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

Diagnosis and treatment of diabetic polyneuropathy should be carried out as soon as possible, since negative consequences are possible, as a result of which a person will lose the ability to work and become disabled.

What is the essence of the problem?

More than half of patients diagnosed with diabetes mellitus suffer from the development of various types of polyneuropathy. In this case, a 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 has dysfunction in various body systems. Mostly, polyneuropathy of the upper or lower extremities is diagnosed, which occurs after several years of diabetes mellitus. 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 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 or upper extremities is manifested by impaired sensitivity to external factors that irritate the nervous system. The symmetrical sensorimotor form of the deviation includes the symptoms of both previous types of the disease.

If the peripheral nervous system is damaged in a diabetic, then polyneuropathy can be of 2 types:

Autonomous. With this type of disease, the autonomous system (AS) is affected, due to which the patient dies in most cases.
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:

Genesis of pathology: why does it develop?

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

Symptoms that signal a problem

Each patient has different symptoms of diabetic polyneuropathy, depending on the severity of the disorder. The table shows the degree of the pathological process and the features of the course:

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

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

sensitive symptom. It includes aching, cutting and stabbing pains that appear at different times of the day. The patient's sensitivity is disturbed, and he does not feel temperature changes or vibrations.
Motor. There is constant muscle weakness in the legs or arms, reflexes disappear, the patient is worried about diabetic tremor and cramps in the calves.
Vegetative. Tachycardia develops and blood pressure decreases with a sharp change in body position. The patient is haunted by disturbed 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 are the diagnostic procedures?

If a diabetic has found at least a few signs of diabetic polyneuropathy, then you should immediately see a doctor. The latter will analyze the received complaints and examine the patient. It is important to find out if there is a tendon reflex, 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 lipoproteins;
measurement of glucose levels in blood fluid and urine;
laboratory study 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 of DP with traditional means is often supplemented with drugs of natural origin. It is important to understand that an unconventional treatment method alone will not bring any result, 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 wild rose are used to prepare a medicinal infusion.

Bay leaf and fenugreek. The components are taken in a ratio of 1: 3, mixed, poured with boiling water and infused for 2 hours. Drink the decoction throughout the day as a tea.
Oat seeds, flax seeds, beans and blueberry leaves. All products are crushed and mixed. For 2 st. 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 pass, it is necessary to use the remedy three times a day, 150 ml each.
Hawthorn and wild rose. 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 stalks, which are walked for 10 minutes daily, will help normalize blood circulation and improve the sensitivity of the legs.

Effective drugs

For the treatment of diabetic polyneuropathy, pharmaceutical drugs 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

In pathology, different therapeutic methods are used depending on the severity of DP. If the legs are damaged, then they should be warmed up with a massage and warm socks. But in no case is a heating pad or a hot bath used. And also physiotherapy for diabetic polyneuropathy includes the following procedures:

Forecast and prevention

If diabetic polyneuropathy is diagnosed at an early stage, then it can be completely eliminated. Untimely 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 for more than 5 years should be regularly examined. It is also worth carefully monitoring the condition of the lower and upper limbs, and if there are wounds or injuries, seek help. It is worth keeping your blood glucose levels under control every day and moving more. Important in the prevention of diabetic polyneuropathy is the intake of multivitamins, which contain vitamins A, B, C, E.

Diabetic polyneuropathy: symptoms, classification and directions of treatment

Diabetic polyneuropathy is a complex of diseases of the nervous system that occur slowly and result from an excess amount of 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, an increased level of sugar in the blood begins to inhibit the vital processes of the whole organism. Suffer not only the kidneys, liver, blood vessels, but also peripheral nerves, which is manifested by a variety of symptoms of damage to the nervous system. Due to fluctuations in the level of glucose in the blood, the functioning of the autonomic and autonomic nervous system is disrupted, which is manifested by difficulty in breathing, heart rhythm disturbance, and dizziness.

Diabetic polyneuropathy occurs in almost all diabetic patients, it is diagnosed in 70% of cases. Most often, it is detected in the later stages, however, with regular preventive examinations and an attentive attitude to the state 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 a violation of the sensitivity of the skin and pain, more often occurring at night.

The mechanism of development of metabolic disorders in diabetes mellitus

Due to excess blood sugar, 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.
Violation of fructose metabolism leads to excessive production of glucose, which accumulates in a large volume and disrupts the osmolarity of the intracellular space. This, in turn, provokes swelling of the nervous tissue and impaired conduction between neurons.
The 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 and the absolute violation of the impulse conduction process are reduced.

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 of damage to large nerve fibers.

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

numbness of the lower and upper limbs;
tingling and burning sensation in the limbs;
loss of sensitivity of the skin to temperature fluctuations;
chills of the limbs;
redness of the skin of the feet;
swelling in the feet;
pain that disturbs 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:

imbalance;
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;
stool disorders;
general muscle weakness;
decreased visual acuity;
convulsive syndrome;
sagging skin and muscles around the face and neck;
speech disorders;
dizziness;
violations of the swallowing reflex;
sexual disorders: anorgasmia in women, erectile dysfunction in men.

Classification

Depending on the localization 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 has suffered the most as a result of metabolic disorders.

The following types of diseases are distinguished:

The defeat of 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 of the motor form;

Diabetic polyneuropathy of the sensory form;

Diabetic polyneuropathy of sensorimotor mixed form.

Defeat of the conducting nerve pathways, leading to the development of diabetic mononeuropathy.

Diabetic polyneuropathy that occurs when the autonomic nervous system is affected:

Diabetic alcoholic polyneuropathy is also distinguished, which develops against the background of regular alcohol consumption. It is also manifested by a burning and tingling sensation, 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.
Lumbar-thoracic 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 about 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 skin tone;
disruption of the sweat glands;
insensitivity to temperature fluctuations;
lack of pain threshold;
the inability to feel the change in the position of the body in space and vibration.

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

All this further leads to disruption of the musculoskeletal system, muscular dystrophy, 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 disturbances are observed 5-7 years after the diagnosis of diabetes mellitus. The sensory form differs from other forms of dibetic polyneuropathy in specific pronounced symptoms:

resistant parasthesia;
feeling of numbness of the skin;
sensitivity disorders in any modality;
symmetrical pain sensations in the lower extremities that occur at night.

Autonomic diabetic polyneuropathy.

The cause of vegetative disorders is an excess of sugar in the blood - a person experiences fatigue, apathy, headache, dizziness, tachycardia attacks, increased sweating, darkening of 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. Cardiac arrhythmias, often associated with autonomic diabetic polyneuropathy, can be fatal due to sudden cardiac arrest.

Treatment: main directions of therapy

The treatment of diabetes is always complex and aims to control blood sugar levels, as well as neutralize the symptoms of diseases that are secondary. Modern combined drugs affect not only metabolic disorders, but also concomitant diseases. Initially, you need to normalize the level of sugar - 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.
Reception of vitamin complexes, necessarily containing vitamin E, which improves the conductivity of nerve fibers and neutralizes the negative effects of high blood sugar concentrations.
Taking vitamins of group B, which have a beneficial effect on the functioning of the nervous system and the musculoskeletal system.
The intake of 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, which neutralize pain in the limbs.
Taking antibiotics, which may be needed in case of infection of ulcerative formations on the legs.
The appointment of magnesium preparations for convulsions, as well as muscle relaxants for spasms.
The appointment of drugs that correct the heart rhythm, with persistent tachycardia.
Prescribing a minimum dose of antidepressants.
Appointment of actovegin - 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 medical therapy and compliance with 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 mellitus should be extremely attentive to his health. The presence of initial neurological symptoms, even the most insignificant ones, is a reason for urgent medical attention.

DIABETIC POLYNEUROPATHY

Severe pain symptoms

Near severe clinical disorders

Early disability of patients

Significant deterioration in the quality of life of patients in general

With disease duration

With the age of patients

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 is 13-54%

In patients with type 2 diabetes is 17-45%

2. Damage to the peripheral nervous system:

Sensory shape (symmetrical, asymmetrical)

Motor form (symmetrical, asymmetrical)

Sensorimotor form (symmetrical, asymmetrical)

diabetic mononeuropathy(isolated lesion of the pathways of the cranial or spinal nerves)

autonomic (vegetative) neuropathy:

Thin and thick fibers

Focal mononeuropathies of the extremities

Proximal motor (amyotrophy)

Truncal radiculoneuropathy, etc.

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

Pseudo-syringomyelic - characterized by a decrease in pain and temperature sensitivity in combination with neuropathy of autonomic fibers, a skin biopsy reveals a clear lesion of the axons of small fibers and a moderate lesion of large fibers

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

Polyol metabolic pathway

Decreased activity of protein kinase C

Free radical destruction of cell membranes

Impaired metabolism of free fatty acids

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 the adrenergic symptoms-precursors are leveled)

Changes in the bioavailability of oral sugar-lowering drugs

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

Presence of symptoms that worsen at night, such as burning, sharp and stabbing pain

Absence or disturbance of sensitivity and weakening or absence of reflexes

Poor DM control, weight loss

Diffuse pain (torso)

There may be hyperesthesia

May be associated with initiation of antidiabetic therapy

Minimal sensory disturbances or normal sensation on peripheral neurological examination

Usually occurs in older people with undiagnosed and poorly controlled type 2 diabetes

Manifested by muscle weakness; affects, as a rule, the proximal muscles of the lower extremities; onset subacute

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

Symptoms are absent or there is numbness of the feet, a violation of temperature and pain sensitivity with a lack of reflexes

Proximal motor (amitrophy)

Associated chronic inflammatory demyelinating neuropathies

Pain (most often burning in nature, worse at night)

Decreased sensitivity - vibration, temperature, pain, tactile

Decrease or loss of reflexes

Increase or decrease in temperature

The presence of callus (callus) in areas of high pressure

Acute pain (small fiber disease) neuropathy

Chronic pain (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 since the diagnosis of the disease

Decreased Achilles reflexes

Decreased peripheral vibration sensitivity

First, age-related changes can give a similar clinical picture.

Secondly, DP can often be asymptomatic and detected only by electroneuromyography.

5.higher height

violation of vibration sensitivity

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

Additional method (if possible) - biotensiometry

temperature sensitivity disorder

Mandatory method - touching with a warm / cold object

pain sensitivity disorder

Mandatory method - needle pricking

impaired tactile sensation

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

impairment of proprioceptive sensitivity

Mandatory method - detection of sensitive ataxia (instability in the Rombeog position)

Motor form of neropathy

manifestations: muscle weakness, muscle atrophy

A mandatory method is to identify the weakening or absence of tendon reflexes (Achilles, knee)

Additional method (if possible) - electroneuromyography

Autonomous form of neuropathy

The manifestation of orthostatic hypotension (decrease in blood pressure is more than or equal to 30 mmHg when changing body position from horizontal to vertical)

No acceleration of heart rate on inspiration and deceleration on expiration

Prba Valsalva (lack of acceleration of heart rate during straining)

Additional method (if possible)

24-hour BP monitoring (no nocturnal BP drop)

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 RR to the minimum is less than or equal to 1.2)

gastrointestinal form (enteropathy)

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

Additional method (if possible) - gastroenterological examination

Mandatory method - diagnosed by the absence of 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

Provided to all patients with type 1 diabetes mellitus 5 years after diagnosis and to all patients with type 2 diabetes at diagnosis, then annually

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

Thorough examination of the lower extremities and feet

Measures aimed at achieving and maintaining sustainable DM compensation

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

B vitamins - benfotiamine and cyanocobalamin - inhibitors of glycolysis, blocking 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 in the development of osteoporosis

Treatment of concomitant infections, etc.

Currently, two main approaches are put forward in the implementation of directed neurotropic therapy of DP, as well as in neuropharmacology in general:

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

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

The possibility of using proven standard effective combinations of biologically active substances within the same dosage form (simplification of the procedure for choosing a therapeutic agent for a practitioner)

Reduction of involuntary polypharmacy while maintaining or increasing the effectiveness of treatment

Compliance improvement (ease of use for the patient and doctor)

Increasing the availability of treatment, dependent on the cost of drugs

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

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

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

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

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 action: accumulation of glycogen in the liver; increased activity of a number of enzymes, optimization of liver function.

Detoxification action (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 (an inhibitor of NMDA-dependent channels)

Tolperisone (Na channel blocker and membrane stabilizer)

in a double-blind, placebo-controlled study evaluating the efficacy of glyceryl trinitrate spray in 48 patients with painful diabetic neuropathy. Twenty-four patients in the study group applied topical glyceryl trinitrate spray on their legs during sleep for four weeks, while the other 24 used a spray containing placebo. Glyceryl trinitrate was well tolerated and only one patient was excluded from the study due to adverse side effects. The researchers attribute the positive effect to vasodilation due to nitric oxide, a derivative of glyceryl trinitrate. Good results have been obtained when this spray is used in combination with valproic acid.

Diabetic polyneuropathy of the lower extremities

A long-term excess of glucose in the blood, damaging the blood vessels, is no less detrimental to the nervous system. Polyneuropathy is a severe complication of diabetes mellitus, in which several large plexuses of peripheral nerves that control the functions of the lower extremities can be affected at once.

What is diabetic polyneuropathy

Multiple lesions of nerve fibers are observed in patients suffering from diabetes 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, respiration, digestion, and muscle contraction. Diabetic polyneuropathy of the lower extremities (DLN) is a pathology that begins in the feet and then spreads higher and higher.

The pathogenetic mechanism of the disease is very complex and has not been fully elucidated by scientists. Violations 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 a foot problem can turn a person into an invalid. Diabetic polyneuropathy is encrypted by doctors under the 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 fatal.

Another classification is based on the functions of the nervous system, which are violated as a result of the development of pathology:

sensory polyneuropathy associated with increased pain in the legs, or, conversely, with 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 such an ailment do not feel pain in certain places of the foot and lower leg. These 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 ("cock" 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. Typical for diabetics with distal DPN is a dull, aching pain that is often so severe that the person cannot sleep. In addition, sometimes the shoulders begin to ache. Polyneuropathy progresses, and this leads to muscle atrophy, bone deformities, flat feet, and amputation of the feet.

peripheral

With this type of disease, severe disorders of the sensorimotor functions of the legs occur. Diabetics have pain and numbness not only in the feet, ankles, lower legs, but also in the hands. Peripheral polyneuropathy occurs mainly when doctors prescribe strong 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 stop the drug.

Sensory polyneuropathy

The main feature of the pathology is the loss of sensation in the legs, the degree of which can vary significantly. From slight 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 passes to the second, rising higher and higher, affecting the fingers and hands, torso, head.

Dysmetabolic

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

Why do people with diabetes develop neuropathy?

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

endocrine disorders;
severe liver or kidney disease;
depression, weakening of the immune system;
infections;
abuse of alcoholic beverages;
poisoning with toxic chemicals;
tumors.

Symptoms

The main manifestations of the disease of all types:

Sensitive symptoms - pain, weakening or exacerbation of the perception of temperature changes, vibration.
Motor symptoms - convulsions, tremors, muscle atrophy of the limbs.
Vegetative symptoms - edema, hypotension, tachycardia, stool disorders, impotence.

Burning and tingling of the legs

Sensation as if the soles of the feet are on fire, occurs when the fibers of the peripheral nerve that runs from the spine to the feet are damaged. Burning feet is not a disease, but a symptom that manifests 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

First, a diabetic experiences weakness, numbness in the feet. Then these sensations arise in the legs, hands. As the polyneuropathy of the lower extremities progresses, muscle atrophy increases and tactile sensitivity decreases. The feet become difficult to control and hang down. The hands become numb, starting from the tips of the fingers. With a long 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 examination of the patient:

checking unconditioned reflexes;
pain sensitivity test;
vibration response test;
thermal test;
skin nerve biopsy;
electroneuromyography (ENMG), which can show whether nerve impulses travel along muscle fibers.

Treatment of diabetic polyneuropathy of the lower extremities

Completely such complications cannot be 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, spacious shoes, minimal walking, cool baths help reduce pain. A contrast shower relieves the burning sensation of the feet. It is necessary to use drugs that dilate peripheral vessels that 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 adjust the carbohydrate metabolism of the diet.

Medical therapy

The main means for the complex treatment of patients with a diagnosis of 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 repair damaged nerves;
Actovegin, which improves the blood supply to the nerve endings;
Isodibut, Olrestatin, Sorbinil, protecting nerves from glucose;
antibiotics - with the threat of gangrene development.

Treatment without drugs

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

magnetotherapy;
electrical stimulation;
hyperbaric oxygenation;
acupuncture;
massage;
exercise therapy (physiotherapy).

With diabetes, a person develops numerous complications that negatively affect the functioning of internal organs. Also, the peripheral nervous system is often affected - if individual nerve fibers are disturbed, the doctor diagnoses diabetic neuropathy, in the case of a massive lesion, diabetic polyneuropathy is detected.

This disease develops in diabetics with the first and second type of diabetes mellitus, the risk of developing the disease is 15-50 percent of cases. Usually, diabetic polyneuropathy is diagnosed if a person has been deficient in insulin for a long time and has an elevated blood glucose level.

Peripheral nerves are disturbed as a result of changes in the mechanism of the metabolic process in tissues. Nerve fibers undergo oxygen starvation, the concentration of nitric oxide decreases, which worsens blood supply and disrupts the functioning of the nervous system.

What is diabetic polyneuropathy

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

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

Also, the disease is classified according to the types of damage to the functions of the nervous system. In particular, diabetic polyneuropathy sensory form 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

Such a pathology, which can be seen in the photo, is referred to as a variety of the 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 the genesis of this type of complication is most often diabetes mellitus, while a person's working capacity decreases. The disease itself is very dangerous for both health and life of a diabetic.

Distal polyneuropathy usually affects the lower extremities, but can sometimes affect the hands. A person feels a pulling and dull pain, which is so severe that the patient cannot sleep normally at night. Pain worsens at rest and may worsen during long walks.

Additionally, paresthesia makes itself felt, which is manifested by numbness, "crawling goosebumps", tingling, chilliness or burning, heaviness and weakness of the legs, sometimes pain is felt in the shoulders, forearms, and hips. 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, the sensitivity in the toes is noticeably reduced, after a while the symptoms can spread to the upper limbs. If the treatment of diabetic polyneuropathy of the lower extremities is not started in time, a person may develop serious complications that are life-threatening.
The disease is accompanied by a violation of thin and sometimes thick nerve fibers. If thin fibers are damaged, the patient's temperature and pain sensitivity of 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 work of the motor apparatus is disrupted, the person feels weakness in the legs, muscle atrophy develops, sweating worsens, the skin dries out, the bones are noticeably deformed. The skin acquires a pink or reddish tint, symmetrical pigmentation appears in the region of the lower leg and back of the feet, the lower limbs atrophy or undergo deformation.
As a result, osteoarthropathy develops, which is characterized by transverse and longitudinal flat feet, increased deformity of the ankles, and an increase in the size of the feet from the transverse side. Such violations on the feet can be either unilateral or bilateral.
Due to prolonged pressure on the deformed area of the bone, neuropathic ulcers occur on the outer sides of the feet and between the toes. Such wounds at first do not cause pain due to reduced 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 diagnose in a timely manner and know how to treat such a pathology. To accurately determine the diagnosis, a neurological examination is performed to examine the degree of sensitivity and reflexes of the patient.

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

At the same time, it is important to regularly monitor glucose levels, if necessary, a diabetic takes painkillers.

Diabetic polyneuropathy: symptoms

At different stages of the disease, the signs can differ significantly - at the zero stage, the 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 on the territory of the neurophysiological department.

At the second clinical stage, chronic pain, acute pain, amyotrophy and painless form are distinguished. In the chronic pain form, diabetics feel burning and pain in the legs, while sensitivity is noticeably reduced, as a result of which polyneuropathy of the lower extremities is diagnosed. The symptoms may be especially worse at night.

When an acute pain form develops, pain begins to spread throughout the body, in some cases, increased sensitivity is observed on the lower extremities. Amyotrophy is accompanied by muscle weakness and severe pain at night. With a painless form, a person completely does not feel pain and 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 area of the feet, the development of Charcot's foot is possible, in this case, the disease often leads to amputation of the foot.

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

Sensitive symptoms include disturbances in the form of aching, cutting, shooting, burning pains. In a diabetic, sensitivity decreases or, conversely, increases, hands and feet go numb. Also, the patient may not feel vibration or temperature changes.
Symptoms of motor activity are accompanied by weakness or atrophy of the muscle tissues of the legs, lack of reflection, trembling of the limbs, cramps of the caviar muscles.
Including in a diabetic, the functioning of the autonomic system is disrupted, this is manifested by tachycardia, a decrease in 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 complaints of the diabetic, the symptoms present and certain factors. The disease is quite difficult to detect, as older people may experience similar clinical signs due to age-related changes.

Including sometimes the symptoms do not manifest themselves in any way, therefore, a violation can be detected only when passing 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 height, the presence of diabetic retinopathy and nephropathy, reduced sensitivity to vibrations, and weakened tendon reflexes.

If a person has a sensory form of the disease, vibration sensitivity is measured for diagnostic purposes using a tuning fork, the degree of sensitivity to temperature changes is determined, pain sensitivity is detected by pricking 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 in studying the bioelectrical activity of muscle tissues.
In the case of an autonomous form of polyneuropathy, the heart rate is measured during inhalation and exhalation, a gastroenterological and urological examination is carried out, and how prone a person is to orthostatic hypotension is checked.

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 the sensitivity himself with the help of any warm and cold objects. Tactile sensations can be detected with cotton swabs that are driven over the skin.

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

To lower blood sugar levels, sugar-lowering drugs are taken.
To normalize the work of the nervous system, the doctor prescribes the intake of B vitamins, antidepressants in a small dosage, drugs containing thioctic acid.
Against seizures, Gabapentin is an effective remedy, and analgesics and anesthetics are also required. Magnesium helps relieve muscle cramps, muscle relaxants relieve spasms.
To increase the energy resources of neurons, it is recommended to take Actovegin.
If a person has tachycardia, take Nebivolol or Metoprolol.
In order to eliminate irritation on the skin, Kapsikam, Apizartron, Finalgon are used.

Of the non-drug remedies, special physiotherapy, relaxing massage, acupuncture, magnet therapy, and electrical stimulation can cure pathology.

Proven folk methods help to get rid of wounds and ulcers on the skin with diabetic polyneuropathy; for this, herbal infusions, healing oils, and useful decoctions are used.

Be sure to exclude any alcoholic beverages from the diet so that the body is strong and healthy.

Preventive measures

With timely diagnosis, proper therapy, and prevention, it is possible to stop the development of the disease in time. For this purpose, it is important for diabetics to consult a doctor five years after the discovery of diabetes mellitus and be examined for the presence or absence of diabetic polyneuropathy in a child or adult. After that, you need to pass the control every year.

Dysmetabolic polyneuropathy is an ailment that can develop against the background of the presence of somatic problems predetermined by metabolic disorders:

diabetes mellitus;
diseases of the kidneys, liver;
problems of the digestive tract.

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

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

Symptoms of polyneuropathy can also become harbingers of this disease.

Hypoxia with changes can become an important factor in the development of neuropathy. In view of this, the use of sugar by the peripheral nerves will be impaired.

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

Not the last role will be played by a violation in other types of metabolism that are present against the background of diabetes:

water-electrolyte;
lipid;
protein.

Clinical picture of the disease

In each case, the course of dysmetabolic polyneuropathy may be different. If the disease develops early enough and is manifested by a significant decrease in vibrational sensitivity, then knee and Achilles reflexes may be lost.

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, certain sections of the nerve trunks are damaged. As a rule, nerve damage occurs:

ischial;
median;
elbow;
femoral.

These problems may be accompanied by paresis of the corresponding muscle groups, pain and sensitivity disorder. If the femoral nerve was affected, then in this case there is a loss of knee reflexes.

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

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

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

Vegetative and trophic disorders are not uncommon in polyneuropathy. Problems with urination and postural hypotension develop.

How to treat?

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

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

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

Polyneuropathy in systemic ailments

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

In some cases, signs of polyneuropathy can 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 rheumatoid arthritis, polyneuropathy is also observed. Initially, it will manifest itself as sensory disturbances, and then 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:

vegetative;
motor;
sensitive.

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

Hereditary polyneuropathy

First of all, it 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.

Porphyric polyneuropathy will be manifested due to the neurological complex of symptoms. In this case, pain, weakness in the muscles, paresthesia (upper and lower extremities) occur. Motor manifestations can gradually increase, up to distal paralysis or paresis.

With this disease, the patient will feel:

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

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

Amyloid polyneuropathy

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

stool disorders (constipation and diarrhea);
pain in the digestive tract;
heart failure;
macroglossia (an 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, at the moment it does not exist.

Distal sensorimotor polyneuropathy

In diabetes, long nerve fibers are most often affected. Diabetic polyneuropathy is observed in 40% of diabetics. This type of disease 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 any pain or high temperatures.

Ulcers appear on the lower extremities,. Severe joint damage and fractures are not ruled out.

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

As the disease progresses, there will be a violation in the work of the musculoskeletal system. When this happens:

bone deformity;
muscle dystrophy;
excessive dryness of the skin;
the appearance of age spots;
reddish skin tone;
sweat gland dysfunction.

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. 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

In the presence of lesions of the autonomic nervous system against the background of the course of diabetes, the patient will feel:

darkening in the eyes;
fainting when taking a vertical position;
dizziness.

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

The cause of a sudden death can be a heart rhythm disturbance in diabetic polyneuropathy.

Those people who suffer from this disease will feel problems from the genitourinary system - urinary incontinence occurs. The bladder will lose the ability to completely empty, 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 (the 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 apparatus 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 due to serious autoimmune processes, intoxications, heredity and infections, while the most dangerous is the case when this 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 sensation of vibration in the limbs, and the patient begins to perceive heat and cold, and temperature changes worse. With sensory polyneuropathy, negative symptoms of sensory disturbance, a feeling of "gloves" and "socks", and a violation of the sensitivity of 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, atactic form and mixed form. In the atactic form of the disease, symptoms such as impaired coordination of movement, paresthesia, numbness, instability (especially with closed eyes) are noted. Muscle strength usually remains unchanged, however, when examined by a doctor and tested for strength associated with loss of deep sensation, it can decrease significantly.

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

With sensory polyneuropathy, the main symptoms are most often asymmetric, 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 develops, 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 sometimes even the trunk and face. Symptoms can develop within a few days or 1-2 months.

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

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

For the diagnosis of sensory polyneuropathy, an anamnesis is required with a thorough identification of other diseases, dietary habits, a list of medications that the patient used, descriptions of heredity, previous infectious diseases that could affect the development of polyneuropathy, an assessment of the patient's work places, in order to ascertain the fact of contact with toxic substances , ENMG results, as well as specific results of skin nerve biopsy, etc.

To date, the treatment of sensory polyneuropathy is rather poorly developed. The most commonly used treatments are corticosteroids, cytostatics, plasmapheresis, and immunoglobulin, but all too often treatment attempts are unsuccessful. Against the background of immunotherapy, there is a partial regression of symptoms and stabilization of the condition, 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, if not to recovery, then to 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, it is impossible to carry out a significant recovery, but one can hope to stop the progress of the disease and stabilize the patient's condition.

Polyneuropathy is a number 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 a decrease in sensitivity. The legs are the most affected by this disease.

Disease classification

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

According to the predominant damage to the fibers

All nerve fibers are divided into three types: sensory, motor and autonomic. With the defeat of each of them, different symptoms appear. Next, let's take a look at each type. polyneuroglia:

Motor (motor). This species is characterized by weakness in the muscles, which extends from the bottom up and can lead to a complete loss of the ability to move. Deterioration of the normal state of the muscles, leading to their refusal to work and the frequent occurrence of seizures.
touch 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 desensitization.
Vegetative. In this case, there is profuse sweating, impotence. Problems with urination.
mixed- includes all of the above symptoms.

By damage to the cells of the nerve structures

A nerve fiber consists of axons and myelin sheaths that wrap around these axons. This view is divided into two subspecies:

When destruction of the myelin sheaths of axons development is faster. Sensory and motor nerve fibers are more affected. The vegetative ones are destroyed slightly. Both proximal and distal regions are affected.
Axonal the same characters in that development proceeds slowly. Vegetative nerve fibers are disturbed. Muscles atrophy quickly. Distribution begins with the distal sections.

By localization

By localization there are:

distillate- in this case, the parts of the legs that are located most far are affected.
Proximal- the parts of the legs that are located higher are affected.

Cause

Because of there are:

Dysmetabolic. It develops as a result of a violation of the course of processes in the nervous tissues, which is provoked by substances produced in the body subsequently of certain diseases. After they appear in the body, these substances begin to be transported with the blood.
toxic polyneuropathy of the lower extremities. Occurs with the use of toxic substances such as mercury, lead, arsenic. It often appears when
the use of antibiotics, but the most common type of polyneuropathy is alcoholic.
In cases alcoholic polyneuropathy lower limbs, the following symptoms appear: increased pain, impaired ability to move in the legs, impaired sensitivity. The rapid onset of trophy in the muscles.
diabetic polyneuropathy of the lower extremities. It occurs in people suffering from diabetes for a long period of time, which is 5-10 years. It manifests itself in the form of such symptoms: impaired sensitivity, spots on the skin appear, a burning sensation in the feet.

Primary and Secondary

In this case:

TO primary polyneuropathies include hereditary and idiopathic types. This is such a disease as Guillain-Barré syndrome.
Co. secondary includes polyneuropathy resulting from poisoning, metabolic disorders, 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 such main causes:

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

Symptoms of the disease

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

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

Diagnostic methods

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

In the process of this, the doctor must carefully examine all the external signs and changes, find out from the patient whether his immediate family had the same disease.

Polyneuropathy is also diagnosed using various procedures:

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

Treatment of pathology

Treatment of polyneuropathy of the lower extremities has its own characteristics. For example, the treatment of diabetic polyneuropathy of the lower extremities will in no way depend on the refusal of alcohol, in contrast to the alcoholic form of the disease.

Features of treatment

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

Thus, at the first manifestations of its symptoms, it is necessary to find out the cause of its occurrence without delay.

And only after that eliminate the factors that will provoke it. Thus, the 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.

Medical therapy

Depending on the type of disease, the following drugs:

in cases of severe disease, methylprednisolone is prescribed;
with severe pain, analgin and tramadol are prescribed;
drugs that improve blood circulation in the vessels in the area of nerve fibers: vasonite, thrintal, pentoxifylline.
vitamins, preference is given to group B;
medicines that improve the process of obtaining nutrients by tissues - mildronate, piracetam.

Physiotherapy

The treatment for this disease is quite a complicated process taking a long period of time.

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

It includes such procedures:

massotherapy;
exposure to magnetic fields on the peripheral nervous system;
stimulation of the nervous system with the help of electrical appliances;
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 should be carried out by purifying the blood with a special apparatus.

Healing Fitness

Exercise therapy must 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. In the event that you are not cured of this disease, this can lead to the fact that you will no longer feel your lower limbs, the muscles will come into terrible shape and, as a result, you may lose the ability to move.

Forecast

If treatment is started in a timely manner, then 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 the severity of its course.

Preventive measures

To eliminate the possibility of a disease such as polyneuropathy, you need to follow 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.

Necessary remove alcohol from your life.
Necessarily use protective drugs when working with toxic substances in order to prevent their penetration into the body.
Recommended monitor product quality that you use, because in case of poisoning with these products, the process of destruction and disruption of the normal functioning of nerve fibers starts. This leads to the development of polyneuropathy.
Should be carefully what doses to control you are taking medications and never use them unnecessarily. It is advisable to strictly follow the doctor's instructions and not self-medicate.
Mandatory required to take measures in case of detection of infectious or viral diseases. Urgently need to see a doctor and not run these diseases, which can then be the cause of the development of polyneuropathy.

As a rule, polyneuropathy cannot be prevented.

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

Even if you have some kind of illness you need to tell your doctor right away, 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 deal with a disease that is just beginning its development than with a disease that has been progressing for a long time, which then in the end can also lead to all sorts of complications.

Video: Diabetic polyneuropathy of the lower extremities

How to self-diagnose polyneuropathy? What is the peculiarity of the diabetic form of the disease. Why is nerve sensitivity lost?

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Distal

This term means that diabetes affects the nervous system located distally, that is, away from the body and internal organs. This term is opposite in meaning to the word "proximal", that is, the closest. That is, these are the “ends” of the body. There is a good figurative expression in neurology: a sock-and-glove lesion. It is in these places that elevated blood sugar levels produce the most damage to the nerves. This is because at the periphery of the nerves, the myelin sheath is thinner (because the nerves themselves are thinner, like long branches), which is the "insulator" of the nerve fiber. It is more vulnerable to the damaging effects of sugar. In addition, it is on the periphery that circulatory disorders 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 occur 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 is harmful. In this case, chronic, long-term hyperglycemia is to blame - high blood sugar. Patients feel that the legs and arms suffer almost equally.

sensorimotor

This word includes the meaning of defeat. Sensorimotor - means a sensory plus motor form, that is, a violation of sensitivity (sensory disorders), which is combined with motor disorders, that is, movement disorders. Of course, on the feet and ankles, 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 equally suffer from an excess of sugar and begin to "work poorly." In particular, sensory disturbances are manifested:

General decrease in sensitivity (hypesthesia). The patient cannot understand which toe the doctor took, unless you look and move the foot.
Paresthesias appear (a feeling of crawling), numbness may occur.
The most agonizing sensation is hyperpathia, a perverse sensitivity in which there is an excruciating sensation of heat in the feet. They don't hurt, but kind of "burn". A patient with polyneuropathy tries to stick his legs out from under the covers at night, often goes to the bathroom and wets them with cold water. As long as the feet are wet, all is well. As soon as they dry, the unpleasant sensations appear again.

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

Polyneuropathy

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

lower limbs

Why are the legs involved? In fact, the symptoms of neuropathy in diabetes also appear in the hands, 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 there are already prerequisites 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 the legs.

Now everyone knows what this complex diagnosis means. The treatment of diabetic polyneuropathy is no less complicated: it is impossible to completely eliminate the toxic damage to the nerves by glucose, which lasted for years, in one day or even a month. 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 are of great importance, preferably in the form of a combined preparation, for example, Milgamma. Physiotherapeutic procedures are also used, for example, electrophoresis of thiamine or dibazol. With polyneuropathy, it is very important to observe 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 a "diabetic foot", which in advanced cases is fraught even with amputation.

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 in this complication of diabetes mellitus 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 deformity to sudden death. Diabetic neuropathy (ICD code 10: G63.2) is considered to be one of the most dangerous diseases requiring urgent medical intervention. The disease affects both the somatic and the autonomic nervous system, so the failure of any of them threatens the patient with a fatal outcome. 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 some organs or entire systems, which can lead to the development of diseases such as orthostatic hypotension or osteoarthropathy. Among patients there are different types of visceral neuropathy, the most common among which are:

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

Somatic polyneuropathy

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

Causes of polyneuropathy

Diabetic polyneuropathy can occur 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 to stop the development of complications. However, there are other causes of diabetic polyneuropathy, such as chemical or drug poisoning. Often there are cases caused by chronic intoxication (avitaminosis). The following systemic pathologies can lead to the appearance 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 the etiological factor. There is a separate classification of diabetic polyneuropathy, which includes two types - this is the mechanism of damage and the type of nerve fiber cells.

Each of them is divided into several subspecies, for example, according to the mechanism of damage, a neuropathic, demyelinating or axonal disease is distinguished. There are several more pathologies related to the type of nerve fiber, they include: mixed, sensory, autonomic, motor and sensorimotor. The most common is sensory diabetic polyneuropathy, which causes a weakening of vibrational 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 knows other factors that affect 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 a few photos on the Internet.

Sensory form of polyneuropathy

With the defeat of the zone of neurons responsible for the motor functions of the body, the work of the motor apparatus 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. 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 abnormalities of a hereditary nature, because it is almost impossible to cure such an ailment. Loss of sensation in the extremities and muscle paresis are among the main symptoms indicating the development of the disease. The patient may feel a burning, itching or tingling sensation that occurs for no apparent reason.

Distal polyneuropathy

There are several types of CNS 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 can cause loss of sensation in the lower or upper extremities, anisocoria, or strabismus. The characteristic signs of pathology include:

muscle cramps;
uremic itching;
violation of pupillary reflexes;
severe pain in the feet;
mummification of gangrenous tissue.

The pain syndrome can reach critical states, when the patient is unable to move or perform other activities. During the development of a distal complication, symptoms of paresthesia are noted, covering the hips, upper leg 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 signs of the development of pathology become apparent - acute or subacute damage to some brain fibers:

femoral;
sciatic;
oculomotor;
trigeminal.

Most patients experience decreased reflexes, severe pain, burning, tingling, etc. Older people abruptly begin to lose weight, 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 operable intervention to remove trophic ulcers or gangrene, which at first are 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 certain group of diseases without special equipment. The patient should give detailed answers regarding well-being or complain about the functioning of organ systems. After the history, you will need to use a diabetic neuropathy neurology kit to determine your blood glucose levels and perform additional procedures:

encephalopolyneuropathy;
study of Achilles reflexes;
electromyography;
echocardiography;
general urine analysis.

How to treat neuropathy

Therapy includes an integrated approach to solving the problem after clarification of all previous measures. It is very important to determine the cause of the onset of the disease, after which treatment of 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 medicines contain a large amount of B and C vitamins, and detoxification therapy is carried out in parallel.

Decreased blood sugar

There are several ways to lower the level of sugar in human blood, which are used to treat patients suffering from diabetes. Doctors recommend using not only medications to lower blood sugar, but also completely change the diet. Food consumed during the day should exclude the ingestion of a large amount of easily digestible carbohydrates. Patients are forbidden to take food such as pasta or potatoes. Their place should be taken by vegetables that can lower sugar levels.

Alpha lipoic acid for diabetes

Thioctic acid is directly involved in the processes of metabolism and energy formation by the body. This substance is considered the most powerful antioxidant, helps to 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 assimilation occurs.

Inhibitors in diabetes mellitus

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

Non-steroidal anti-inflammatory drugs

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

Actovegin with polyneuropathy

Antioxidant drugs help normalize metabolic disturbances in the nerve and have been used for the past few years in the treatment of diabetes mellitus. Treatment of diabetic polyneuropathy with Actovegin is an absolutely safe measure due to the fact that the substance does not cause side effects. For several years, not a single negative precedent has been registered with the participation of this remedy; its composition includes exclusively physiological components.

Treatment of diabetic polyneuropathy of the lower extremities

Complications caused by high blood glucose 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 a drug and non-drug component. To normalize sugar levels, doctors prescribe a special diet that includes 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 alternative methods of treatment as additional procedures. There are several effective recipes, some for internal use and others for external use only. The most extreme is trampling on the leaves and stems of nettles with bare feet. Treatment of polyneuropathy with folk home remedies can only be used if there is control from a specialist.

Prevention of polyneuropathy

The occurrence 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 that cause the onset of the disease. For a favorable prognosis, the patient must adhere to a special diet and lead an active lifestyle, which involves playing sports or gymnastics.

sovets.net

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%, moderately in 43.7%, and sharply 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 had no diseases of the peripheral nervous system before the diagnosis of diabetes.

In the patients we observed, among the subjective disorders, pain syndrome was most often noted. Basically, these were dull, diffuse, pulling pains in symmetrical parts of the limbs. In some patients, they were so strong that they disturbed the night's sleep. In 68 patients, the pain increased 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 thighs, in 5 in the hands, in 13 in the forearm and in 10 in the shoulder region.

Paresthesias were also frequent, which were manifested by a feeling of tingling, "crawling", numbness, chilliness, "humming" and burning. A burning sensation, mainly in the feet, was indicated by 12.3% of patients (in addition, with a detailed survey, such a sensation could be detected in some other patients, but it was not sharp, inconsistent and bothered them little). In the presence of this symptom, patients preferred not to close their feet at night and touched cold objects with their soles. Sometimes the burning sensation was aggravated by the touch of linen, which forced such patients to bandage their legs, for even the touch of silk underwear caused a sensation "as if the legs were being cut." These sensations were intensified in damp weather. Paresthesias were more often localized in the 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 "on rubber soles", that they had "wool or wooden feet", that the soles were "dressed with fur" or "sand was poured", etc.

A feeling of weakness and heaviness in the lower extremities (and in some of them also in the upper ones) 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 did not have spontaneous pain in these muscles. Soreness of the leg muscles was noted 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). Yet more often it was diffuse muscle soreness.

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

In the study of the symptom of Lasegue, 36.8% in the first phase had pain in the popliteal region, in the region of the calf muscles, or along the entire back of the thigh. However, usually the pain did not spread along the sciatic nerve and there was no pain in the lumbar region. Thus, this symptom was mainly associated with stretching of painful muscles.

These data show that irritative pain syndrome, including pain, paresthesia, dysesthesia, soreness of muscles and nerve trunks, is often observed in distal polyneuropathy. This syndrome should be distinguished from neuromyalgia during decompensated 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 in decompensated diabetes" (or "neuromyalgia" for short). For hyperglycemia, as is known, is the most characteristic symptom 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 of neuromyalgia, and not of neuralgia or neuritis.

As our observations showed, in patients with diabetes at the age of up to 12 years (and especially at 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 with diabetes at an older age. Thus, out of 139 patients who developed diabetes before the age of 12 years and who did not have signs of distal polyneuropathy, this neuromyalgia was observed only in 14 (10.8%) patients and, as a rule, was mild. Among patients who developed diabetes at an older age, this neuromyalgia was observed 4-6 times more often. The possible reasons for this difference will be discussed below.

Often, the occurrence of neuromyalgia in patients with non-durable diabetes causes an erroneous diagnosis of "diabetic polyneuritis" or "neuropathy", and with its disappearance when diabetes is compensated, they write about "polyneuritis remission". When conducting a differential diagnosis, it should be taken into account that the specified neuromyalgia, in contrast to the irritative-pain syndrome in distal polyneuropathy, occurs only during a period of severe decompensation of diabetes, pain during it is not accompanied by paresthesias and is usually diffuse in nature, covering, in addition to the upper and lower extremities, more and trunk muscles and, finally, neuromyalgia quickly disappears when diabetes is compensated.

With distal polyneuropathy, vibrational sensitivity often suffers, as many authors point out. We determined the perception of the intensity and duration of vibration 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 was studied in 83 of them (under the age of 55 years), as well as in 15 patients with diabetes without signs of distal polyneuropathy, and in 22 healthy subjects.

In general, diabetic patients have a significantly reduced perception of vibration duration on the lower and upper limbs compared to healthy subjects. In patients without signs of damage to the peripheral nerves, the perception of the duration of the vibration was even somewhat greater than in the control group. In patients with irritative-pain syndrome in the absence of violations of superficial types of sensitivity and reflex disorders, compared with patients without signs of damage to peripheral nerves, a significant shortening of the perception of vibration duration was revealed. The shortening of the vibration duration somewhat increases in patients with irritative pain syndrome and a decrease in knee and Achilles reflexes. In patients with a decrease in knee and Achilles reflexes and foot hyperesthesia, there is a further decrease in vibration sensitivity. The minimum perception of vibration duration was in patients with decreased knee and Achilles reflexes and hypesthesia of the "socks" type. In 12 (out of 83) patients, there was a loss of vibration sensitivity on the ankles and lower legs, but in none of these cases anesthesia was observed, but there was only hypesthesia of superficial types of sensitivity. An individual analysis showed that the state of vibrational sensitivity in persons who fell ill with 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. At the same time, it turned out that in patients, first of all, the perception of vibration intensity decreases, and secondly, its duration.

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

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

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

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

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

Often, with distal polyneuropathy, pain sensitivity also suffers. Of the 82 patients with impaired 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 proceeded in parallel. Of the 46 patients with tactile hypesthesia, in 11 it reached the degree of anesthesia.

Our studies have shown that a violation of surface 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 callosity of the skin), which is innervated by the cutaneous branches of the tibial nerve. nerve. We compared the state of sensitivity on the dorsal 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 to 33 years. These patients did not have non-diabetic diseases of the peripheral nervous system and there was no pronounced callosity of the skin of the soles. Hypesthesia on the dorsal surface of the feet was in 69 patients, of which the sensitivity on the plantar surface of the feet was preserved in 7 (10.2%), increased in 52 (75.3%) and reduced in 10 (14.5%).

If patients with hyperesthesia on the soles of the feet were characterized by complaints such as: "sand is poured on the sole", then for patients with hypoesthesia of the soles these complaints were different: "I walk like on cotton wool", "I do not feel the soil under my feet" and "I can fall , especially at night". Among the 10 patients with such hypesthesia, there were mainly people over 50 years old, with severe diabetes, with a duration of diabetes 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 had gangrene previously). 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 hypesthesia of the soles of the feet. During dynamic monitoring of 6 of these 10 patients, it was found that hypesthesia on the soles of the feet occurs several years after its appearance on the rear of the feet. The above observations indicate that although the literature often indicates the presence of hypesthesia of the "sock" and "stocking" type within the framework of distal polyneuropathy, however, in many such cases, hypesthesia is present only on the back of the foot, and on the sole, apparently, is absent. 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 a violation of touch, the ability of such patients to self-service is significantly limited, and the ability to read Braille is also reduced. The main place in the formation of touch, as is known, is occupied by tactile sensitivity, and the most common method for studying the acuity of touch is to determine the discrimination threshold using Weber's compass.

The analysis showed that out of 85 patients with moderately and pronounced disorders of discriminatory sensitivity, persons over 40 years of age with a duration of diabetes of more than 10 years, with a pronounced distal polyneuropathy of the lower extremities predominated. In patients with childhood type of development of distal polyneuropathy, this disorder occurred ceteris paribus (duration and severity of diabetes, presence of microangiopathy, etc.) noticeably later than in patients with adult type of development of distal polyneuropathy.

Of the 22 patients who lost their sight, 20 had 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 prevent our patients from learning to read using the Braille method. True, some of these patients had to repeatedly moisten their finger while reading in order to better perceive the tattoos, while others avoided taking "rough" home work, since after it it was difficult for them to "distinguish" letters for several days.

Less often than other types of sensitivity, the muscular-articular feeling 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 noted much more often and to a more pronounced degree on the lower extremities than on the upper ones and was mainly distributed according to the polyneuritic (distal) type in the form of "socks" and "gloves", spreading in cases of moderately and especially pronounced 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 did the areas of sensory impairment have a "spotted" appearance. In 1/3 of the patients, there were clear asymmetries (but not one-sidedness) in the severity of sensory disorders.

Thus, sensory disturbances in patients with distal polyneuropathy are manifested by a combination of symptoms of irritation and prolapse. Initially, symptoms of irritation usually occur, and then - 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.

Movement disorders were observed in 21 patients. Of these, 11 had foot paresis. Only in 4 patients did this paresis reach a pronounced degree. A decrease in strength in the proximal limbs was detected in 14 patients, and malnutrition 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 muscles of the distal sections. It is typical for 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 trunk obesity. Atrophy captures the muscles of the thigh, lower leg and foot. There is no pulsation of the arteries of the feet. The skin of the feet and lower legs is atrophic, looks like "varnished", atrophic pigment spots on the lower leg, trophic changes in the nails. Achilles and knee jerks are absent. Hypesthesia of the distal type. Increased fatigue of the legs when walking, without changing lameness.

At the same time, the ischemic type of amyotrophy in its "pure" form is observed in elderly and senile patients with non-lasting diabetes, with pronounced 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 sections of the upper limbs 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. So, in 1968, M. Ellenberg, based on significant clinical material among diabetic patients over the age of 60, revealed symmetrical atrophy of the muscles of the hands in only 24. Of our 6520 patients, we observed a similar atrophy only in 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 a sharp exhaustion of the patient. Apparently, "neuropathic cachexia" should also be attributed to 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 extremities 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. Especially sharp muscle hypertrophy was observed in women with "hypermuscular lipodystrophy syndrome". Of the 14 such patients examined by us, who also suffer from diabetes mellitus, 6 showed signs of distal polyneuropathy. However, we excluded them from the analysis due to the presence of "secondary" diabetes in them.

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Causes of diabetic polyneuropathy

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

Polyneuropathy affects both nervous systems. If the work 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 not noticeable. Therefore, during scheduled examinations, it is necessary to undergo an examination by a neurologist.

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

Polyneuropathy in diabetes mellitus is manifested by a variety of symptoms, since two human nervous systems are involved in the pathology. According to the quality of manifestation, the symptoms are divided into active and "passive".

Active symptoms include sharp and vivid discomfort sensations:

Burning sensation.
Sharp pains.
Tingling.
Too much pain sensitivity.
Sensation of pain from a simple touch.

"Passive" stimuli include stiffness of the limbs, numbness, "necrosis" of tissues, and unsteady gait.

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

Diarrhea.
In men - erectile dysfunction, in women - anorgasmia.
Urinary incontinence.
Flabbiness of the skin and muscles of the face.
Visual impairment.
Seizures.
Dizziness.
Speech disorder.
Violation of swallowing reflexes.

Polyneuropathy sensory-motor (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 diabetic patients. For sensory-motor polyneuropathy, the following symptoms are characteristic: 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 diabetic patient may injure his leg and not notice it, or not feel too hot water in the bath. Wounds, ulcers begin to appear on the patient's legs, fractures or damage to the joints 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, the bones are deformed, and muscle dystrophy occurs. Excessive dryness of the skin is observed, the sweat glands stop working, the skin acquires a reddish tint, pigment 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, however, the occurrence of inflammatory processes may require amputation of the limbs.

Autonomous diabetic polyneuropathy

With damage to the autonomic (autonomic) nervous system due to diabetes, a person may experience dizziness, blackouts and fainting when standing up. With this form of polyneuropathy, 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 the disruption of heart rhythms in diabetic polyneuropathy, which can lead to sudden death.

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

Treatment of diabetic polyneuropathy

With early diagnosis of complications of diabetes, you can count on the complete disappearance of symptoms of neuropathy. Treatment of diabetic polyneuropathy is carried out in a complex manner, with an impact on both the cause of the onset and the symptoms of the disease.

Vitamins of group B (B1, B2, B6, B12) help to reduce the negative effect of sugar on nerve fibers and improve the passage of impulses along the nerve pathways.
Alpha-lipoic acid removes excess glucose from nerve fibers and, with the help of enzymes, repairs damaged nerve cells.
A special group of drugs is prescribed (Olrestatin, Sorbinil, Olredase, Tolrestat), which prevent the synthesis of glucose and reduce its negative effect on nerve fibers.
Non-steroidal anti-inflammatory drugs (Ibuprofen, Diclofenac) are used to relieve pain.
To relieve convulsions and numbness, drugs containing calcium and potassium are prescribed.
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 the right drugs, but also on compliance with the 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 diet and lead an active lifestyle.

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

The following decoction helps to maintain normal blood sugar levels: put chopped bay leaves (1 tablespoon) in a thermos. Add 3 tbsp. fenugreek (seeds), pour 1 liter of boiling water and leave for a couple of hours. Infusion to take during the day.

With distal polyneuropathy, it is useful to rub the legs with wild rosemary tincture. Half a glass of rosemary pour 500 ml of vinegar (9%) and leave for 10 days. Ready infusion is used in a diluted form in a ratio of 1: 1. The composition should be rubbed into the legs 3 times a day.

St. John's wort is poured with hot vegetable oil. Insist 3 weeks. Then the oil is filtered and 1 tablespoon is added to it. minced ginger root. This oil is used for massage of the upper and lower extremities and for body wraps.

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

Alcoholic polyneuropathy has similar symptoms to diabetic. The disease develops after prolonged alcohol dependence. Alcoholic polyneuropathy is treated with the following composition: a few tsp are added 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.

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

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

For sick limbs, it is useful to make warm baths. Pour into a bowl 100 g of chopped sage leaves, oregano, motherwort, stems and leaves of Jerusalem artichoke. Pour 3 liters of boiling water and let it brew for one hour. The duration of the procedure is 15-20 minutes. If there are no medicinal herbs at hand, make a warm foot bath, and then smear your feet with ointment with bee or snake venom.

With diabetic polyneuropathy, it is better to replace potatoes with Jerusalem artichoke. Jerusalem artichoke helps to 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), microcirculation disorders in the peripheral nerves. Damage to the axons of the nerves 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

According to the type of manifestations and localization of symptoms, the following forms of diabetic polyneuropathies are distinguished:

Proximal symmetric polyneuropathy (amyotrophy).
Asymmetric proximal neuropathy of large nerves (often femoral, sciatic or median).
Neuropathy of the cranial nerves.
Asymptomatic polyneuropathy.
Distal types of polyneuropathy.

Distal polyneuropathy is the most common type of diabetic polyneuropathy. It occupies more than 70% of all types of this disease. The word distal indicates the defeat of the parts of the limbs remote from the body (hands, feet). Chaei quickly affects the lower limbs. Depending on the nature of the lesion, the following forms are distinguished:

Touch.
Motor.
Vegetative.
Mixed (sensory-motor, 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 muscle trophic disorders, weight loss of the entire limb, and a decrease in its strength. Autonomic and sensory functions suffer to a lesser extent.
Diabetic neuropathies of the cranial nerves differ depending on the degree of damage to a particular pair. Thus, the most common lesion of the oculomotor nerve, which manifests itself more often in the form of acutely developing painful ophthalmoplegia. Damage to the optic nerve is characterized by a pronounced decrease in vision, the presence of blurring in the eyes, impaired twilight vision. The trigeminal, trochlear, and facial nerves are less commonly affected. Acute ischemia is the most common cause of CCN lesions, and timely therapy usually leads to good results.
Asymptomatic polyneuropathies are usually discovered incidentally during a routine neurological examination. They are manifested by a decrease in tendon reflexes, more often knee reflexes.
Distal forms of polyneuropathy appear, as a rule, quite clearly. So, the presence of sensory disorders manifests itself in the form of a crawling sensation in the patient, painful burning, numbness in the limb. Also, a person may notice a pronounced violation 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 disorders can lead to the development of foot deformity and, subsequently, the appearance of a diabetic foot.

Vegetative disorders can lead to the development of tachycardia, hypotensive orthostatic reactions, bowel and bladder dysfunction, reduced potency, impaired sweating. It also increases the risk of sudden cardiac death.

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

Diagnostics

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

Treatment

Treatment of diabetic polyneuropathy should be comprehensive, carried out in conjunction with an endocrinologist and a general practitioner. First of all, you need to control your blood sugar levels. It is also mandatory to exclude the presence of micro- and macroangiopathy, if necessary, carry out appropriate treatment.

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

In the presence of painful convulsions, muscle relaxants, anticonvulsants can be used. In the case of severe pain syndrome, symptomatic treatment of NVPS 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 deformity, orthopedic selection of insoles and shoes is necessary. In all cases, the most important role is played by careful skin care, prevention of microdamages.

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Distal polyneuropathy is one of the varieties 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 a foot ulcer. 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 mellitus is the so-called distal polyneuropathy. With this type of polyneuropathy, in most cases the lower and occasionally upper limbs are affected.

The most common symptom in distal polyneuropathy is pain. Usually it is a pulling and dull pain. Sometimes the pain reaches such a level that it does not allow you to sleep at night. The pain syndrome becomes stronger when the patient is at rest, but can also be observed during long walking. Quite often, paresthesias make themselves felt, which manifest themselves in the form of numbness, a feeling of "creeping goosebumps", tingling, chilliness, or, conversely, burning sensation. There is a feeling of heaviness and even weakness in the legs.

Shoulders, forearms, and the upper part of the legs - the thighs - may also hurt. Pain can be felt on palpation of the upper leg, and this is one of the main symptoms in establishing a diagnosis of dangerous distal polyneuropathy. In the absence of appropriate treatment, the pathology becomes more and more serious.

The initial signs of diabetic distal neuropathy manifest themselves in the fingers of the lower extremities, with the development of the process, 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 hands.

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

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

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

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

Prolonged exposure to pressure in the area of bone deformities eventually inevitably leads to the occurrence 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 focuses on this defect.

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

To make a diagnosis of distal polyneuropathy, it is sufficient to identify the following criteria, according to a scale of symptoms and signs. These include moderate signs with no symptoms or presence 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 the definition of reflexes.

The main reason for the progressive development of distal neuropathy, first of all, is the presence of a large amount of glucose. In this regard, the most effective method of treating the disease, which allows you to turn the process in the opposite direction, is the constant monitoring of the level of glycemia in the blood. In addition, it is necessary to carry out symptomatic treatment, which is important in the relief of pain.