Diabetic cause neuropathy complications: diagnosis and medical treatment

2021-07-27 01:06 AM

Neurological complications, manifesting in many different forms, the most common are peripheral neuropathy, and autonomic neuropathy

Microvascular complications include ocular, renal, and neurological complications. These complications are related to high blood sugar and can be prevented when blood sugar is controlled

Outline

Neurological complications are a common complication in diabetic patients, manifesting in many different forms, the most common being peripheral neuropathy and autonomic neuropathy (about 50% of patients). type 2 diabetes with this complication). Other forms of injury such as cranial nerve palsy, muscle atrophy are less common.

Definitive diagnosis and treatment

Cardiovascular autonomic neuropathy

Diagnose:

Clinical symptoms: resting tachycardia >100 beats/min, asymptomatic myocardial infarction, orthostatic hypotension, hypothermia.

Diagnostic tests:

Measure resting heart rate > 100 beats/min.

+ Check postural blood pressure: measure systolic blood pressure the first time in the lying position, the second time in the standing position 3 minutes after standing up suddenly. Response: normal systolic blood pressure drop < 10 mmHg, orthostatic hypotension when systolic blood pressure drops > 20 mmHg and/or diastolic blood pressure drop > 10 mmHg on standing.

Treatment:

Control blood sugar well and treat symptoms with:

Beta-blockers when tachycardia makes the patient uncomfortable.

Avoid predisposing factors for postural hypotension: low-salt diet, diuretics, antidepressants, avoid sudden sitting up, immobilize the lower leg before standing up.

Drugs: fluor hydrocortisone (Florinef) 100-300μg/day, dihydroergotamine (Tamik), octreotide (a somatostatin derivative)...

Autonomic neuropathy of the upper gastrointestinal tract

Diagnose:

Clinical symptoms: choking, bloating, slow digestion, heartburn, burning or pain in the epigastrium, nausea, vomiting.

Findings: gastroscopy with contrast showed dilated stomach, slow food circulation, gastroscopy - the esophagus.

Treatment:

Well control blood sugar and treat symptoms with one of the following drugs:

Metoclopramide (Primperan): 10-20mg/day, divided into 3 times, taken 30 minutes before meals.

Domperidone (Motilium): 10-20mg/day, divided into 3 times, taken 30 minutes before meals.

Cisapride (Propulsid): 10mg/day, divided into 4 times.

Erythromycin: 500 - 750mg/day. 4 times in 4 weeks.

Autonomic neuropathy of the lower gastrointestinal tract

Symptom:

Digestive disorders. persistent constipation or diarrhea.

Treatment:

Constipation: a balanced diet, enough fiber, divided into many meals. Medicines: sorbitol or lactulos, octreotid 150μg/day.

Diarrhea: metronidazole 750mg/ng for 3 weeks, loperamide 2mg x 4 times/day, cholestyramine 4g/day, octreotid 150μg/day.

Genitourinary autonomic neuropathy - Bladder neuropathy

Symptom:

Urinary incontinence, difficulty urinating, urinary retention.

Diagnose:

Measure residual urine volume by ultrasound.

Cystoscopy: bladder dilatation due to loss of tone.

Treatment:

Good control of blood sugar and symptomatic treatment.

Overactive bladder: direct parasympathomimetic (urecholine) or indirect ambenonium chloride.

Overactive bladder: anticholinergic parasympathetic suppression with oxybutinin (Ditropan).

Genitourinary Neuropathy

Men :

Erectile dysfunction due to decreased endothelium nitric oxide, impotence, retrograde semen.

Evaluation: sexual intercourse, genital examination, test for testosterone, blood prolactin.

Treatment: good control of blood sugar, psychological counseling and symptomatic treatment with Sildenafil, Vardenafil...

Female:

Menstrual disorders, amenorrhea, vaginal dryness, decreased sensation in the groin area, loss of sensation of sexual arousal.

Evaluation: asking about sex, genital examination, urinalysis.

Treatment: topical estrogen cream or use of hormone replacement therapy if there are no contraindications.

Vasomotor neuropathy

Increased sweating of the face and body, occurring at the start of meals, during exercise, or at night.

Decreased sweating in the distal lower extremities: dry skin, itching, hair loss, scabs, cracks, increased calluses and nail dystrophy, increased risk of foot ulcers. Severe cases can be seen in the upper extremities, the lower body.

Treatment: scopolamine, vasodilators (Buflomedil, Ginkgo biloba).

Unrecognized hypoglycemia

Long-standing diabetes leads to disturbances in the release of catecholamines and sometimes glucagon as loss of vagal control overshadows hypoglycemia (see also complications of hypoglycemia).

Peripheral nerve complications

Physical symptoms:

Paresthesia in the extremities: the feeling of crawling, numbness, tingling, burning.

Reduced or lost sensation of skin contact, the sensation of heat.

Loss of sensation up to “boots” in the legs, “gloves in the hands”.

Dull or paroxysmal pain increased pain sensation in the extremities and abdomen at night.

Physical examination:

Superficial sensory evaluation with 10g monofilament, examine 10 sites. Loss of 2/10 positions is assessed for superficial sensory disturbances, loss of 4/10 positions is assessed as having a risk of diabetic foot disease.

Assessment of depth sensation (vibration-onto-emotional sensation).

Electromyography exploration.

Treatment:

Good control of blood sugar and symptomatic treatment with one of the following drugs:

Ibuprofen 200 - 400mg, every 4-6 hours, maximum 1200mg/day.

Tricyclic antidepressants (amitriptyline 25mg), starting dose 25-50mg, maximum 150mg/day.

Carbamazepine (Tegretol 200mg): 100-200mg/day, maximum 600mg/day, divided into 3 -4 times.

Gabapentin (Neurontin 300mg): 300mg x 3 times/day, maximum 3600mg/day.

Pregabalin (Lyrica 75mg; 150mg; 300mg): 75mg x 2 times/day, increase 150mg x 2l/day after 1-week, maximum 300mg x 2 times/day, in the following days.