Diabetic polyneuropathy (Greek "poly" = many, "neuron" = nerve) is a disease of several peripheral nerves that can occur in people with diabetes. Peripheral nerves are all nerves that are located outside the brain and spinal cord and run to specific organs. Permanently elevated blood glucose levels (hyperglycemia) can cause irreversible damage to peripheral nerves.
Increased blood glucose levels (hyperglycemia) can trigger occlusion of the small blood vessels, causing a lack of oxygen in the nerve cells (microangiopathy).
Two types of diabetic polyneuropathy can be distinguished:
- Is the somatic nervous system (control of conscious bodily functions, for example conscious movements) damaged by diabetes mellitus, one speaks of a peripheral diabetic polyneuropathy.
- Is the autonomic (also: vegetative) nervous system (regulation of organic functions that cannot be influenced by the will, for example digestion) is affected, one speaks of a vegetative diabetic polyneuropathy. However, the autonomic nervous system is rarely affected.
Diabetic polyneuropathy belongs to the insidious diseases. This means that there is not always a perceptible sign of nerve damage. For this reason, people with diabetes should have their nerves regularly checked by their general practitioner or diabetologist. Have the diabetologist examine you.
Peripheral diabetic polyneuropathy
In peripheral diabetic polyneuropathy, the somatic nervous system is affected (photo: unsplash).
Symptoms
The symptoms of diabetic neuropathy are wide-ranging and often overlap. Thus, peripheral neuropathy can cause a disturbance of the sensation of pain, touch and temperature. Chronic pain, sensory disturbances, paralysis and cardiac arrhythmias are also frequently diagnosed. Typical symptoms include:
- Tingling
- Numbness
- Decreased sensory stimuli for example for temperatures
- Reduced pain sensation
- Burning, stabbing pain
restless legs syndrome
In some cases, signs of the so-called restless legs syndrome can also be detected. These are feelings of tension and pressure in the leg regions, which occur mainly when resting in the evening. Patients also complain of tingling and cramp-like pain. Since movement reduces the disturbances, affected persons usually develop a pathological urge to move ("restless legs"). Sensory-motor symptoms usually occur from the toes, feet and lower legs upwards. If the leg musculature is affected, there may be unsteadiness in motor locomotion or an unaccustomed tendency to stumble.
The diabetic foot syndrome
hyperglycemia is often the cause of what is known as diabetic foot syndrome. Due to the reduced sensitivity to pain, injuries to the feet remain unnoticed by people suffering from diabetes. In most cases, this leads to inflammation of the wounds, which usually heal poorly and spread to the deeper tissue structure. In the worst case, this can result in an amputation.
Diagnosis
Whether there is damage to the sensorimotor nerves can be easily determined by simple examination methods. The following aspects, among others, are examined:
- pain sensor
- Sensitivity to touch
- Temperature sensitivity
- Reflexes of the achilles and hamstrings
- pressure point and touch sensitivity on the foot
If there is evidence of diabetic polyneuropathy, the physician will initiate further examinations to manifest the disease of the sensorimotor nerves.
Vegetative diabetic neuropathy
In autonomic diabetic neuropathy, heartburn and nausea can be typical symptoms (photo: pexels)
Symptomatology
If the autonomic nervous system is affected by neuropathy, the symptomatology depends on the organs affected. Pulse changes or disturbed blood pressure usually indicate nerve damage in the area of the cardiovascular system. In addition, polyneuropathic damage to the autonomic nervous system is often accompanied by dysphagia, heartburn, nausea and bladder weakness.
Diagnosis
It is much more difficult to diagnose damage to the autonomic nervous system. Here the anamnesis (patient history) plays an important role. An ECG or 24-hour ECG can be used to determine any damage to the cardiovascular system. In the case of autonomic neuropathy of the gastric nerves, the following examination methods, among others, are available:
- ultrasound examination (sonography)
- gastroscopy (gastroscopy)
- Measurement of the gastric emptying speed
Therapy
If a diabetic polyneuropathy has been diagnosed, the priority is to prevent further development of the nerve damage. It is essential that patients stop smoking and abstain from alcohol. In addition, the blood sugar, blood fat and blood pressure values must be optimized. Pain management initiated in a controlled manner by a healthcare professional helps to alleviate the discomfort caused by diabetic polyneuropathy and helps to maintain the patient’s quality of life.
Frequency of diabetic polyneuropathy
Today, there is no medical doubt that hyperglycemia is a major cause of peripheral and autonomic nerve damage. The likelihood of developing diabetic polyneuropathy therefore depends on a number of factors. there is no doubt that the blood glucose level plays a decisive role. There are no significant differences between type 1 and type 2 diabetes.