Diabetic Neuropathy
Diabetic neuropathy, along with retinopathy, neuropathy and macroangiopathy, are the main complications of diabetes. Known as a disease since ancient times, as it was studied, with records and announcements, from 1798, by John Rollo describing pain and paresthesias of the lower extremities, to the greatest neurologist of the 19th century, Jean Martin Charcot, in 1880, founder of neuropathic arthropathy. 8% of diabetic patients have established neuropathy, while of the rest 50% will acquire it in 25 years.
Poor metabolic control, duration of diabetes, age and albuminuria lead to diabetic neuropathy.
Autonomic nervous system (ANS) neuropathy is more common in types I while reversible mononeuropathy is more common in types II.
Clinically classified into:
Polyneuropathy:which includes sensory and autonomic nervous system neuropathy such as cardiovascular-gastrointestinal-genitourinary.
Mononeuropathy: symmetrical sensorimotor neuropathy affects the peripheral nerves mainly of the lower extremities with a ‘stocking’ distribution characterized by reduced superficial and deep sensation, resulting in injuries and ulceration.
ANS neuropathy affects various systems of the body.
The gustatory sweating of the face during the intake of food rich in spices – and especially cheese – night sweats if not due to hypoglycemia, urinary retention in the bladder, unconscious hypoglycemia, gastroparesis, fecal incontinence, erectile dysfunction are some symptoms.
Finally, the diabetic foot with coexisting infection constitutes 60% of non-traumatic amputations in the lower extremities.
Recommendations:
1) All patients with diabetes should be checked for neuropathy at the time of dissemination in types II and 5 years later in types I.
2) Education of all patients on foot self-care.
3) Good metabolic control and strict regulation of both pre- and postprandial hyperglycemia.
