Diabetic neuropathy is a group of nerve disorders which are related to diabetes mellitus, resulting in lose of nerve function. There are many factors that contribute to nerve damage, all of which are related to high blood glucose level over a long period.

SYMPTOMS:
Nerve damage is symptomless, though it is often associated with pain, numbness or tingling sensation in distal part of the body like hands, arms, feet and legs. It can also occur in other organs of the body like the heart, gastrointestinal tract organs and sex organs.

CONTRIBUTING FACTORS:

Hyperglycemia; micro vascular injuries to the vessel which is supplying blood, oxygen and nutrients to the nerves; high fat content which can obstruct the artery; hypertension; smoking alcohol.

MECHANISM:
Chiefly there is loss of blood supply to the nerve, which results in severely damaging the nerve. The consequence of which is the loss of sensation in the part where it is supplying. The vessels suffer micro vascular injuries due to high blood sugar levels by the alteration of protein structure, elevated levels of protein kinase c which decreases nerve conduction velocity, formation of oxygen radicals and activation of altered biochemical pathway called polyol pathway. Although experimental evidence has yet to show the significance of polyol pathway.

TYPES OF NEUROPATHY:

Peripheral neuropathy: the most common type of neuropathy usually affects toes, feets, legs and arms. Autonomic neuropathy: it usually affects heart, blood vessels, lung, urinary tract, sex organs, sweat glands and eyes. Focal neuropathy: it usually affects thighs, hips, buttocks and legs. Proximal neuropathy: usually affects pelvis and lower back and abdomen

TREATMENT:

There is no particular treatment to cure the condition, although it could be managed symptomatically. The concentration is focused on reducing the pain however nothing could be done for the underlying cause.

Tight glucose control is necessary for preventing the further progress of the disease as uncontrolled blood glucose could cause morbidities like foot ulcers and eventually amputation. Patients are counseled for especial care for their foot and use foot wears most of the time, even in their homes to prevent injuries. They are advised to keep checking their feet for any lose of sensation. In a clinical setting, it is done by using different grams of monofilaments and a crude touch method.

In medication, the mainstay is the pain control. Hence, tricyclic antidepressant, serotinine reuptake inhibitor and antiepileptic drugs are used. In other treatments, alpha lipoic acid and anti oxidants in non-prescriptive dietary supplement has shown some benefits. For the relief of pain in chronic neuropathy, other treatment choices include acupuncture, meditation, prescribed exercise and cognitive therapy. Nonetheless in more recent years, photo energy therapies devices are becoming more popular to reduce symptoms.

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