetes
complications, including neurological complications. Keeping blood sugar stable
is the best way to protect the nerves and blood vessels.
*
Time has diabetes. The risk of neuropathy due to diabetes increased over time
with diabetes, especially if blood sugar is not well controlled. Neuropathy can
automatically affect the digestive system, bladder and sexual function, which
occurs mainly in patients with diabetes are not good blood sugar control or
diabetes over 20 years. The rate of peripheral nerve disease occurs in most
patients with diabetes> 25 years.
*
Age. Older patients more at risk from diabetes nerve.
*
Gender. Men prone to neurological disease due to diabetes than women.
*
Increased cholesterol. Increased bad cholesterol damage the small blood vessels
feeding the nerves.
*
Cigarette smoking. Smoking is the arteries harden and narrow and reduces blood
flow to the legs. Making slow healing wounds and hurting peripheral neuropathy.
Diagnostic
tests
Neurological
disease due to diabetes is usually diagnosed based on symptoms, medical history
and physical examination. The doctor will examine your muscle tone, bone tendon
reflexes, touch sensation, thermal sensation and vibration sense.
Usea
soft nylon brush lightly over the foot. If the patient does not feel the nylon
on the feet, which is a sign of loss of sensation.
Other
tests
In
some cases, the following tests may be screaming:
*Assessment
of neurotransmitters. This test is used to evaluate the conductive speed of
nerve fibers in the limbs, usually used to diagnose carpal tunnel syndrome.
American
Diabetes Association recommends that all public patients with diabetic foot
should be examined at least once each year. In addition, foot inspection to
detect signs of inflammation, cracked skin, calluses, deformed joints each doctor
visit
Complications
Neurological
disease due to diabetes can cause many serious complications
*
Loss of sense of truth. Because of nerve damage causing loss of sensation in
the legs, so the patient does not detect the injury, swelling and pain in the
leg wound infection can be severe. Very high risk of infection due to decreased
blood flow to the legs. Infection can spread to the bone and tissue necrosis.
It is difficult to treat, need to be amputated legs or arms.
*
Charcot Joints. This occurs when the joints in the legs disfigured by nerve
damage
*
Primary and primary infection does not control. Neurological damage bladder
control patients could not state the end, still urine in the bladder after
urinating, when it is so easy to create conditions for germs to develop in the
bladder and kidneys, leading to infection urinary tract. Nerve damage also affects
the ability to sense when you urinate and control of urination.
*
Hypoglycaemia without warning. Normally, when blood sugar dropped too low, below
70 mg / dL, or below 3.0 mmol / L patients will have symptoms such as trembling
hands, sweating, heart palpitations... Here are the warning symptoms of
patients. Neuropathy can automatically make the patient may not manifest
symptoms of hypoglycemia and is not treated promptly, very easy to coma and
even death.
*
Low blood pressure... Neurological damage control circulatory system will
impact the ability to adjust the body's blood pressure. When that cause low
blood pressure when changing positions from sitting to standing, causing
symptoms of dizziness or shock. Called postural hypotension.
*
Gastrointestinal disorders. Automatic nerve damage control digestive system
will cause many digestive problems, including constipation, diarrhea or
constipation interspersed diarrhea, nausea, vomiting, bloating or loss of feeling
good mouth. A serious complication that is paralyzed stomach, as food from the
stomach slowly cause nausea and vomiting.
*
Sexual dysfunction. Neuropathy usually automated nerve damage affecting the
genitals, causing erectile dysfunction in men and vaginal dryness in women.
*
Increased or decreased sweating. When the sweat glands do not function
normally, the body will not be able to regulate body temperature. Typically,
neurological diseases causing automatic sweat more, especially at night
Drugs
and treatment
Treatment
of neurological diseases caused by diabetes to focus on:
*
Slow progression of disease
*
Reduce pain
*
Treatment of complications
*
Rehabilitation
Slow
progression of the disease.
Keep
blood sugar constant in the normal limits will help slow the progression of
peripheral neuropathy and can reduce symptoms. Target blood glucose:
*
Blood sugar before meals: 90 to 130 mg / dL (5 to 7 mmol / L)
*
2 hour postprandial blood glucose <180 mg / dL (10 mmol / L)
*
Hemoglobin A1c <7%
Sugar
HbA1c is associated with hemoglobin - substance inside red blood cells carrying
oxygen. It reflects the average blood glucose of patients in 2-3 months
To
help slow the nerve damage:
*
As recommended by your doctor about foot care
*
Keep blood pressure within limits
*
The healthy diet and reasonable
*
Regular physical activity that
*
Maintain ideal body weight
*
Stop smoking
*
Absolute alcohol or stop drinking, if permitted, shall not exceed one per day
for women beer or two cans, for men.
Analgesic
Treatment
of pain in neurological disease caused by diabetes is very difficult. Many
drugs have been used to relieve pain but not effective in all patients and many
side effects.
These
medications include:
*
Anti-epileptic Drugs: Drugs such as gabapentin (Neurontin), pregabalin (Lyrica)
and carbamazepine (Tegretol), used to treat epilepsy, but it is also used to
treat neuropathic pain. Side effects include drowsiness and dizziness.
*
Antidepressants, including amitriptyline, nortriptyline (Pamelor), desipramine
(Norpramin) and imipramine (Tofranil), may reduce pain mild to moderate, but
also has many side effects. The new antidepressants better pain relief and
fewer side effects.
*
Lidocaine patch. Patch containing lidocaine local anesthetic and helps relieve
pain. Usually no more side effects, sometimes causing redness.
*Capsaicin
is a substance extracted from chillies, when applied on the skin, capsaicin
cream (ArthriCare,... Zostrix) can reduce pain..
*
Other drugs. Painkillers such as codeine or central oxycodone (OxyContin) may
be used to relieve pain. But the drugs can cause many adverse effects of
long-term treatment.
Other
types of treatment
Many
non-drug treatments can help relieve pain. Can be combined with drugs to treat:
*
Alpha-lipoic acid (ALA). Alpha-lipoic acid is an antioxidant found in food, can
help reduce symptoms of peripheral neuropathy.
*
Electrical stimulation through the skin: This method uses a small electric
current stimulation to reduce pain, but this method is not effective in all
patients and all types of pain.
*
Acupuncture. National Institutes of Health of the United States have applied
acupuncture in the treatment of chronic pain including neuropathic pain.
*
Relaxation techniques. Reduce the pressure and pain. Relaxation techniques
include deep breathing exercises or looking at pictures, yoga...
Treatment
complications
Urinary
tract complications. Anti-spasm medication (anticholinergics), changing
county... to reduce urination urinary tract symptoms.
Gastrointestinal
disorders. When the stomach is paralyzed, the patient should eat several meals
a day, each meal should eat less, down fiber and fats in the diet.
*
Postural hypotension. Patients with postural hypotension should avoid alcohol,
drink plenty of water and stood up from tu.Co many drugs to treat postural
hypotension, such as fludrocortisone to increase blood pressure.
*
Sexual dysfunction. Sildenafil (Viagra), tadalafil (Cialis) and vardenafil
(Levitra) may improve sexual function in men, but these drugs may not be
effective and safe for everyone. Women may need substance through vaginal
estrogen cream to prevent vaginal dryness.
Prevention
Patients
can prevent and delay complications of neurological disease due to diabetes by
keeping blood sugar within permissible limits, foot care and lifestyle changes.
Blood
sugar control:
Target
blood sugar
*
Blood sugar before meals: 90 to 130 mg / dL (5 to 7 mmol / L)
*
2 hour postprandial blood glucose <180 mg / dL (10 mmol / L)
*
Hemoglobin A1c <7%
Foot
care
To
protect your feet to avoid serious complications:
*
Check feet every day. If patients do not see the soles of the feet, to use
mirrors or inspection by a relative vacuum. Find the area swelling, boils,
wounds, red...
*
Retain a clean and dry. Wash your feet daily with warm water. If your feet can
not feel temperature, test temperature of water by absorbent towel to touch
other body areas, such as wrist, elbow or used for testing. Dry your feet
gently Rub the skin can cause scratches. Dry the feet of the interstitial fluid
and apply to damp skin if dry skin.
Cut
nails carefully. Cut nails straight lines and careful sanding edges. Do not cut
corners feet deep.
*
Based calluses. Use a pumice or nail files for filing calluses or maybe surgery
to remove, but patients do not voluntarily cut calluses.
*
Wear clean socks and dry. Cotton socks should even go in the house.
*
Wear shoes both legs. Always wear shoes to protect feet just to avoid foot
injuries. Should buy shoes in the afternoon because then your feet will be
larger than the morning
Lifestyle
changes
*
Control blood pressure. Diabetic patients are at risk of hypertension than 2
times higher than people without diabetes. If both hypertension and diabetes,
patients with increased risk of complications in blood vessels and reduced
blood flow information. Control blood pressure <130/85 mmHg
*
Choose foods that have health benefits. Select balanced diet, especially
greens, fruits, whole grain wheat. Keeping an ideal body weight.
*
Physical activity daily. Daily activities to help protect the heart and improves
blood flow, and which help stabilize blood sugar and blood pressure.
*
Stop smoking. Diabetic patients smoking increase the risk of stroke and
myocardial infarction than 2 times compared with diabetic patients not smoking.
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