DIABETIC NEUROPATHY

Neuropathies are characterized by a progressive loss of nerve fiber function. Diabetic neuropathy is the
presence of symptoms and /or signs of peripheral nerve dysfunction in people with diabetes after
exclusion of other causes (Boulton, 1998; Juster-Switlyk, 2016).

Neuropathies are the most common complication of diabetes mellitus (DM) affecting up to 50%of
patients with type1 and type 2 DM. Neuropathies severely decrease patient’s quality of life (QoL), it also
causes complications (eg falls, foot ulcers, cardiac arrhythmias) and more severe ones as in fractures,
amputations, and even death.

TYPES

1. Peripheral Neuropathy: Peripheral neuropathy is a type of nerve damage that typically affects
the feet and legs and sometimes affects the hands and arms. This type is the most common and
affect one-third to one-half of people with DM
2. Autonomic Neuropathy: is damage to the nerves that control your internal organs, leading to
problems with the heart rate and blood pressure, digestive system, bladder, sex organs, sweat
glands, and eyes. The damage can also lead to hypoglycemia unawareness
3. Focal Neuropathies: is a damage to single nerves, most often in your hand, head, torso, or leg.
The most common types are entrapment syndromes such as carpal tunnel syndrome.
4. Proximal Neuropathy: is a rare and disabling type of nerve damage in the hip, buttock or thigh.
The damage typically affects one side of the body and may rarely spread to the other side.
Symptoms gradually improve over a period of months or years
EPIDEMIOLOGY

In a study, the overall prevalence of diabetic peripheral neuropathy in Africa was 46%. Based on the
subgroup analysis, the highest prevalence of diabetic peripheral neuropathy in DM patients was
reported in West Africa at 49.4%.

The lowest was observed in Central Africa at 35.9% .This discrepancy could be explained by studies using
different diagnostic criteria for diabetic neuropathy, the quality of the health care service, and the
duration and severity of diabetes (Sanny K, 2017)

PATHOPHYSIOLOGY

The factors leading to the development of diabetic neuropathy are not understood completely. It is
generally accepted to be a multifactorial process. Development of symptoms depends on many factors,
such as total hyperglycemic exposure and other risk factors such as elevated lipids, blood pressure,
smoking, increased height, and high exposure to other potentially neurotoxic agents such as ethanol.

Genetic factors may also play a role

-POLYOL PATHWAY

Hyperglycemia causes increased levels of intracellular glucose in nerves, leading to saturation of the
normal glycolytic pathway. Extra glucose is shunted into the polyol pathway and converted to sorbitol
and fructose by the enzymes aldose reductase and sorbitol dehydrogenase. Accumulation of sorbitol
and fructose lead to reduced nerve myoinositol, decreased membrane Na+/K ,AaTpase activituy,
impaired axonal transport, and structural breakdown of nerves, causing abnormal action potential
propagationThis is the rationale for the use of aldose reductasre inhibitors to improve nerve conduction.
Etiology/Risk Factors

Prolong elevated level of blood sugar (Poor glycemic control)

Other factors are:

-Hypertension

- Advance

- age

-Lifestyle factors (smoking and alcohol)

DIFFERENTIAL DIAGNOSIS

-Alcohol neuropathy

-Chronic inflammatory demyelinating neuropathy

-Vasculitis

SIGNS AND SYMPTOMS

-Diminished vibratory perception

- Decreased knee and ankle reflex

- Reduced protective sensation such as -pressure, hot and cold, pain

- Diminished ability to sense position of toes and feet

-Numbness, pricking and tingling sensation

-Allodyna

-Burning/aching pain