Diabetic polyneuropathy, sensorimotor form, distal type. Diabetic sensory distal polyneuropathy

Diabetic polyneuropathy should be diagnosed and treated as soon as possible, since there may be negative consequences resulting in the person losing the ability to work and becoming disabled.

What is the essence of the problem?

More than half of patients diagnosed with diabetes suffer from the development of various types of polyneuropathy. In this case, the deviation is diagnosed, as a rule, in the last stages, when it is much more difficult to treat a person.

DP is associated with abnormalities in the nervous system, due to which the patient experiences dysfunction in various body systems. Mostly, polyneuropathy of the upper or lower extremities is diagnosed, which occurs after several years of diabetes. The disorder syndromes appear gradually and develop slowly, so the patient does not always seek medical help on time.

Classification

Diabetic polyneuropathy in type 2 diabetes mellitus can manifest itself in different forms and at any time. The table shows the types of pathology, depending on the genesis and damage to part of the nervous system:

With the motor type of pathology, the patient has impaired coordination, movements become incorrect and uncontrollable. Sensory polyneuropathy of the lower extremities or upper extremities is manifested by deteriorated sensitivity to external factors that irritate the nervous system. The symmetrical sensorimotor form of deviation includes symptoms of both previous types of the disease.

If a diabetic has damage to the peripheral nervous system, then polyneuropathy can be of 2 types:

• Autonomous. With this type of disease, the autonomic system (AS) is affected, which is why the patient in most cases dies.
• Somatic. Such diabetic neuropathy often provokes multiple ulcers on the patient’s legs.

The modern classification of diabetic polyneuropathy divides the disorder based on the intensity of pathological signs:

Pathology genesis: why does it develop?

The sensory form and other types of DP are a complex disorder that develops against the background of long-term diabetes mellitus. With a constant lack of insulin in the patient’s body and an increase in glucose levels, disturbances in the vascular system are observed. In a patient, a provoking factor for the development of diabetic polyneuropathy is also a deviation in the metabolic process in cells and tissues, due to which the peripheral nervous system is not able to function normally. The functioning of nerve fibers (NF) is disrupted due to their regular oxygen starvation and reduced concentration of nitric oxide.

Symptoms signaling a problem

The signs of diabetic polyneuropathy differ for each patient, depending on the severity of the disorder. The table shows the degrees of the pathological process and the features of its course:

Modern standards divide the clinical symptoms of diabetic polyneuropathy into 3 types:

With the motor type of symptoms, the patient may be bothered by cramps in the calves.

• Sensitive symptom. Includes aching, cutting and stabbing pains that appear at different times of the day. The patient's sensitivity is impaired and he does not feel temperature changes or vibrations.
• Motor. There is constant muscle weakness in the legs or arms, reflexes disappear, and the patient is bothered by diabetic tremors and cramps in the calves.
• Vegetative. Tachycardia develops and blood pressure decreases with a sudden change in body position. The patient is haunted by broken stools, in which constipation alternates with diarrhea. Men with DP may develop impotence, and women may develop breast cancer (BC).

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What procedures does diagnostics include?

If a diabetic has detected at least a few signs of diabetic polyneuropathy, then he should immediately see a doctor. The latter will analyze the complaints received and examine the patient. It is important to find out whether there is a tendon reflex and how much tactile sensitivity is reduced. The diagnosis of “diabetic distal polyneuropathy” can be confirmed through laboratory and instrumental examinations:

A blood glucose test will help confirm the diagnosis.

• analysis for cholesterol and lipoprotein levels;
• measuring glucose levels in blood fluid and urine;
• laboratory testing of C-peptide and glycosylated hemoglobin;
• electrocardiography and ultrasound diagnostics of the heart;
• electroneuromyography;
• biopsy;
• CT and MRI.

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Necessary treatment

Can it be cured using folk remedies?

The general standard of treatment for DP with traditional means is often supplemented with drugs of natural origin. It is important to understand that an unconventional treatment method on its own will not bring any results, and complications may also arise if you do not consult a doctor before using the components. Treatment with folk remedies is carried out using the following components:

Hawthorn and rose hips are used to prepare medicinal infusions.

• Bay leaf and fenugreek. The components are taken in a ratio of 1:3, mixed, poured with boiling water and infused for 2 hours. Use the decoction throughout the day as tea.
• Oat seeds, flax seeds, beans and blueberry leaves. All products are crushed and mixed. At 2 tbsp. l. raw materials use half a liter of boiled water, pour and place in a water bath for 10-15 minutes. In order for diabetic polyneuropathy of the lower extremities to go away, it is necessary to use the product three times a day, 150 ml.
• Hawthorn and rosehip. Use 20 grams of the fruits of each plant, which are crushed and brewed in a thermos with 500 ml of boiling water. Let stand for 12 hours, then filter and take half a glass 30 minutes before meals.

Nettle stems, which you walk on for 10 minutes every day, will help normalize blood circulation and improve the sensitivity of your legs.

Effective drugs

To treat diabetic polyneuropathy, pharmaceutical medications are used that eliminate unpleasant symptoms. With early diagnosis, it is possible to completely eliminate neuropathy using drugs and folk remedies. Complex therapy includes the use of the following therapeutic agents:

Physiotherapy for diabetic polyneuropathy

For pathology, different treatment methods are used depending on the severity of DP. If your feet are damaged, they should be warmed up with a massage and warm socks. But under no circumstances should a heating pad or hot bath be used. Physiotherapy for diabetic polyneuropathy also includes the following procedures:

Prognosis and prevention

If diabetic polyneuropathy is diagnosed at an early stage, it can be completely cured. Late detection of pathology leads to complications, disability or death of the patient. To prevent negative consequences and the development of DP, patients with diabetes mellitus need to be regularly examined for more than 5 years. You should also carefully monitor the condition of the lower and upper extremities, and if wounds or injuries appear, seek help. It is worth keeping your blood glucose levels under control every day and moving more. It is important to take multivitamins that contain vitamins A, B, C, and E in the prevention of diabetic polyneuropathy.

Diabetic polyneuropathy: symptoms, classification and directions of treatment therapy

Diabetic polyneuropathy is a complex of diseases of the nervous system that occur slowly and arise as a result of excess sugar in the body. In order to understand what diabetic polyneuropathy is, you need to remember that diabetes mellitus belongs to the category of serious metabolic disorders that negatively affect the functioning of the nervous system.

In the event that competent medical therapy has not been carried out, elevated blood sugar levels begin to inhibit the vital processes of the entire body. Not only the kidneys, liver, and blood vessels suffer, but also the peripheral nerves, which is manifested by a variety of symptoms of damage to the nervous system. Due to fluctuations in blood glucose levels, the functioning of the autonomic and autonomic nervous system is disrupted, which is manifested by difficulty breathing, heart rhythm disturbances, and dizziness.

Diabetic polyneuropathy occurs in almost all patients with diabetes; it is diagnosed in 70% of cases. Most often, it is detected in the later stages, but with regular preventive examinations and careful attention to the condition of the body, it can be diagnosed in the early stages. This makes it possible to stop the development of the disease and avoid complications. Most often, diabetic polyneuropathy of the lower extremities is manifested by impaired skin sensitivity and pain, often occurring at night.

The mechanism of development of metabolic disorders in diabetes mellitus

• Due to excess sugar in the blood, oxidative stress increases, which leads to the appearance of a large number of free radicals. They have a toxic effect on cells, disrupting their normal functioning.
• An excess of glucose activates autoimmune processes that inhibit the growth of cells that form conductive nerve fibers and have a destructive effect on nerve tissue.
• Impaired fructose metabolism leads to excess production of glucose, which accumulates in large volumes and disrupts the osmolarity of the intracellular space. This, in turn, provokes swelling of the nervous tissue and disruption of conduction between neurons.
• A reduced content of myoinositol in the cell inhibits the production of phosphoinositol, which is the most important component of the nerve cell. As a result, the activity of energy metabolism decreases and the process of impulse conduction is completely disrupted.

How to recognize diabetic polyneuropathy: initial manifestations

Disorders of the nervous system that develop against the background of diabetes are manifested by a variety of symptoms. Depending on which nerve fibers are affected, there are specific symptoms that occur when small nerve fibers are damaged, and symptoms that occur when large nerve fibers are damaged.

1. Symptoms that develop when small nerve fibers are damaged:

• numbness of the lower and upper extremities;
• tingling and burning sensation in the limbs;
• loss of sensitivity of the skin to temperature fluctuations;
• chills of extremities;
• redness of the skin of the feet;
• swelling in the feet;
• pain that bothers the patient at night;
• increased sweating of the feet;
• peeling and dry skin on the legs;
• the appearance of calluses, wounds and non-healing cracks in the foot area.

2. Symptoms that occur when large nerve fibers are damaged:

• balance disorders;
• damage to large and small joints;
• pathologically increased sensitivity of the skin of the lower extremities;
• pain that occurs with a light touch;
• insensitivity to finger movements.

In addition to the listed symptoms, the following non-specific manifestations of diabetic polyneuropathy are also observed:

• urinary incontinence;
• bowel disorders;
• general muscle weakness;
• decreased visual acuity;
• convulsive syndrome;
• sagging skin and muscles in the face and neck;
• speech disorders;
• dizziness;
• swallowing reflex disorders;
• sexual disorders: anorgasmia in women, erectile dysfunction in men.

Classification

Depending on the location of the affected nerves and symptoms, there are several classifications of diabetic polyneuropathy. The classical classification is based on which part of the nervous system is most affected by metabolic disorders.

The following types of disease are distinguished:

• Damage to the central parts of the nervous system, leading to the development of encephalopathy and myelopathy.
• Damage to the peripheral nervous system, leading to the development of pathologies such as:

Diabetic polyneuropathy motor form;

Diabetic sensory polyneuropathy;

Diabetic polyneuropathy of sensorimotor mixed form.

Damage to the nerve pathways leading to the development of diabetic mononeuropathy.

Diabetic polyneuropathy, which occurs when the autonomic nervous system is damaged:

Diabetic alcoholic polyneuropathy, which develops against the background of regular alcohol consumption, is also distinguished. It also causes burning and tingling sensations, pain, muscle weakness and complete numbness of the upper and lower extremities. Gradually, the disease progresses and deprives a person of the ability to move freely.

The modern classification of diabetic polyneuropathy includes the following forms:

• Generalized symmetrical polyneuropathies.
• Hyperglycemic neuropathy.
• Multifocal and focal neuropathies.
• Thoracolumbar radiculoneuropathy.
• Diabetic polyneuropathy: acute sensory form.
• Diabetic polyneuropathy: chronic sensorimotor form.
• Autonomic neuropathy.
• Cranial neuropathy.
• Tunnel focal neuropathies.
• Amyotrophy.
• Inflammatory demyelinating neuropathy, occurring in a chronic form.

What forms are most common?

Distal diabetic polyneuropathy or mixed polyneuropathy.

This form is the most common and occurs in approximately half of patients with chronic diabetes mellitus. Due to excess sugar in the blood, long nerve fibers suffer, which provokes damage to the upper or lower extremities.

The main symptoms include:

• loss of the ability to feel pressure on the skin;
• pathological dryness of the skin, pronounced reddish tint of the skin;
• disruption of the sweat glands;
• insensitivity to temperature fluctuations;
• lack of pain threshold;
• inability to feel changes in body position in space and vibration.

The danger of this form of the disease is that a person suffering from the disease can seriously injure his leg or get a burn without even feeling it. As a result, wounds, cracks, abrasions, ulcers appear on the lower extremities, and more serious injuries to the lower extremities are also possible - joint fractures, dislocations, severe bruises.

All this further leads to disruption of the musculoskeletal system, muscular dystrophy, and bone deformation. A dangerous symptom is the presence of ulcers that form between the toes and on the soles of the feet. Ulcerative formations do not cause harm, since the patient does not experience pain, however, a developing inflammatory focus can provoke amputation of the limbs.

Diabetic polyneuropathy sensory form.

This type of disease develops in the later stages of diabetes mellitus, when neurological complications are pronounced. As a rule, sensory impairments are observed 5-7 years after the diagnosis of diabetes mellitus. The sensory form differs from other forms of diabetic polyneuropathy by specific, severe symptoms:

• persistent parasthesias;
• feeling of numbness of the skin;
• disturbances of sensitivity in any modality;
• symmetrical pain in the lower extremities that occurs at night.

Autonomic diabetic polyneuropathy.

The cause of autonomic disorders is excess sugar in the blood - a person experiences fatigue, apathy, headache, dizziness, and attacks of tachycardia, increased sweating, and darkening in the eyes with a sharp change in body position also often occur.

In addition, the autonomous form is characterized by digestive disorders, which slows down the flow of nutrients into the intestines. Digestive disorders complicate antidiabetic therapy: it is difficult to stabilize blood sugar levels. Heart rhythm disturbances, often occurring in the autonomic form of diabetic polyneuropathy, can be fatal due to sudden cardiac arrest.

Treatment: main areas of therapy

Treatment of diabetes mellitus is always comprehensive and aims to control blood sugar levels, as well as neutralize symptoms of secondary diseases. Modern combination drugs affect not only metabolic disorders, but also concomitant diseases. Initially, you need to normalize your sugar level - sometimes this is enough to stop the further progression of the disease.

Treatment for diabetic polyneuropathy includes:

• The use of drugs to stabilize blood sugar levels.
• Taking vitamin complexes that necessarily contain vitamin E, which improves the conductivity of nerve fibers and neutralizes the negative effects of high blood sugar concentrations.
• Taking B vitamins, which have a beneficial effect on the nervous system and musculoskeletal system.
• Taking antioxidants, especially lipoic and alpha acids, which prevent the accumulation of excess glucose in the intracellular space and help restore damaged nerves.
• Taking painkillers - analgesics and local anesthetics that neutralize pain in the limbs.
• Taking antibiotics, which may be needed if leg ulcers become infected.
• Prescribing magnesium supplements for seizures, as well as muscle relaxants for spasms.
• Prescription of drugs that correct heart rhythm for persistent tachycardia.
• Prescribing a minimum dose of antidepressants.
• The purpose of Actovegin is a drug that replenishes the energy resources of nerve cells.
• Local wound healing agents: capsicam, finalgon, apizartron, etc.
• Non-drug therapy: therapeutic massage, special gymnastics, physiotherapy.

Timely diagnosis based on regular preventive examinations, competent therapeutic therapy and adherence to preventive measures - all this allows you to smooth out the symptoms of diabetic polyneuropathy, as well as prevent further development of the disease. A person suffering from such a serious metabolic disorder as diabetes must be extremely attentive to his health. The presence of initial neurological symptoms, even the most minor ones, is a reason to urgently seek medical help.

DIABETIC POLYNEUROPATHY

Severe pain symptoms

A number of severe clinical disorders

Early disability of patients

Significant deterioration in the quality of life of patients in general

With the duration of the disease

As patients age

With somatic DP to the development of ulcerative lesions of the lower extremities

With autonomous DP to high mortality of patients

In patients with type 1 diabetes it is 13-54%

In patients with type 2 diabetes it is 17-45%

2. Lesions of the peripheral nervous system:

Sensory form (symmetrical, asymmetrical)

Motor form (symmetrical, asymmetrical)

Sensorimotor form (symmetrical, asymmetrical)

diabetic mononeuropathy(isolated damage to the conduction tracts of the cranial or spinal nerves)

autonomic (autonomic) neuropathy:

Thin and thick fibers

Focal mononeuropathies of the extremities

Proximal motor (amyotrophy)

Truncal radiculoneuropathies, etc.

True - characterized by positive neurological symptoms, including burning, tingling, signs of distal decreased sensitivity, decreased Achilles reflex

Pseudosyringomyelic - characterized by a decrease in pain and temperature sensitivity in combination with neuropathy of autonomic fibers; skin biopsy reveals obvious damage to the axons of small fibers and moderate damage to large fibers

Acute - acute burning pain dominates, allodynia, hypersensitivity to piercing stimulation, weight loss, insomnia may be observed, erectile dysfunction in men, skin biopsy analysis indicates active degeneration of myelinated and unmyelinated fibers

Polyol pathway of metabolism

Decreased protein kinase C activity

Free radical destruction of cell membranes

Free fatty acid metabolism disorder

Absorption of carbohydrates is impaired

The signs of hypoglycemia are masked (the mechanisms of its counterregulation are suppressed - the glucagon phase of adaptation is inhibited and adrenergic warning symptoms are leveled)

The bioavailability of oral hypoglycemic drugs changes

Subclinical DP at stage 1 can be diagnosed in specialized neurophysiological departments. Such diagnostic tests are not recommended for daily use.

Having symptoms that are worse at night, such as burning, sharp and stabbing pain

Absent or impaired sensitivity and weakened or absent reflexes

Poor control of diabetes, weight loss

Diffuse pain (torso)

Hyperesthesia may occur

May be associated with initiation of antihyperglycemic therapy

Minimal sensory disturbance or normal sensation on peripheral neurological examination

Typically occurs in older adults with undiagnosed and poorly controlled type 2 diabetes

Manifested by muscle weakness; usually affects the proximal muscles of the lower extremities; subacute onset

Usually accompanied by pain, mainly at night, with minimal sensory disturbances

There are no symptoms or numbness of the feet, impaired temperature and pain sensitivity with absence of reflexes

Proximal motor (amitrophy)

Associated chronic inflammatory demyelinating neuropathies

Pain (usually burning, worse at night)

Reduced sensitivity - vibration, temperature, pain, tactile

Decreased or lost reflexes

Increase or decrease in temperature

Presence of callus (callus) in areas of high pressure

Acute painful (small fiber disease) neuropathy

Chronic painful (damage to large and small fibers) neuropathy

Patients with type 1 diabetes 1 year after the onset of the disease

Patients with type 2 diabetes from the moment of diagnosis of the disease

Weakened Achilles reflexes

Decreased peripheral vibration sensitivity

Firstly, age-related changes may give a similar clinical picture

Secondly, DP can often be asymptomatic and detected only during an electroneuromyographic study

5.higher growth

Vibration sensitivity disorder

Mandatory method - calibrated tuning fork (values ​​less than 4/8 octave scale on the head of the big toe)

Additional method (if possible) – biotensiometry

disturbance of temperature sensitivity

Mandatory method – touching with a warm/cold object

pain sensitivity disorder

Mandatory method - tingling with a needle

tactile sensitivity disorder

Mandatory method - touching the plantar surface of the foot with monofilament

impaired proprioceptive sensitivity

A mandatory method is to identify sensory ataxia (instability in the Rombeog position)

Motor form of neuropathy

manifestations: muscle weakness, muscle atrophy

A mandatory method is to identify weakened or absent tendon reflexes (Achilles, knee)

Additional method (if possible) – electroneuromyography

Autonomic form of neuropathy

The presence of orthostatic hypotension (a decrease in blood pressure by more than or equal to 30 mm Hg when the body position changes from horizontal to vertical)

Absence of heart rate acceleration during inhalation and deceleration during exhalation

Valsalva's symptom (lack of heart rate acceleration when straining)

Additional method (if possible)

Daily blood pressure monitoring (no nighttime blood pressure decrease)

Holter ECG monitoring (the difference between the maximum and minimum heart rate during the day is less than or equal to 14 beats/min)

ECG recording during the Valsalva maneuver (the ratio of the maximum to the minimum RR is less than or equal to 1.2)

gastrointestinal form (enteropathy)

Mandatory method - diagnosed according to the clinic of alternating diarrhea and constipation, gastroparesis, biliary dyskinesia

Additional method (if possible) – gastroenterological examination

Mandatory method - diagnosed by the absence of the urge to urinate, the presence of erectile dysfunction, retrograde ejaculation

Additional method (if possible) – urological examination

asymptomatic form - diagnosed by the absence of clinical symptoms

It is carried out for all patients with type 1 diabetes mellitus 5 years after diagnosis of the disease and for all patients with type 2 diabetes mellitus at diagnosis, then annually

Determination of temperature, pain, tactile and vibration sensitivity, tendon reflexes

Thorough examination of the lower limbs and feet

Activities aimed at achieving and maintaining stable compensation for diabetes

Aldose reductase inhibitors - blockers of the polyol pathway of glucose metabolism

B vitamins - benfotiamine and cyanocobalamin - glycolysis inhibitors that block the glucotoxic effect and the formation of glycosylation end products

Lipoic acid - activates mitochondrial enzymes and glucose oxidation, inhibits gluconeogenesis

Essential fatty acids - have an antioxidant effect and reduce hyperlipidemia.

Elimination of pain syndrome

Elimination of cramps in the limbs

Prevention and treatment of foot ulcers

Correction of bone mineral density during the development of osteoporosis

Treatment of concomitant infections, etc.

Currently, two main approaches have been put forward in the implementation of targeted neurotropic therapy for DP, as in neuropharmacology in general:

The use of combined neurotropic drugs containing components that influence various parts of the pathogenesis of this syndrome and complement each other in pharmacodynamic and clinical terms

The use of single-drug drugs of a complex polytopic type of action, which have versatile and important effects from the point of view of pharmacology and clinical practice

Possibility of using proven standard effective combinations of biologically active substances within one dosage form (simplification of the procedure for choosing a medicinal product for a practitioner)

Reducing forced polypharmacy while maintaining or increasing treatment effectiveness

Improving compliance (ease of use for the patient and the doctor)

Increasing access to treatment depending on the cost of drugs

(1) Today, thioctic (-lipoic) acid preparations are considered the most effective drugs in the treatment of DP.

Effect on energy metabolism, glucose and lipid metabolism: participation in the oxidative decarboxylation of a-keto acids (pyruvate and a-ketoglutarate) with activation of the Krebs cycle; increased uptake and utilization of glucose by the cell, oxygen consumption; increase in basal metabolism; normalization of gluconeogenesis and ketogenesis; inhibition of cholesterol formation.

Cytoprotective effect: increased antioxidant activity (direct and indirect through the vitamin C, E and glutathione systems); stabilization of mitochondrial membranes.

Influence on the reactivity of the body: stimulation of the reticuloendothelial system; immunotropic effect (reduction of IL1 and tumor necrosis factor); anti-inflammatory and analgesic activity (associated with antioxidant effects).

Neurotropic effects: stimulation of axon growth; positive effect on axonal transport; reducing the harmful effects of free radicals on nerve cells; normalization of abnormal glucose supply to the nerve; prevention and reduction of nerve damage in experimental diabetes.

Hepatoprotective effect: accumulation of glycogen in the liver; increasing the activity of a number of enzymes, optimizing liver function.

Detoxification effect (FOS, lead, arsenic, mercury, sublimate, cyanides, phenothiazides, etc.)

Activation of protein kinase C

Formation of non-enzymatic glycation products

Tizanidine (alpha-2 adrenergic agonist)

Baclofen (GABAB receptor antagonist)

Diazepam (GABAA receptor agonist)

Memantine (NMDA-gated channel inhibitor)

Tolperisone (Na channel blocker and membrane stabilizer)

in a double-blind, placebo-controlled study evaluating the effectiveness of glyceryl trinitrate spray in 48 patients with painful diabetic neuropathy. Twenty-four patients in the study group used topical glyceryl trinitrate spray on their legs during sleep for four weeks, while the other 24 used a spray containing a placebo. Glyceryl trinitrate was well tolerated, and only one patient was withdrawn from the study due to adverse side effects. Researchers associate the positive effect with vasodilation, which occurs due to nitric oxide, a derivative of glyceryl trinitrate. Good results were obtained when using this spray in combination with valproic acid.

Diabetic polyneuropathy of the lower extremities

A prolonged excess of glucose in the blood, having a destructive effect on blood vessels, is no less destructive for the nervous system. Polyneuropathy is a severe complication of diabetes mellitus, which can affect several large plexuses of peripheral nerves that control the functions of the lower extremities.

What is diabetic polyneuropathy

Multiple lesions of nerve fibers are observed in patients suffering from diabetes mellitus for more than one decade, in 45-54% of cases. The role of peripheral nervous regulation of the body is extremely important. This system of neurons controls the brain, heartbeat, breathing, digestion, and muscle contraction. Diabetic polyneuropathy of the lower extremities (DPN) is a pathology that begins in the feet and then spreads higher and higher.

The pathogenetic mechanism of the disease is very complex and is not fully understood by scientists. Disorders of the functions of the peripheral nervous system are diverse. Each type of DPN has its own clinical picture. However, all forms of this complication are dangerous and require patient treatment, otherwise the leg problem can turn a person into a disabled person. Diabetic polyneuropathy is encrypted by doctors under code G63.2 according to ICD-10, indicating the variant of the disease.

Types of neuropathy

Since the peripheral nervous system is divided into somatic and autonomic (vegetative), two types of diabetic polyneuropathy are also called. The first gives rise to multiple non-healing trophic ulcers of the lower extremities, the second - problems with urination, impotence and cardiovascular accidents, often with fatal outcomes.

Another classification is based on the functions of the nervous system that are disrupted as a result of the development of pathology:

• sensory polyneuropathy associated with increased pain in the legs, or, conversely, loss of tactile sensitivity;
• motor polyneuropathy, which is characterized by muscular dystrophy and loss of the ability to move;
• sensorimotor polyneuropathy, combining the features of both of these complications.

A manifestation of the latter, mixed pathology is neuropathy of the peroneal nerve. Diabetics with this disease do not feel pain in certain places of the foot and lower leg. These same parts of the surfaces of the legs do not react to either cold or heat. In addition, patients lose the ability to control their feet. Patients are forced to walk, raising their legs unnaturally high ("rooster" gait).

Diabetic distal polyneuropathy

This is a pathology that causes the death of nerve fibers. The disease leads to a complete loss of tactile sensitivity and ulceration of the farthest part of the lower extremities - the feet. The typical condition for diabetics with distal DPN is a dull, aching pain, which is often so severe that the person cannot sleep. In addition, sometimes my shoulders begin to ache. Polyneuropathy progresses, and this leads to muscle atrophy, bone deformation, flat feet, and foot amputation.

Peripheral

With this type of disease, severe disorders of the sensorimotor functions of the legs occur. Diabetics suffer from pain and numbness not only in their feet, ankles, lower legs, but also in their hands. Peripheral polyneuropathy occurs mainly when doctors prescribe potent antiviral drugs with serious side effects: Stavudine, Didanosine, Saquinavir, Zalcitabine. It is important to diagnose this pathology in a timely manner in order to immediately discontinue the drug.

Sensory polyneuropathy

The main feature of the pathology is loss of sensation in the legs, the degree of which can vary significantly. From minor tingling to complete numbness, accompanied by the formation of ulcers and deformation of the feet. At the same time, the lack of sensitivity is paradoxically combined with unbearably severe pain that occurs spontaneously. The disease first affects one leg, then often moves to the second, rising higher and higher, affecting the fingers and hands, torso, and head.

Dysmetabolic

The occurrence of this type of complication is often provoked, in addition to diabetes, by diseases of the stomach, intestines, kidneys, and liver. Many nerve plexuses of the extremities may be affected. When the sciatic and femoral neurons are disturbed, pain, trophic ulcers, difficulties with movement appear, knee and tendon reflexes disappear. The ulnar, trigeminal, and optic nerves are often damaged. Dysmetabolic polyneuropathy can occur without pain.

Why do people with diabetes develop neuropathy?

The main reason is high blood glucose levels and prolonged insulin deficiency. The deterioration of cellular metabolism has a detrimental effect on peripheral nerve fibers. In addition, diabetic leg polyneuropathy can be caused by:

• endocrine disorders;
• severe liver or kidney diseases;
• depression, weakened immunity;
• infections;
• alcohol abuse;
• poisoning with toxic chemicals;
• tumors.

Symptoms

The main manifestations of the disease of all types:

1. Sensitive symptoms – pain, weakening or worsening of the perception of temperature changes, vibration.
2. Motor symptoms – convulsions, tremors, muscular atrophy of the limbs.
3. Autonomic symptoms - edema, hypotension, tachycardia, stool disorders, impotence.

Burning and tingling in the legs

The feeling that the soles of the feet are on fire occurs when the peripheral nerve fibers that run from the spine to the feet are damaged. Burning feet are not a disease, but a symptom that manifests itself in polyneuropathy in diabetes mellitus. Damaged neurons are activated and send false pain signals to the brain, although the soles of the feet are intact and there is no fire.

Loss of sensation in the foot

At first, the diabetic experiences weakness and numbness in the feet. Then these sensations arise in the legs and hands. As lower extremity polyneuropathy progresses, muscle atrophy increases and tactile sensitivity decreases. The feet become difficult to control and droop. The hands become numb, starting from the fingertips. With a long-term pathological process, loss of sensitivity affects part of the body in the chest and abdomen.

Diagnosis of the disease

Polyneuropathy of the lower extremities is detected using the following methods of examining the patient:

• testing unconditioned reflexes;
• pain sensitivity test;
• checking response to vibration;
• thermal test;
• cutaneous nerve biopsy;
• Electroneuromyography (ENMG), which can show whether nerve impulses travel along muscle fibers.

Treatment of diabetic polyneuropathy of the lower extremities

Such complications cannot be completely cured, but their development can be slowed down. How to treat neuropathy of the lower extremities? The main condition is the normalization of blood glucose. Analgesics, loose shoes, minimal walking, and cool baths help reduce pain. A contrast shower relieves burning feet. It is necessary to use drugs that dilate peripheral vessels and affect the transmission of nerve impulses. Treatment of polyneuropathy of the lower extremities becomes more effective when taking B vitamins. It is also important to correct carbohydrate metabolism with diet.

Drug therapy

The main means for the complex treatment of patients diagnosed with polyneuropathy of the lower extremities:

• antidepressants Amitriptyline, Imipramine, Duloxetine, blocking the reuptake of the hormones norepinephrine and serotonin;
• anticonvulsants Pregabalin, Carbamazepine, Lamotrigine;
• analgesics Targin, Tramadol (doses are strictly limited - drugs!);
• vitamin complex Milgamma;
• Berlition (thioctic or alpha lipoic acid), which has the ability to restore damaged nerves;
• Actovegin, which improves blood supply to nerve endings;
• Isodibut, Olrestatin, Sorbinil, protecting nerves from glucose;
• antibiotics - if there is a threat of gangrene development.

Treatment without drugs

The hope of being cured with the help of homemade or folk remedies alone is a utopia. It is necessary to take medications and actively use:

• magnetic therapy;
• electrical stimulation;
• hyperbaric oxygen therapy;
• acupuncture;
• massage;
• Exercise therapy (physical therapy).

With diabetes, a person develops numerous complications that negatively affect the functioning of internal organs. The peripheral nervous system is also often affected - if individual nerve fibers are damaged, the doctor diagnoses diabetic neuropathy; in the case of mass damage, diabetic polyneuropathy is detected.

This disease develops in diabetics with the first and second types of diabetes mellitus; the risk of the disease is 15-50 percent of cases. Typically, diabetic polyneuropathy is diagnosed if a person has had a lack of insulin for a long time and has elevated blood glucose levels.

Peripheral nerves are damaged as a result of changes in the mechanism of the metabolic process in tissues. Nerve fibers are exposed to oxygen starvation, the concentration of nitric oxide decreases, due to which blood supply deteriorates and the functioning of the nervous system is disrupted.

What is diabetic polyneuropathy

Pathological disorders are divided into several types, depending on the type of lesion and the severity of the disease. As is known, the peripheral nervous system is somatic and autonomic. Based on this, there is somatic and autonomic polyneuropathy in diabetes mellitus.

In the first case, diabetic polyneuropathy of the lower extremities is provoked in the form of numerous ulcers. The second type of disease often leads to the death of the patient.

The disease is also classified according to the type of damage to the functions of the nervous system. In particular, the sensory form of diabetic polyneuropathy manifests itself in the form of loss of sensitivity to temperature changes.

With the motor form, muscle weakness appears, with the somatic form, the signs of manifestations of both forms are combined.

Diabetic distal polyneuropathy

Sugar level

This pathology, which can be seen in the photo, is classified as a type of disease. It is accompanied by the death of nerve fibers, due to which a person loses all sensitivity, and numerous ulcers develop on the feet.

The cause of this type of complication is most often diabetes mellitus, which reduces a person’s performance. The disease itself is very dangerous both for the health and life of a diabetic.

Distal polyneuropathy usually affects the lower extremities, but can sometimes affect the arms. A person feels a nagging and dull pain, which can be so strong that the patient cannot sleep normally at night. The pain intensifies at rest and can worsen during long walking.

Additionally, paresthesia makes itself felt, which is manifested by numbness, “crawling goose bumps,” tingling, chilliness or burning, heaviness and weakness of the legs, and sometimes pain is felt in the shoulders, forearms, and thighs. The feeling of pain during palpation of the lower leg is considered the main symptom by which pathology is diagnosed.

• At the initial stage of the disease, sensitivity in the toes noticeably decreases; after some time, symptoms may spread to the upper extremities. If treatment for diabetic polyneuropathy of the lower extremities is not started in time, a person may develop serious life-threatening complications.
• The disease is accompanied by disruption of thin and sometimes thick nerve fibers. When thin fibers are damaged, the patient's temperature and pain sensitivity in the legs decrease. If the pathology affects thick nerve fibers, the diabetic partially or completely loses tactile sensitivity.
• With the further development of the disease, the functioning of the musculoskeletal system is disrupted, the person feels weakness in the legs, muscle atrophy develops, sweating worsens, the skin dries out, and the bones are noticeably deformed. The skin acquires a pink or reddish tint, symmetrical pigmentation appears in the area of ​​the lower leg and the back of the feet, the lower limbs atrophy or become deformed.
• As a result, osteoarthropathy develops, which is characterized by transverse and longitudinal flat feet, increased deformation of the ankles, and an increase in the size of the feet on the transverse side. Such foot disorders can be either unilateral or bilateral.
• Due to prolonged pressure on the deformed area of ​​the bone, neuropathic ulcers occur on the outside of the feet and between the toes. Such wounds initially do not cause pain due to decreased sensitivity, but after a while, when the inflammatory process begins, the diabetic pays attention to the skin defect.

In order to prevent the development of serious complications that lead to amputation of the lower limb, it is important to carry out timely diagnosis and know how to treat such a pathology. To accurately determine the diagnosis, a neurological examination is performed to study the degree of sensitivity and reflexes of the patient.

The main reason for the progression of the pathology is elevated blood sugar levels, therefore, in children and adults, therapy is carried out with hypoglycemic agents.

It is important to regularly monitor glucose levels; if necessary, the diabetic takes painkillers.

Diabetic polyneuropathy: symptoms

At different stages of the disease, the symptoms may differ significantly - at stage zero, symptoms are completely absent. The first stage has no characteristic signs, but the doctor can diagnose the disease by examining ready-made blood tests and the results of diagnostic testing in the neurophysiology department.

At the second clinical stage, chronic pain, acute pain, amyotrophy and painless form are distinguished. In the chronic painful form, diabetics experience a burning sensation and pain in the legs, while sensitivity is noticeably reduced, as a result of which polyneuropathy of the lower extremities is diagnosed. Symptoms may especially intensify at night.

When an acute painful form develops, pain begins to spread throughout the body, in some cases increased sensitivity is observed in the lower extremities. Amyotrophy is accompanied by muscle weakness and severe pain at night. In the painless form, a person does not completely feel pain or temperature changes.

The doctor diagnoses the third stage of the disease, when serious complications are observed. Numerous wounds and ulcers can be seen in the foot area; Charcot's foot may develop; in this case, the disease often leads to amputation of the foot.

All possible signs of the disease can be divided into three main groups:

1. Sensitive symptoms include disturbances in the form of aching, cutting, shooting, burning pain. In a diabetic, sensitivity decreases or, conversely, increases, arms and legs go numb. Also, the patient may not feel vibration or temperature changes.
2. Symptoms of motor activity are accompanied by weakness or atrophy of the muscle tissue of the legs, lack of reflexion, trembling of the limbs, and cramps of the calf muscles.
3. Including a diabetic, the functioning of the autonomic system is disrupted, this is manifested by tachycardia, decreased blood pressure when a person changes body position, constipation, diarrhea, impotence, impaired sweating, and edema.

Diagnosis and treatment of polyneuropathy

The disease is diagnosed based on the diabetic's complaints, existing symptoms and certain factors. The disease is quite difficult to detect, since older people may experience similar clinical signs due to age-related changes.

In addition, sometimes the symptoms do not manifest themselves at all, so the disorder can only be identified by undergoing a special examination.

Most often, this disease is detected in older men; there is also a risk of developing diabetic polyneuropathy in diabetes mellitus with prolonged hyperglycemia, high patient stature, the presence of diabetic retinopathy and nephropathy, decreased sensitivity to vibrations, and weakened tendon reflexes.

• If a person has a sensory form of the disease, for diagnostic purposes vibration sensitivity is measured using a tuning fork, the degree of sensitivity to temperature changes is determined, and pain sensitivity is detected by tingling the legs with a special needle. This includes testing tactile sensitivity and the diabetic’s ability to sense the position of body parts.
• If a motor form of the disease is suspected, tendon reflexes are assessed and electromyography is performed, which consists of studying the bioelectrical activity of muscle tissue.
• In the case of an autonomous form of polyneuropathy, the frequency of heart contractions during inhalation and exhalation is measured, a gastroenterological and urological examination is carried out, and it is checked how prone the person is to orthostatic hypotension.

During the examination, the doctor checks whether the diabetic feels touch, pain, heat, cold, vibration and pressure. Various devices are used for this, but the patient, if necessary, can check sensitivity himself using any warm or cold objects. Tactile sensations can be detected with cotton swabs that are moved over the skin.

If a diabetic is diagnosed with diabetic polyneuropathy, treatment must be comprehensive, all causes that provoke the disease must be eliminated. To do this, on the recommendation of the attending physician, various drugs are prescribed to relieve symptoms and alleviate the patient’s condition.

1. To lower blood sugar levels, take antihyperglycemic medications.
2. To normalize the functioning of the nervous system, the doctor prescribes B vitamins, small dosages of antidepressants, and drugs containing thioctic acid.
3. Gabapentin is an effective remedy against seizures; analgesics and anesthetics are also necessary. A magnesium supplement helps relieve muscle cramps, and muscle relaxants relieve spasms.
4. To increase the energy resources of neurons, it is recommended to take the drug Actovegin.
5. If a person has tachycardia, take Nebivolol or Metoprolol.
6. To eliminate skin irritation, Capsicam, Apizartron, and Finalgon are used.

Among non-drug remedies, special physiotherapy procedures, relaxing massage, acupuncture, magnetic therapy, and electrical stimulation can cure pathology.

Proven folk methods are very helpful in getting rid of wounds and ulcers on the skin with diabetic polyneuropathy; herbal infusions, healing oils, and healthy decoctions are used for this.

Be sure to exclude any alcoholic drinks from your diet to keep your body strong and healthy.

Preventive measures

With timely diagnosis, proper therapy, and prevention, the progression of the disease can be stopped in time. For these purposes, it is important for diabetics to consult a doctor five years after the discovery of diabetes mellitus and undergo an examination for the presence or absence of diabetic polyneuropathy in a child or adult. After this, you need to undergo control every year.

Dysmetabolic polyneuropathy is a disease that can develop against the background of somatic problems predetermined by metabolic disorders:

• diabetes mellitus;
• kidney and liver diseases;
• problems of the digestive tract.

These diseases become a prerequisite for deficiency of thiamine and other vitamins. In addition, multiple lesions of peripheral nerve endings can be observed quite often.

Develops in diabetes mellitus in 90% of cases. The exact number of such problems will directly depend on the duration of diabetes, however, in no way depends on the degree of its severity.

Symptoms of polyneuropathy can also become harbingers of this disease.

An important factor in the development of neuropathy can be hypoxia with changes. Due to this, the use of sugar by peripheral nerves will be impaired.

As a result of failures in the glycolysis process, an excess of lactic acid and pyruvic acid will accumulate. There have been cases of changes in the process of thiamine phosphorylation.

An important role will be played by disturbances in other types of metabolism that are present against the background of diabetes mellitus:

• water-electrolyte;
• lipid;
• protein.

Clinical picture of the disease

In each specific case, the course of dysmetabolic polyneuropathy may be different. If the disease develops early enough and manifests itself as a significant decrease in vibration sensitivity, then loss of the knee and Achilles reflexes may be observed.

This subclinical case of polyneuropathy does not cause pain, but develops over several years in a row.

Diabetic polyneuropathy can be characterized by subacute or even acute development. In this case, damage to individual sections of the nerve trunks occurs. As a rule, nerve damage occurs:

1. sciatic;
2. middle;
3. elbow;
4. femoral

These problems may be accompanied by paresis of the corresponding muscle groups, pain and sensitivity disorders. If the femoral nerve has been affected, then loss of knee reflexes is observed.

In addition, damage to the cranial nerves (abducens, trigeminal, oculomotor) was noted.

There is a third type of diabetic polyneuropathy. It is characterized by damage to some nerves of the extremities and the development of sensory and motor disorders (the lower extremities are especially affected).

Tendon reflexes may completely disappear, and upon palpation, pain in the nerve trunks is felt.

Autonomic and trophic disorders are common in polyneuropathy. Problems with urination and postural hypotension develop.

How to treat?

First of all, carbohydrate metabolism should be adjusted using insulin injections and a special balanced diet. The doctor may recommend:

• painkillers;
• B vitamins;
• finlepsin;
• ganglioblockers (gangleron);
• espa-lipon ().

The regulations for measures that are used to get rid of neuropathy will be shown.

Polyneuropathy in systemic diseases

If a patient has lupus erythematosus, which affects the skin, kidneys and joints, then polyneuropathy is characterized by the development of paralysis or paresis of the proximal muscles, loss of some tendon reflexes. A significant decrease in sensitivity to pain is also likely.

In some cases, signs of polyneuropathy may become the first manifestations of the development of the underlying disease. Medicine knows forms with significant damage to various nerves of the arms and legs.

In this case, we will talk about mononeuropathy. In severe cases of rheumatoid arthritis, polyneuropathy is also observed. Initially, it will manifest itself as sensory disturbances, and then as quite severe sensorimotor neuropathy.

If periarteritis nodosa is present, then sequential neuropathy of individual cranial and spinal nerves develops. Such violations will be associated with severe disorders:

1. vegetative;
2. motor;
3. sensitive.

This form of neuropathy is often accompanied by symptoms of inflammatory angiopathy in other organs and systems.

Hereditary polyneuropathy

First of all, this is polyneuropathy, which develops with porphyria (genetic enzyme disorders). The main symptoms of this hereditary disease are:

• pain in the abdominal cavity;
• increased blood pressure;
• damage to the central nervous system;
• producing urine with a characteristic dark color.

Porphyritic polyneuropathy will manifest itself due to a neurological complex of symptoms. In this case, pain, muscle weakness, and paresthesia (upper and lower extremities) occur. Motor manifestations can gradually increase, up to distal paralysis or paresis.

With this illness, the patient will feel:

1. soreness of the nerve trunks;
2. loss of all types of sensitivity.

To make an adequate diagnosis, the doctor will take into account all the existing symptoms of porphyrin metabolism disorders. To get rid of the disease, the doctor recommends intravenous and oral administration of glucose in a dosage of up to 400 mg (the same treatment is indicated for other forms of polyneuropathy).

Amyloid polyneuropathy

The amyloid type of polyneuropathy develops in those patients who have a history of hereditary amyloidosis. Its main clinical symptoms are:

• bowel disorders (constipation and diarrhea);
• pain in the digestive tract;
• heart failure;
• macroglossia (increase in the size of the tongue).

With this disease, sensory disturbances predominate, for example, soreness of the limbs, loss of pain and temperature sensitivity. At later stages, paresis also joins the disorders.

As for adequate therapy, it does not exist at the moment.

Distal sensorimotor polyneuropathy

In diabetes mellitus, long nerve fibers are most often affected. Diabetic polyneuropathy occurs in 40% of diabetics. This type of illness is characterized by the absence of a feeling of pressure, changes in ambient temperature, pain, vibration and location relative to other objects.

Sensory polyneuropathy is dangerous because a diabetic may not feel pain or high temperatures.

Ulcers appear on the lower extremities. Serious joint damage and fractures cannot be ruled out.

Sensorimotor polyneuropathy can manifest itself with active symptoms, for example, quite severe pain in the legs, which is especially worse at night.

As the disease progresses, disturbances in the functioning of the musculoskeletal system will be observed. This happens:

• bone deformation;
• muscle dystrophy;
• excessive dryness of the skin;
• the appearance of pigment spots;
• reddish skin tone;
• dysfunction of the sweat glands.

The most significant symptoms of distal polyneuropathy in diabetes mellitus will be ulcers that occur between the toes and on the soles of the feet. The lesions are not capable of causing discomfort due to the absence of pain. In advanced cases, we will talk about amputation of limbs.

Autonomic polyneuropathy in diabetes

If there are lesions of the autonomic nervous system against the background of diabetes mellitus, the patient will feel:

1. darkening of the eyes;
2. fainting when taking a vertical position;
3. dizziness.

This form of polyneuropathy will be accompanied by disruptions in the normal functioning of the digestive tract, which is manifested by a slowdown in the flow of food into the intestines. Because of this, it is almost impossible to stabilize the concentration of glucose in the blood of a diabetic.

The cause of sudden death may be cardiac arrhythmia due to diabetic polyneuropathy.

Those people who suffer from this disease will experience problems with the genitourinary system - urinary incontinence occurs. The bladder will lose the ability to completely empty itself, which becomes a prerequisite for the development of infectious diseases. In men, erectile dysfunction will be noted against the background of autonomic polyneuropathy, and in women, dyspareunia (inability to achieve orgasm).

Sensory polyneuropathy is a disease whose symptoms are caused by damage to neurons that are responsible for motor functions, due to which the functions of the motor system can be severely impaired. This dangerous disease is very common in patients with diabetes. Just as in cases with other types of polyneuropathies, one of the decisive factors in the choice of treatment and its subsequent results is the timely detection of the disease.

Sensory polyneuropathy can appear due to various reasons, including serious autoimmune processes, intoxications, heredity and infections, while the most dangerous case is when the disease is inherited or acquired due to a special genetic predisposition.

The main symptoms of this dangerous sensory polyneuropathy are loss of sensitivity, unreasonable sensations of burning, tingling and itching, a feeling of vibration in the limbs, and the patient begins to perceive heat and cold, temperature changes worse. With sensory polyneuropathy, negative symptoms of sensory impairment, a feeling of “gloves” and “socks”, and impaired sensitivity in the lower abdomen are also possible.

Depending on what type of neurons is damaged, three main forms of sensory polyneuropathy can be distinguished: hyperalgesic form, ataxic form and mixed form. In the atactic form of the disease, symptoms such as impaired coordination of movement, paresthesia, numbness, and instability (especially with eyes closed) are noted. Muscle strength usually remains unchanged, but may decrease significantly when examined by a doctor and tested for strength associated with loss of deep sensation.

The hyperalgesic form implies symptoms such as autonomic dysfunction, pain (most often burning or shooting), decreased pain sensitivity, and decreased temperature sensitivity. The mixed form of sensory polyneuropathy includes symptoms characteristic of the above forms of the disease.

With sensory polyneuropathy, the main symptoms are most often asymmetrical, especially at the very beginning of the disease. So, for example, this disease can begin with one leg, while the second will remain completely healthy for a long time, but as the disease progresses, the symptoms become more symmetrical. Often in the early stages of the disease, not only the legs are affected, but also the upper limbs, and at times even the torso and face. Symptoms can develop within a few days or 1 – 2 months.

Having reached a certain point, a maximum, so to speak, many symptoms most often stabilize for a long time. It often happens that symptoms decrease, but most often, especially with a monophasic course of the disease, they remain at the same level, which is usually quite high, or continue to increase. Unlike Guillain-Barré syndrome, sensory polyneuropathy is characterized by poor functional recovery.

Sensory impairment can range from mild numbness to profound anesthesia with arthropathy and ulcers. With this disease, paresthesia and spontaneous unbearable pain are often observed. At the moment, a complete explanation for this unique disease, which combines a lack of sensitivity to painful stimuli and severe spontaneous pain, has not been found.

To diagnose sensory polyneuropathy, an anamnesis is required with a thorough identification of other diseases, dietary habits, a list of medications that the patient took, a description of heredity, previous infectious diseases that could affect the development of polyneuropathy, an assessment of the patient’s places of work, to establish the fact of contact with toxic substances , ENMG results, as well as specific results of cutaneous nerve biopsy, etc.

To date, treatment for sensory polyneuropathy is rather poorly developed. Treatment most often uses corticosteroids, cytostatics, plasmapheresis and immunoglobulin, however, too often treatment attempts are unsuccessful. Against the background of immunotherapy, partial regression of symptoms and stabilization of the condition is observed, but the reasons for this result are not fully understood, however, in any case, timely therapy plays the main role.

Also, as in all other types of polyneuropathies, timely diagnosis and initiation of treatment contributes to, if not recovery, then stabilization of the patient’s condition. In the case of sensory polyneuropathy, if the disease is not found at an early stage, then, after a significant part of the neurons have died, significant recovery is impossible, but one can hope to stop the progression of the disease and stabilize the patient's condition.

Polyneuropathy is a series of diseases, the causes of which can be varied, but their common characteristic is disruption of the normal functioning of the peripheral nervous system and individual nerves, but in large numbers throughout the body.

Often, it affects the arms and legs, manifesting itself in a symmetrical decrease in muscle performance, deterioration of blood circulation in the affected area, and decreased sensitivity. The legs suffer the most from this disease.

Classification of the disease

Polyneuropathy of the lower extremities is divided into four types, and each of them, in turn, has its own subtypes.

By predominant damage to fibers

All nerve fibers are divided into three types: sensory, motor and autonomic. When each of them is affected, different symptoms appear. Next we will look at each type polyneuroglia:

1. Motor (motor). This type is characterized by muscle weakness that spreads from bottom to top and can lead to complete loss of the ability to move. Deterioration of the normal condition of the muscles, leading to their refusal to work and frequent occurrence of cramps.
2. Sensory polyneuropathy of the lower extremities (sensitive). Characterized by painful sensations, stabbing sensations, a strong increase in sensitivity, even with a light touch on the foot. There are cases of decreased sensitivity.
3. Vegetative. In this case, profuse sweating and impotence are observed. Urinary problems.
4. Mixed– includes all the symptoms listed above.

By damage to cells of nerve structures

A nerve fiber is made up of axons and myelin sheaths that wrap around those axons. This type is divided into two subspecies:

1. When destruction of myelin sheaths of axons development proceeds faster. Sensory and motor nerve fibers are more affected. Vegetative ones are destroyed slightly. Both proximal and distal sections are affected.
2. Axonal same characters in that development proceeds slowly. Autonomic nerve fibers are disrupted. Muscles atrophy quickly. Spread begins from the distal sections.

By localization

By localization there are:

1. Distillate– in this case, the areas of the legs that are located most far away are affected.
2. Proximal– parts of the legs that are located higher are affected.

Cause of occurrence

Because of there are:

1. Dysmetabolic. It develops as a result of a disruption in the flow of processes in nerve tissues, which is provoked by substances produced in the body as a result of certain diseases. Once they appear in the body, these substances begin to be transported in the blood.
2. Toxic polyneuropathy of the lower extremities. Occurs when consuming toxic substances such as mercury, lead, arsenic. Often appears when

   use of antibiotics, but the most common type of polyneuropathy is alcoholic.

3. In cases alcoholic polyneuropathy lower extremities the following symptoms appear: increased pain, decreased ability to move the legs, impaired sensitivity. Rapid onset of trophy in muscles.
4. Diabetic polyneuropathy of the lower extremities. Occurs in people suffering from diabetes mellitus for a long period of time, 5-10 years. It manifests itself in the form of the following symptoms: impaired sensitivity, spots on the skin, burning sensation in the feet.

Primary and secondary

In this case:

1. TO primary Polyneuropathy includes hereditary and idiopathic types. This is a disease called Guillain-Barre syndrome.
2. Co. secondary This includes polyneuropathy resulting from poisoning, metabolic disorders, and infectious diseases.

Causes of the disease

This disease can occur for a number of reasons, but it is not always possible to accurately determine them. Polyneuropathy of the lower extremities has the following main causes:

• inherited causes;
• problems with the immune system that appear as a result of disorders of the body;
• various types of tumors;
• lack of vitamins in the body;
• taking medications unnecessarily or not according to instructions;
• disruption of the endocrine glands;
• kidney and liver problems;
• infections that cause processes that cause inflammation in peripheral nerves;
• poisoning of the body with all sorts of substances.

Symptoms of the disease

When the disease occurs, the functioning of motor and sensory fibers deteriorates. In this case, the following symptoms of lower polyneuropathy appear: limbs:

• partial numbness of the legs;
• swelling of the lower extremities;
• the occurrence of pain sensations;
• stabbing sensations;
• feeling of weakness in the muscles;
• increased or decreased sensitivity.

Diagnostic techniques

Diagnosis is carried out by analyzing the disease and its symptoms, while eliminating diseases that may give similar symptoms.

During this process, the doctor must carefully examine all external signs and changes, and find out from the patient whether his closest relatives had the same disease.

Polyneuropathy is also diagnosed using various procedures:

• biopsy;
• ultrasound diagnostics of internal organs;
• cerebrospinal fluid examination;
• examination using an X-ray machine;
• blood chemistry;
• study of the speed with which the reflex travels along the nerve fibers;
• study of reflexes.

Treatment of pathology

Treatment of polyneuropathy of the lower extremities has its own characteristics. For example, treatment of diabetic polyneuropathy of the lower extremities will not depend in any way on giving up alcohol, unlike the alcoholic form of the disease.

Features of treatment

Polyneuropathy is a disease that does not occur on its own.

Thus, at the first manifestation of its symptoms, it is necessary to immediately find out the cause of its occurrence.

And only after that eliminate the factors that will provoke it. Thus, treatment of polyneuropathy of the lower extremities should be comprehensive and aimed primarily at removing the very root of this problem, because other options will not give any effect.

Drug therapy

Depending on the type of disease, the following are used: drugs:

• in cases of severe disease, methylprednisolone is prescribed;
• for severe pain, analgin and tramadol are prescribed;
• drugs that improve blood circulation in blood vessels in the area of ​​​​nerve fibers: vasonite, trintal, pentoxifylline.
• vitamins, preference is given to group B;
• medications that improve the process of tissues receiving nutrients - mildronate, piracetam.

Physiotherapy

Therapy for this disease is quite a complex process, taking a long period of time.

Especially if polyneuropathy is caused by chronic or hereditary forms. It is started after drug treatment.

These include: procedures:

• massotherapy;
• exposure to magnetic fields on the peripheral nervous system;
• stimulation of the nervous system using electrical devices;
• indirect effect on organs.

In the case when the body is affected by toxic substances, for example, if the patient has alcoholic polyneuropathy of the lower extremities, treatment must be carried out using blood purification with a special device.

Healing Fitness

Exercise therapy should definitely be prescribed for polyneuropathy of the lower extremities, which makes it possible to maintain muscle tone.

Complications of the disease

Otherwise she can become chronic and bring a huge variety of problems. If you are not cured of this disease, it can cause you to lose feeling in your lower limbs, the muscles will fall into terrible shape and, as a result, you may lose the ability to move.

Forecast

If treatment is started in a timely manner, the prognosis is very favorable. Only there is one exception– treatment of chronic polyneuropathy. It is impossible to completely get rid of this disease, but there are ways to reduce its severity.

Preventive measures

To eliminate the possibility of a disease such as polyneuropathy, you need to adhere to a number of recommendations and prescriptions.

They are associated with measures that can prevent possible damage and disruption of the normal functioning of the peripheral nervous system.

1. Necessary remove alcohol from your life.
2. Necessarily use protective drugs when working with toxic substances in order to prevent their penetration into the body.
3. Recommended monitor product quality that you consume, because in case of poisoning with these products, the process of destruction and disruption of the normal functioning of nerve fibers starts. This entails the development of polyneuropathy.
4. Should be carefully control in what doses you are taking medications and under no circumstances use them unnecessarily. It is advisable to strictly follow the doctor’s instructions and not self-medicate.
5. Mandatory take measures if you discover infectious or viral diseases. You need to see a doctor urgently and not let these diseases progress, which can then cause the development of polyneuropathy.

As a rule, polyneuropathy cannot be prevented.

But, if you discover it, you immediately consult a doctor, thereby you will have the opportunity to significantly reduce the degree of development of the disease and the period of rehabilitation. It consists of visiting a physiotherapy room and therapeutic massages.

Even if you have some kind of illness you must immediately inform your doctor about this, and not self-medicate, because you cannot know for sure the symptoms of this disease, confuse it with another, and start treatment for the wrong one.

And, in principle, it is easier to fight a disease that is just beginning to develop than a disease that has been progressing for a long time, which can then ultimately lead to all sorts of complications.

Video: Diabetic polyneuropathy of the lower extremities

How to independently diagnose polyneuropathy? What are the features of the diabetic form of the disease? Why is nerve sensitivity lost?

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Distal

This term means that diabetes mellitus affects the nervous system located distally, that is, away from the body and internal organs. This term is the opposite in meaning to the word “proximal,” that is, closest. That is, these are the “endings” of the body. In neurology, there is a good figurative expression: a sock-and-glove lesion. It is in these places that elevated blood sugar levels do the most damage to the nerves. This happens because at the periphery of the nerves the myelin sheath is thinner (because the nerves themselves are thinner, like long branches), which is an “insulator” of the nerve fiber. She is more vulnerable to the harmful effects of sugar. In addition, it is in the periphery that blood supply disturbances often occur. Therefore, the distal form of the disease is the most common.

Symmetrical

Symmetry is an important sign of systemic damage. If signs of polyneuropathy appear only on one leg, then this means that some kind of catastrophe has occurred with the nerves in this particular place: compression, nerve injury or another pathological process has occurred. The symmetry of the lesion suggests that the blood is to blame, which, washing the arms and legs equally, contains a substance that causes harm. In this case, chronic, long-term hyperglycemia—high blood sugar—is to blame. Patients feel that their legs and arms suffer almost equally.

Sensorimotor

This word includes the meaning of defeat. Sensorimotor - means sensory plus motor form, that is, a sensitivity disorder (sensory disorders), which is combined with motor disorders, that is, movement disorders. Of course, on the feet and in the ankle area, as well as on the hands and fingers, various nerves “manage” the conduction of sensitivity and also send motor impulses to the muscles. But they all suffer equally from excess sugar and begin to “perform poorly.” In particular, sensory disorders manifest themselves:

• General decrease in sensitivity (hypoesthesia). The patient cannot understand which toe the doctor grabbed unless he looks and moves his foot.
• Paresthesia (a crawling sensation) appears, and numbness may occur.
• The most painful sensation is hyperpathy - a perverted sensitivity that causes a painful sensation of heat in the feet. They do not hurt, but seem to “burn.” A patient with polyneuropathy tries to stick his legs out from under the blanket at night, often goes to the bathroom and wets them with cold water. As long as your feet are wet, everything is fine. As soon as they dry out, the unpleasant sensations appear again.

Movement (motor) disorders are manifested by depression or complete absence of the Achilles tendon reflex, but weakness in the feet most often occurs. If you ask a patient with polyneuropathy to try to walk on tiptoes, and then on his heels, then most likely he will not succeed or it will turn out very unstable and clumsy: the muscles do not work. And not because they are paralyzed, but because the nerve cannot conduct a full motor impulse, since it is “poisoned” with glucose.

Polyneuropathy

Actually, this term means that it is not the brain or spinal cord that is affected, but many nerves in the periphery (poly means many). It is this “scattered” type of lesion that is characteristic of polyneuropathy. Lesions of the “socks” and “gloves” type, in addition to diabetes, are characteristic of poisoning with salts of heavy metals (lead) or due to prolonged abuse of alcohol (alcoholic form).

Lower limbs

Why are the legs involved? In fact, the symptoms of neuropathy in diabetes also appear in the arms, but they are more pronounced in the legs. There are reasons for this:

• It is in the legs, in old age, when this symptomatology usually occurs, that prerequisites already exist in the form of circulatory disorders: varicose veins, endarteritis, thrombophlebitis.
• In addition, the legs are constantly loaded in a completely different way than the arms, because when walking the arms rest.
• Often patients, especially those with type 2 diabetes, are overweight, which also adversely affects the health of their legs.

Now everyone knows what this complex diagnosis means. Treatment of diabetic polyneuropathy is no less complex: it is impossible in one day or even a month to completely eliminate toxic damage to the nerves by glucose, which has lasted for years. There are many treatment regimens. For this, for example, intravenous infusions of Berlition and other thioctic acid preparations are used.

In the treatment of polyneuropathy, agents for normalizing microcirculation (Pentoxifylline, Trental), B vitamins, preferably in the form of a combination drug, for example, Milgamma, are of great importance. Physiotherapeutic procedures are also used, for example, electrophoresis of thiamine or dibazole. With polyneuropathy, it is very important to maintain foot hygiene, to prevent the appearance of wounds, cuts and calluses, since poor wound healing in diabetes in combination with polyneuropathy can lead to the appearance of “diabetic foot”, which can even lead to amputation in advanced cases.

You can also be treated with folk remedies, but only with the permission and approval of the attending physician, since traditional medicine alone is not able to cope with this complication. It is important to know that the first and most important condition for a significant improvement in well-being with this complication of diabetes is the achievement of normoglycemia, that is, a long-term decrease in blood sugar levels to normal values.

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What is diabetic polyneuropathy

Damage to the nerves of the peripheral system can lead to the most unpredictable consequences, ranging from foot deformation to sudden death. Diabetic neuropathy (ICD 10 code: G63.2) is rightfully considered one of the most dangerous diseases requiring urgent medical intervention. The disease affects both the somatic and autonomic nervous systems, so the failure of any of them threatens the patient with death. Simultaneous damage to the brain and spinal cord doubles the risk of sudden death.

Autonomic polyneuropathy

The disease has several forms, each of which concerns a specific area in the human body. Autonomic neuropathy in diabetes mellitus is characterized by dysfunction of certain organs or entire systems, which can lead to the development of diseases such as orthostatic hypotension or osteoarthropathy. There are different types of visceral neuropathy among patients, the most common of which are:

• urogenital form;
• respiratory form;
• cardiovascular form;
• sudomotor form;
• gastrointestinal form.

Somatic polyneuropathy

Neurological complications affecting the functioning of the peripheral system are identified in medical circles as a disease that affects the entire body. Somatic polyneuropathy is still an incompletely studied phenomenon, since it is not possible for even the most famous scientific institutions to identify the causes of its occurrence in 25% of cases.

Causes of polyneuropathy

Diabetic polyneuropathy can appear due to various factors, the most important of which is sugar decompensation. According to recent studies, therapy aimed at reducing the concentration of this substance helps stop the development of complications. However, there are other causes of diabetic polyneuropathy, for example, poisoning with chemical compounds or drugs. Often there are cases caused by chronic intoxication (vitaminosis). The following systemic pathologies can lead to the onset of the disease:

• collagenoses;
• ischemia;
• oncological diseases;
• uremia;
• hypothyroidism;
• cirrhosis of the liver.

Classification of polyneuropathy

The disease stimulates the development of a pathological process in the body, which triggers a number of complications, ranging from paralysis of the upper limbs to autonomic disorders. Such manifestations can be divided not only by etiological factor. There is a separate classification of diabetic polyneuropathy, which includes two types - the mechanism of damage and the type of nerve fiber cell.

Each of them is divided into several subtypes, for example, according to the mechanism of damage, they distinguish between neuropathic, demyelinating or axonal disease. There are several more pathologies related to the type of nerve fiber; these include: mixed, sensory, autonomic, motor and sensorimotor. The most common is sensory diabetic polyneuropathy, which causes a weakening of vibration sensitivity.

Motor polyneuropathy

Diabetes mellitus is fertile ground for the development of many serious diseases, such as axonal motor polyneuropathy. The disease is considered a very common problem among people suffering from lesions of the peripheral system or cancer. Medicine also knows other factors that influence the development of pathology - this is a hereditary predisposition or lack of vitamin B.

Diabetic polyneuropathy is often accompanied by discomfort in the lower extremities, however, sometimes the disease also affects the hands. The skin of such patients loses its former elasticity, becomes dry and rough, as can be seen by looking at several photos on the Internet.

Sensory form of polyneuropathy

If the zone of neurons responsible for the motor functions of the body is damaged, the functioning of the motor system may be disrupted. The sensory form of diabetic polyneuropathy is considered a consequence of these complications, the main cause of which is elevated blood sugar levels. However, there are cases of other etiologies, such as neurogenic bladder or mummification of gangrenous tissue.

The most dangerous form of pathology is considered to be genetic deviations of a hereditary nature, because it is almost impossible to cure such a disease. Loss of sensation in the limbs and muscle paresis are among the main symptoms indicating the development of the disease. The patient may experience a burning, itching or tingling sensation that occurs for no apparent reason.

Distal polyneuropathy

There are several types of central nervous system lesions, such as distal or sensory-motor polyneuropathy. The first form is a very common complication that leads to the death of nerve fibers. Ultimately, the process may cause sensory loss in the lower or upper extremities, anisocoria, or strabismus. Characteristic signs of pathology include:

• muscle cramps;
• uremic itching;
• impaired pupillary reflexes;
• severe pain in the feet;
• mummification of gangrenized tissue.

The pain syndrome can reach critical conditions when the patient is unable to move or carry out other activities. During the development of a distal complication, symptoms of paresthesia are noted, covering the thighs, upper legs and even shoulders. The fingers of the lower extremities are the first to suffer, because the progression of the negative manifestations of diabetes mellitus begins with them.

Stages of diabetic polyneuropathy

Some diseases are so difficult to detect in the early stages of development that only with the help of special equipment is it possible to confirm the diagnosis. Neuropathy in diabetes mellitus has three stages of development, each of which includes certain symptoms. At first, the manifestations are completely absent, but at the second stage all the signs of the development of pathology become obvious - acute or subacute damage to some brain fibers:

• femoral;
• sciatic;
• oculomotor;
• trigeminal.

Most patients experience decreased reflexes, severe pain, burning, tingling, etc. Elderly people begin to lose weight sharply, which is also typical for patients with progressive diabetes. The third stage of the disease already requires urgent therapeutic procedures. In some cases, there is a need for surgical intervention to remove trophic ulcers or gangrene, which are initially localized on the lower extremities of the body.

Diagnosis of diabetic polyneuropathy

It will not be possible to identify the form of a complication and attribute it to a specific group of diseases without special equipment. The patient must give detailed answers regarding his state of health or make complaints regarding the functioning of organ systems. After the anamnesis, you will need to use a neurologist's kit for diagnosing diabetic neuropathy to determine blood glucose levels and perform additional procedures:

• encephalopolyneuropathy;
• study of Achilles reflexes;
• electromyography;
• EchoCG;
• general urine analysis.

How to treat neuropathy

Therapy includes an integrated approach to solving the problem after clarifying all previous measures. It is very important to determine the cause of the disease, after which treatment for polyneuropathy in diabetes mellitus can begin. Doctors prescribe glucocorticoid drugs to combat autoimmune processes in the body; in addition, patients take drugs based on potassium salts and adhere to a protein diet. All medications contain large amounts of vitamins B and C, and detoxification therapy is carried out in parallel.

Reduced blood sugar levels

There are several known methods of lowering human blood sugar levels, which are used to treat patients suffering from diabetes. Doctors recommend using not only medications to lower blood sugar, but also completely changing your diet. Food consumed during the day should exclude large amounts of easily digestible carbohydrates from entering the body. Patients are prohibited from eating foods such as pasta or potatoes. Their place should be taken by vegetables that can reduce sugar levels.

Alpha lipoic acid for diabetes

Thioctic acid is directly involved in the processes of metabolism and energy production by the body. This substance is considered the most powerful antioxidant, helps break down glucose and neutralizes the effects of free radicals. Alpha lipoic acid is sold as a dietary supplement and is used therapeutically for serious heart or liver disease. The antioxidant stimulates the processes of glucose transport, due to which their absorption occurs.

Inhibitors for diabetes mellitus

This group of substances is effectively used to treat patients suffering from hypertension. ACE inhibitors for diabetes mellitus are drugs that have a protective effect on the patient’s body. They prevent further progression of the disease, therefore they are the first choice drugs for people at any stage of diabetes. However, taking ACE inhibitors can cause negative reactions such as asymptomatic glycemia or hyperglycemia.

Nonsteroidal anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs are often used in medicine for pain relief. The medicine is considered the most effective among other therapeutic agents, however, uncontrolled use of NSAIDs for pain can cause serious adverse reactions on the part of the patient. To prevent the development of circulatory problems, doctors conduct regular examinations of the patient's condition.

Actovegin for polyneuropathy

Antioxidant drugs help normalize metabolic disorders in the nerve; over the past few years they have been used to treat diabetes mellitus. Treatment of diabetic polyneuropathy with Actovegin is an absolutely safe procedure due to the fact that the substance does not cause side effects. For several years, not a single negative precedent involving this drug has been registered; its composition includes exclusively physiological components.

Treatment of diabetic polyneuropathy of the lower extremities

Complications caused by high blood glucose levels can lead to a variety of consequences; one of the most common cases is diabetic neuropathy of the lower extremities. With such a diagnosis, complex treatment is necessary, which will consist of medicinal and non-medicinal components. To normalize sugar levels, doctors prescribe a special diet, including taking special medications.

Treatment of polyneuropathy of the lower extremities with folk remedies

Drug therapy, with the approval of a doctor, can be supported by traditional methods of treatment as additional procedures. There are several effective recipes, some of which are intended for internal use, while others are exclusively for external application. The most extreme is considered to be trampling on the leaves and stems of nettles with bare feet. Treatment of polyneuropathy with folk home remedies can only be used under the supervision of a specialist.

Prevention of polyneuropathy

The appearance of hereditary diseases cannot be prevented, however, in all other cases, the prevention of diabetic neuropathy is an important therapeutic measure. The main points of treatment are aimed at eliminating the causes of the disease. To achieve a favorable prognosis, the patient must adhere to a special diet and lead an active lifestyle, which includes playing sports or gymnastics.

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The main type of peripheral nerve damage in the patients we observed was distal polyneuropathy, which was detected in 831 (63.9%) of 1300 patients. All these patients had distal polyneuropathy with damage to the nerves of the lower extremities and in 375 of them (45.1%) also the upper extremities. Of the patients with distal polyneuropathy of the lower extremities, it was mild in 28.5%, moderate in 43.7% and severe in 27.8% of patients. Accordingly, for distal polyneuropathy of the upper extremities these figures were 71.4, 23.8 and 4.8%.

Symptoms of distal polyneuropathy. To analyze the frequency and severity of individual symptoms of distal polyneuropathy, we selected 130 patients aged 10-65 years who did not have diseases of the peripheral nervous system before the diagnosis of diabetes.

Among the subjective disorders observed in the patients we observed, the most common symptom was pain. These were mainly dull, diffuse, nagging pains in symmetrical areas of the limbs. In some patients they were so strong that they disturbed night sleep. In 68 patients, the pain intensified at rest, and in 32 when walking. Often the pain intensified at rest after a long walk. In 85 patients, pain was localized in the legs, in 53 in the feet, in 26 in the hips, in 5 in the hands, in 13 in the forearm and in 10 in the shoulder area.

Paresthesia was also common, which manifested itself as a feeling of tingling, “crawling”, numbness, chilliness, “buzzing” and burning. A burning sensation, mainly in the feet, was reported by 12.3% of patients (in addition, during a detailed survey, such a sensation could be identified in some other patients, but it was mild, inconsistent and did not bother them much). If this symptom was present, patients preferred not to cover their feet at night and touched cold objects with their soles. Sometimes the burning sensation intensified when touching the underwear, which forced such patients to bandage their legs, because even the touch of silk underwear caused a feeling “as if their legs were being cut.” These sensations intensified in damp weather. Paresthesia was more often localized in symmetrical areas of the feet and legs and only in 3.1% of patients in the hands.

Patients with dysesthesia complained that they walked as if they were “on rubber soles”, that they had “cotton or wooden legs”, that their soles were “dressed with fur” or “sand was poured”, etc.

A feeling of weakness and heaviness in the lower extremities (and in some also in the upper extremities) was noted by 24 patients, although the study revealed a decrease in strength in 16 of them. During the period of severe decompensation of diabetes mellitus, the frequency of these disorders increased significantly.

In 92 patients, muscle soreness was detected, although a number of them had no spontaneous pain in these muscles. Soreness of the lower leg muscles was observed in 90 patients, thigh muscles in 68, forearm muscles in 41 and shoulder muscles in 37 patients. In 24 patients, this pain was somewhat more pronounced along the nerve trunks (mainly the sciatic nerve). However, more often it was diffuse muscle soreness.

A number of diabetic patients, as well as healthy individuals, experience pain on palpation (especially deep) in the area of ​​the inner surface of the upper half of the leg (medial head of the gastrocnemius muscle and medial part of the soleus muscle), probably due to the neurovascular bundle passing here (tibialis nerve and its branches, posterior tibial artery and its branches). This pain is especially clearly noted when percussed with a neurological hammer. That is why, when diagnosing distal polyneuropathy and neuromyalgia (with decompensation of diabetes), we take into account only diffuse pain in the triceps surae muscle. The indicated soreness of the latter in distal polyneuropathy is usually much stronger than the soreness of the thigh muscles, which can be used in the diagnosis of this polyneuropathy.

When studying Lasegue's symptom, 36.8% in the first phase had pain in the popliteal region, in the calf muscles or along the entire back of the thigh. However, usually the pain did not spread along the sciatic nerve and pain did not occur in the lumbar region. Thus, this symptom was mainly associated with stretching of painful muscles.

The data presented show that irritative pain syndrome, including pain, paresthesia, dysesthesia, soreness of muscles and nerve trunks, is often observed with distal polyneuropathy. This syndrome should be distinguished from neuromyalgia during the period of decompensation of diabetes. The latter form of pathology is known in the literature as “hyperglycemic neuritis” or “hyperglycemic neuralgia”. From our point of view, it is more correct to designate this form as “neuromyalgia with decompensated diabetes” (or “neuromyalgia” for short). For hyperglycemia, as is known, is the most characteristic sign of diabetes mellitus, and this type of neurological pathology occurs only in some patients and only during the period of severe decompensation of diabetes. In addition, clinical symptoms (diffuse pain and muscle soreness) are typical for neuromyalgia, and not for neuralgia or neuritis.

As our observations have shown, in patients with diabetes under the age of 12 years (and especially under the age of 7 years), despite the severe course of diabetes, neuromyalgia during the period of decompensation of diabetes was observed much less frequently than in patients who developed diabetes at an older age. Thus, out of 139 patients who developed diabetes before the age of 12 years and who had no signs of distal polyneuropathy, this neuromyalgia was observed only in 14 (10.8%) patients and, as a rule, was mildly expressed. Among patients who developed diabetes at an older age, this neuromyalgia was observed 4-6 times more often. We will discuss the possible reasons for this difference below.

Often the occurrence of neuromyalgia in patients with short-term diabetes causes an erroneous diagnosis of “diabetic polyneuritis” or “neuropathy”, and with its disappearance when diabetes is compensated, they write about “remission of polyneuritis”. When carrying out differential diagnosis, it is necessary to take into account that the specified neuromyalgia, in contrast to the irritative pain syndrome with distal polyneuropathy, occurs only during the period of severe decompensation of diabetes, the pain with it is not accompanied by paresthesia and is usually diffuse in nature, covering, in addition to the upper and lower extremities, also and trunk muscles and, finally, neuromyalgia quickly disappears when diabetes is compensated.

With distal polyneuropathy, vibration sensitivity often suffers, as many authors point out. We determined the perception of vibration intensity and duration using a tuning fork according to the method of S. V. Babenkova. The perception of vibration intensity was studied in all 130 patients with distal polyneuropathy, and the perception of vibration duration in 83 of them (under the age of 55 years), as well as in 15 diabetic patients without signs of distal polyneuropathy, and in 22 healthy subjects.

In general, in patients with diabetes, the perception of vibration duration in the lower and upper extremities was significantly reduced compared to healthy subjects. In patients without signs of peripheral nerve damage, the perception of vibration duration was even slightly greater than in the control group. In patients with irritative pain syndrome in the absence of impairment of superficial types of sensitivity and reflex disorders, compared with patients who did not have signs of damage to the peripheral nerves, a significant shortening of the perception of vibration duration was revealed. The shortening of vibration duration increases somewhat in patients with irritative pain syndrome and decreased knee and Achilles reflexes. In patients with decreased knee and Achilles reflexes and hyperesthesia of the feet, a further decrease in vibration sensitivity occurs. The minimal perception of vibration duration was observed in patients with decreased knee and Achilles reflexes and “sock-type” hypoesthesia. In 12 (out of 83) patients, loss of vibration sensitivity was noted on the ankles and lower legs, but in none of these cases anesthesia was observed, but only hypoesthesia of superficial types of sensitivity. Individual analysis showed that the state of vibration sensitivity in people who developed diabetes before the age of 12 differs from that observed with a later onset of the disease.

Similar data were obtained when assessing the sensation of vibration intensity in patients. It turned out that in patients, the perception of vibration intensity first of all decreases and, secondly, its duration.

The analysis revealed a certain parallelism in the disturbance of vibration sensitivity in the upper and lower extremities. However, this disorder was mostly in the lower extremities.

Thus, only on the lower extremities was there a loss of vibration sensitivity.

Asymmetrical (but not unilateral) impairment of vibration sensitivity was observed in 1/3 of patients on the lower and 1/2 of patients on the upper extremities.

The following observations are also of interest. In 4 out of 12 patients with loss of vibration sensitivity in the lower extremities, during rapid repeated examinations with a tuning fork, a sensation of vibration arose after 2-8 irritations, which disappeared again when the examination was continued after 4-15 irritations. Apparently, in these 4 patients, compared to the other 8, there was less significant damage to vibration sensitivity.

The data presented indicate that a decrease in vibration sensitivity in diabetic patients aged 20-55 years (with the exception of those with diabetes under the age of 12 years) is one of the early objective signs of damage to peripheral nerves, which can be used to diagnose the presence and severity of distal polyneuropathy. The latter does not apply to patients over 55-60 years of age, who usually have age-related hypopallesthesia.

Often, with distal polyneuropathy, pain sensitivity also suffers. Of the 82 patients with a violation of this type of sensitivity, the majority of patients (58) had hyperalgesia, and 24 had hypalgesia (of which 5 had analgesia). The decrease in heat and cold sensitivity usually occurred in parallel. Of the 46 patients with tactile hypoesthesia, in 11 it reached the level of anesthesia.

Our studies have shown that a violation of superficial sensitivity on the dorsum of the foot (which is innervated by the cutaneous branches of the peroneal nerve) occurs earlier and grows stronger than on the plantar surface of the foot (primarily in its middle third, where there is usually no callus of the skin), which is innervated by the cutaneous branches of the tibial nerve. nerve. We compared the state of sensitivity on the dorsum and plantar surfaces of the feet in 177 patients with moderate and severe forms of diabetes aged from 8 to 73 years and with a duration of diabetes from 1 year to 33 years. These patients did not have diseases of the peripheral nervous system of a non-diabetic nature and there was no pronounced callus of the skin of the soles. Hypoesthesia on the dorsum of the feet was present in 69 patients, of whom sensitivity on the plantar surface of the feet was preserved in 7 (10.2%), increased in 52 (75.3%) and decreased in 10 (14.5%).

If patients with hyperesthesia on the soles of the feet were characterized by complaints like: “sand is poured on the sole,” then for patients with hypoesthesia of the soles these complaints were different: “I walk as if on cotton wool,” “I can’t feel the soil under my feet,” and “I could fall.” , especially at night". Among the 10 patients with such hypoesthesia, there were mainly people over 50 years of age, with a severe form of diabetes, with a diabetes duration of more than 15 years, with severe microangiopathy (which caused practical blindness in 4), as well as severe macroangiopathy of the lower extremities (2 patients previously had gangrene toes of one of the feet). Of these, there were 3 women and 7 men (among the entire group of 177 patients there were 99 women and 78 men), which indicates a significant predominance of men among patients with hypoesthesia of the soles of the feet. During follow-up of 6 of these 10 patients, it was found that hypoesthesia on the soles of the feet occurs several years after its appearance on the dorsum of the feet. The above observations indicate that although the literature often indicates the presence of “sock” and “stocking” type hypoesthesia within the framework of distal polyneuropathy, in many such cases hypoesthesia is present only on the dorsum of the foot, and apparently absent on the sole. The same applies, as we believe, to other, in our terminology, “distal polyneuropathies”: senile, atherosclerotic, hypertensive, intoxication, etc.

The question of the state of touch in patients with diabetic distal polyneuropathy is most important in the group of patients with a sharp decrease in vision, since as a result of impaired sense of touch, the ability of such patients to self-care is significantly limited, and the ability to read using the Braille method is also reduced. As is known, tactile sensitivity occupies the main place in the formation of the sense of touch, and the most common method for studying the acuity of touch is determining the discrimination threshold using a Weber compass.

The analysis showed that out of 85 patients with moderate and severe impairments of discriminatory sensitivity, persons over 40 years of age with diabetes duration of more than 10 years and with severe distal polyneuropathy of the lower extremities predominated. In patients with the childhood type of development of distal polyneuropathy, this disorder arose, all other things being equal (duration and severity of diabetes, the presence of microangiopathy, etc.), noticeably later than in patients with the adult type of development of distal polyneuropathy.

Of the 22 patients who lost their vision, 20 showed a violation of discriminatory sensitivity, but only in 7 it turned out to be pronounced. These data are of interest due to the fact that the presence of a moderate impairment of discriminatory sensitivity did not interfere with learning to read using the Braille method in our patients. True, some of these patients had to repeatedly moisten their fingers when reading in order to better perceive the tattoos, while others had to avoid taking on “rough” home work, since after it it was difficult for them to “distinguish” the letters for several days.

Less frequently than other types of sensitivity, the muscular-articular sense suffered, which in 9 patients manifested itself in poor recognition of small movements of the toes, and only in 3 patients there was a more pronounced decrease.

Violation of these types of sensitivity was observed much more often and to a more pronounced degree in the lower extremities than in the upper extremities and was mainly distributed according to the polyneuritic (distal) type in the form of “socks” and “gloves”, spreading in cases of moderate and especially severe polyneuropathy to the level knee and elbow joints, and in some patients to the level of the hip and shoulder joints. At the same time, the maximum frequency and severity of these disorders was on the feet. Only in 25 out of 109 patients the zones of sensory impairment had a “spotty” appearance. In 1/3 of the patients, clear asymmetries (but not one-sidedness) were noted in the severity of sensory disorders.

Thus, sensory disturbances in patients with distal polyneuropathy are manifested by a combination of symptoms of irritation and loss. Symptoms of irritation usually occur first, followed by loss. The latter, in particular, is the reason that with the long-term existence of distal polyneuropathy, the severity of the pain syndrome, despite the increase in the objective symptoms of this polyneuropathy, decreases.

21 patients had motor disorders. Of these, 11 had foot paresis. Only in 4 patients did this paresis reach a pronounced degree. A decrease in strength in the proximal parts of the extremities was detected in 14 patients, and wasting and atrophy of these parts were found in 3 patients. This type of atrophy, in contrast to proximal amyotrophy, was diffuse, symmetrical with simultaneous atrophy of the distal muscles. It is characteristic of long-term diabetes in elderly and senile patients who have both pronounced macroangiopathy of the lower extremities and pronounced distal polyneuropathy. Thin legs in these patients are often combined with obesity in the torso. Atrophy affects the muscles of the thigh, lower leg and feet. There is no pulsation of the arteries of the feet. The skin of the feet and legs is atrophic, has a “varnished” appearance, atrophic pigment spots on the legs, trophic changes in the nails. Achilles and knee reflexes are absent. Hypoesthesia of the distal type. Increased leg fatigue when walking, without alternating lameness.

At the same time, the ischemic type of amyotrophy in its “pure” form is observed in elderly and senile patients with short-term diabetes, who have severe obliterating atherosclerosis of the vessels of the lower extremities and manifests itself in the same way as in patients who do not suffer from diabetes.

Amyotrophy in distal diabetic polyneuropathy is usually moderate and is mainly limited to the muscles of the distal lower extremities. Atrophy of the muscles of the distal parts of the upper extremities is observed less frequently and to a less pronounced degree than the lower ones, as evidenced not only by our observations, but also by the data of other authors. Thus, in 1968, M. Ellenberg, using significant clinical material among diabetic patients over the age of 60, revealed symmetrical atrophy of the hand muscles in only 24 patients. Of our 6520 patients, we observed similar atrophy in only 19 patients.

Finally, we should dwell on the type of diffuse amyotrophy, which was often observed in the pre-insulin era, and is now extremely rare. This type can be designated as "cachectic". It is associated with severe uncompensated diabetes, leading to severe exhaustion of the patient. Apparently, “neuropathic cachexia” should also be classified as this type, although the role of the neurogenic factor in this cachexia is not clear to us. This also includes amyotrophy with senile exhaustion.

Thus, the following four types of diabetic amyotrophy of the limbs can be distinguished: 1) distal (neuropathic), 2) proximal, 3) ischemic-neuropathic, A) cachectic.

A number of patients showed significant density and some increase in the volume of the muscles of the lower extremities and especially the calf muscles. Particularly dramatic muscle hypertrophy was observed in women with “hypermuscular lipodystrophy syndrome.” Of the 14 such patients we examined, who also suffered from diabetes mellitus, 6 showed signs of distal polyneuropathy. However, we excluded them from the analysis due to the presence of “secondary” diabetes.

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Causes of diabetic polyneuropathy

The human peripheral nervous system is divided into two sections: somatic and autonomic. The somatic nervous system allows a person to consciously control his body. The autonomic system is responsible for the autonomous functioning of internal organs and systems: respiratory, circulatory, digestive systems, etc.

With polyneuropathy, both nervous systems are affected. If the functioning of the somatic system is disrupted, a person begins to experience severe pain, and autonomic polyneuropathy can threaten a person’s life. The insidiousness of the disease is that in the initial stages it is practically invisible. Therefore, during routine examinations it is necessary to be examined by a neurologist.

The pathogenesis of neuropathy is explained by high blood sugar levels. With constant hyperglycemia, metabolism in the nerves is disrupted, oxygen starvation occurs in the nerve endings, and the first symptoms of the disease appear. The disease at the initial stage has a good prognosis: if blood sugar levels are maintained at normal levels, the nerves will begin to recover and the symptoms of polyneuropathy will disappear.

Polyneuropathy in diabetes mellitus manifests itself in a variety of symptoms, since the pathology involves two human nervous systems. According to the quality of manifestation, symptoms are divided into active and “passive”.

Active symptoms include sharp and intense discomfort:

1. Burning sensation.
2. Acute pain.
3. Tingling.
4. Too much pain sensitivity.
5. Feeling pain from a simple touch.

“Passive” stimuli include stiffness of the limbs, numbness, “death” of tissue and unsteadiness of gait.

In addition, diabetic polyneuropathy causes a number of other symptoms:

1. Diarrhea.
2. In men - erectile dysfunction, in women - anorgasmia.
3. Urinary incontinence.
4. Flabbiness of the skin and muscles of the face.
5. Deterioration of vision.
6. Cramps.
7. Dizziness.
8. Speech impairment.
9. Impaired swallowing reflexes.

Sensory-motor polyneuropathy (distal)

In diabetes, long nerve fibers, such as those that run to the lower extremities, are most affected. Diabetic distal polyneuropathy occurs in 40% of patients with diabetes. Sensory-motor polyneuropathy is characterized by the following symptoms: a person completely loses the ability to feel pressure, temperature changes, pain, position relative to other objects, vibration.

The danger of sensory-motor neuropathy is that a person with diabetes may injure their foot and not notice it, or not feel the water in the bath is too hot. Wounds and ulcers begin to appear on the patient’s legs, and fractures or joint damage may occur. Sensorimotor polyneuropathy can manifest itself as active symptoms - severe acute pain in the lower extremities, which worsens at night.

Further development of distal polyneuropathy is accompanied by disturbances in the functioning of the musculoskeletal system, bones are deformed, and muscle dystrophy occurs. Excessive dryness of the skin is observed, sweat glands stop working, the skin takes on a reddish tint, and age spots appear.

Serious symptoms of diabetic distal polyneuropathy are ulcers that form on the soles of the feet and between the toes. Ulcers do not cause discomfort due to loss of pain sensitivity, but the occurrence of inflammatory processes may require amputation of the limbs.

Autonomic diabetic polyneuropathy

If the autonomic nervous system is damaged due to diabetes, a person may experience dizziness, darkening of the eyes, and fainting when standing up. With this form of polyneuropathy, the functioning of the digestive system is disrupted, the flow of food into the intestines slows down, which makes it much more difficult to stabilize blood sugar levels.

Of particular concern is abnormal heart rhythms in diabetic polyneuropathy, which can lead to sudden death.

The disease affects the genitourinary system, causing problems such as urinary incontinence. The bladder may not empty completely, which further increases the risk of infection. In men with the autonomic form of polyneuropathy, erectile dysfunction may be observed, and in women, dyspareunia (sexual dysfunction in which a woman does not experience orgasm).

Treatment of diabetic polyneuropathy

With early diagnosis of diabetes complications, you can expect complete disappearance of neuropathy symptoms. Treatment of diabetic polyneuropathy is carried out comprehensively, targeting both the cause and symptoms of the disease.

1. B vitamins (B1,B2,B6,B12) help reduce the negative impact of sugar on nerve fibers and improve the passage of impulses along nerve pathways.
2. Alpha lipoic acid removes excess glucose from nerve fibers and, with the help of enzymes, restores damaged nerve cells.
3. A special group of drugs is prescribed (Olrestatin, Sorbinil, Olredaza, Tolrestat) that interfere with the synthesis of glucose and reduce its negative impact on nerve fibers.
4. Non-steroidal anti-inflammatory drugs (Ibuprofen, Diclofenac) are used to relieve pain.
5. To relieve cramps and numbness, medications containing calcium and potassium are prescribed.
6. If you have leg ulcers, a course of antibiotics may be prescribed.

Polyneuropathy: treatment with folk remedies

Success in the treatment of polyneuropathy depends not only on correctly selected drugs, but also on compliance with rules that significantly reduce the risk of complications in diabetes. Patients with diabetes should constantly monitor their blood sugar levels, body weight, as well as follow a diet and lead an active lifestyle.

Folk remedies that are used in addition to drug treatment help treat polyneuropathy.

The following decoction helps maintain normal blood sugar levels: put crushed bay leaves (1 tbsp) in a thermos. Add 3 tbsp. fenugreek (seeds), pour 1 liter of boiling water and leave for a couple of hours. Take the infusion throughout the day.

For distal polyneuropathy, it is useful to rub your feet with wild rosemary tincture. Pour half a glass of wild rosemary with 500 ml of vinegar (9%) and leave for 10 days. The finished infusion is used diluted in a 1:1 ratio. The composition should be rubbed into the feet 3 times a day.

Fresh St. John's wort herb is poured with hot vegetable oil. Insist for 3 weeks. Then filter the oil and add 1 tbsp. chopped ginger root. This oil is used for massage of the upper and lower extremities and for wraps.

With polyneuropathy, the nerve fibers suffer from a lack of vitamins and other nutrients. The following cocktail will help saturate the nerve fibers: add 2 tbsp to a glass of kefir. peeled crushed sunflower seeds and finely chopped parsley. Take the cocktail in the morning half an hour before meals.

Alcoholic polyneuropathy has similar symptoms to diabetic ones. The disease develops after prolonged alcohol dependence. Alcoholic polyneuropathy is treated with the following composition: add a few tsp to half a glass of freshly squeezed carrot juice. honey, olive oil and one egg. The drink should be taken 2 times a day 1-2 hours before meals.

Milk thistle, mint and olive oil are used to cleanse the liver for alcoholic polyneuropathy. Grind the milk thistle seeds, pour in heated olive oil (150 ml) and add 2 tbsp. finely chopped dry mint leaves.

Trampling on nettles is considered a very old and effective method of treating polyneuropathy. Place the stems of stinging nettle on the floor and trample on them for 10-15 minutes.

It is useful to take warm baths for sore limbs. Pour 100 g of chopped sage leaves, oregano, motherwort, stems and leaves of Jerusalem artichoke into a bowl. Pour 3 liters of boiling water and let it brew for one hour. The duration of the procedure is 15-20 minutes. If you don’t have medicinal herbs on hand, make a warm foot bath, and then smear your feet with ointment containing bee or snake venom.

For diabetic polyneuropathy, it is better to replace potatoes with Jerusalem artichoke. Jerusalem artichoke helps stabilize blood sugar levels, improves the functioning of the digestive system and speeds up metabolism.

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Causes

The development of the disease is associated with a chronic hyperglycemic state, lack of insulin (absolute or relative), and microcirculation disorders in peripheral nerves. Damage to nerve axons usually develops, but segmental demyelination may also occur. The combination of polyneuropathy and angiopathy of the extremities is the leading cause of trophic disorders in diabetes mellitus, in particular the cause of the development of diabetic foot.

Classification

Based on the type of manifestations and localization of symptoms, the following forms of diabetic polyneuropathies are distinguished:

• Proximal symmetrical polyneuropathy (amyotrophy).
• Asymmetrical proximal neuropathy of large nerves (usually femoral, sciatic or median).
• Neuropathies of the cranial nerves.
• Asymptomatic polyneuropathies.
• Distal types of polyneuropathy.

Distal polyneuropathy is the most common type of diabetic polyneuropathy. It accounts for more than 70% of all types of this disease. The word distal indicates damage to parts of the extremities remote from the body (hands, feet). The lower extremities are more quickly affected. Depending on the nature of the lesion, the following forms are distinguished:

• Sensory.
• Motor.
• Vegetative.
• Mixed (sensorimotor, motor-sensory-vegetative, sensory-vegetative).

Symptoms

The clinical picture of the disease depends on the form of polyneuropathy, the degree of nerve damage, and blood sugar levels.

• Proximal polyneuropathies are characterized, first of all, by the development of impaired muscle trophism, weight loss of the entire limb, and a decrease in its strength. Autonomic and sensory functions are affected to a lesser extent.
• Diabetic cranial nerve neuropathies vary depending on the extent of the individual pair's involvement. Thus, the most common lesion is the oculomotor nerve, which often manifests itself in the form of acutely developing painful ophthalmoplegia. Damage to the optic nerve is characterized by a pronounced decrease in vision, blurred vision, and impaired twilight vision. Less commonly, the trigeminal, trochlear, and facial nerves are affected. The most common cause of cranial nerve damage is acute ischemia, and timely therapy usually leads to good results.
• Asymptomatic polyneuropathies are usually discovered incidentally during a routine neurological examination. They manifest themselves as a decrease in tendon reflexes, most often knee reflexes.
• Distal forms of polyneuropathy usually manifest themselves quite clearly. Thus, the presence of sensory disorders manifests itself in the presence of a crawling sensation in the patient, a painful burning sensation, and numbness in the limb. A person may also notice a pronounced disturbance of sensitivity, may notice a feeling of “walking on a pillow”, in which he does not feel support and his gait is disturbed. In the distal form of diabetic polyneuropathy of the lower extremities, painful cramps often develop. Gait disturbances can lead to the development of foot deformities and, subsequently, the development of diabetic foot.

Autonomic disorders can lead to the development of tachycardia, hypotensive orthostatic reactions, dysfunction of the intestines and bladder, decreased potency, and impaired sweating. The risk of sudden cardiac death also increases.

Motor disturbances in the distal form of polyneuropathy are rare, especially in the isolated form. They are characterized by the development of hypotrophy of distal muscle groups and a decrease in their strength.

Diagnostics

Diagnosis of the disease is based on the clinical picture, neurological examination and documented fact of the presence of diabetes mellitus for a long time. In difficult situations, it is possible to conduct an ENMG study and additional consultation with an endocrinologist.

Treatment

Treatment of diabetic polyneuropathy should be comprehensive and carried out jointly with an endocrinologist and therapist. The first thing you need to do is control your blood sugar levels. It is also imperative to exclude the presence of micro- and macroangiopathies and, if necessary, carry out appropriate treatment.


To relieve neurological manifestations, thioctic (alpha-lipoic) acid preparations (berlition and its analogues) are most widely used. Drug therapy is carried out in adequate dosage (the initial dose should be at least 300 mg per day) and in long courses (at least 1.5 months). B vitamins are also widely used.

If painful cramps are present, muscle relaxants and anticonvulsants can be used. In case of severe pain, symptomatic treatment with NSAIDs and other analgesics can be resorted to.

Exercise therapy, physiotherapy, and massage play an important role in the treatment of diabetic polyneuropathy. If there are signs of foot deformation, orthopedic selection of insoles and shoes is necessary. In all cases, the most important role is played by careful skin care and prevention of microdamage.

neurosys.ru

Distal polyneuropathy is one of the types of polyneuropathy. This is a disease that is characterized by the process of death of nerve fibers, which, in turn, entails the loss of all sensitivity and the further development of foot ulcers. This disease is the most common complication that develops in diabetes mellitus, which significantly reduces the patient’s performance and, in general, threatens his life and health.

The main type of damage to nerve fibers in patients with diabetes is the so-called distal polyneuropathy. With this type of polyneuropathy, in most cases the lower and occasionally the upper extremities are affected.

The most common symptom of distal polyneuropathy is pain. Usually these are nagging and dull pains. Sometimes the pain reaches such a level that it prevents you from sleeping at night. The pain becomes stronger when the patient is at rest, but can also be observed during prolonged walking. Quite often, paresthesias make themselves felt, which manifest themselves in the form of numbness, a sensation of “crawling goosebumps,” tingling, chilliness, or, conversely, burning. You feel heaviness and even weakness in your legs.

The shoulders, forearms and upper legs – thighs – may also hurt. Pain can be felt when palpating the upper part of the leg - this is one of the main symptoms when diagnosing dangerous distal polyneuropathy. In the absence of appropriate treatment, the pathology becomes increasingly serious.

The initial signs of diabetic distal neuropathy manifest themselves in the fingers of the lower extremities; as the process develops, similar symptoms of deterioration in sensitivity make themselves felt in the fingers of the upper extremities. The disease rarely begins to develop from the distal parts of the arms.

With distal polyneuropathy, thin and sometimes thick nerve fibers are usually affected. If thin fibers are affected to a greater extent, the disease is characterized by a significant decrease in temperature and pain sensitivity. In case of damage to thick fibers, tactile sensitivity is partially lost or even completely lost. Signs of diabetic distal neuropathy are observed in approximately 40% of people with diabetes, approximately half of these individuals complain of pain.

Further development of distal polyneuropathy can lead to serious disorders of the musculoskeletal system - weakness in the lower extremities and muscle atrophy. The patient's sweating process noticeably worsens, and the skin becomes drier. Typical bone deformities are acquired.

The color of the skin also changes slightly, acquiring a bright pink, even reddish tint, and symmetrical areas of pigmentation appear on the lower part of the lower leg and the back of the foot. Nails can atrophy or, conversely, may become deformed.

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As a result, osteoarthropathy develops, which is characterized by flat feet, both transverse and longitudinal, increased ankle deformity, as well as an increase in the size of the foot in the transverse dimension. Such changes observed in the foot can be either unilateral or bilateral.

Prolonged pressure in the area of ​​bone deformities ultimately inevitably leads to the development of neuropathic ulcers, usually on the outside of the foot and between the toes. Such ulcers do not cause pain for some period of time due to partially lost sensitivity, and only the development of the inflammatory process draws attention to this defect.

In this regard, early diagnosis of distal polyneuropathy is especially important - this reduces the risk of developing a foot ulcer and even possible amputation of the lower limb. Unfortunately, no standard has yet been established for determining neuropathic abnormalities in a patient suffering from diabetes.

To make a diagnosis of distal polyneuropathy, it is sufficient to identify the following criteria, according to the scale of symptoms and signs. These include moderate signs without or with symptoms and minor signs with moderate symptoms.

To more accurately determine the severity of clinical manifestations, it is necessary to conduct an additional neurological examination for the presence of sensorimotor disorders. This examination includes a detailed study of absolutely all types of sensitivity and determination of reflexes.

The main reason for the progressive development of distal neuropathy is, first of all, the presence of large amounts of glucose. In this regard, the most effective method of treating the disease, which allows you to reverse the process, is constant monitoring of blood glucose levels. In addition, it is necessary to carry out symptomatic treatment, which is important in relieving pain.