Symptoms are usually first noticed on the toes. If the disease progresses, the symptoms may gradually shift to the legs, in the case of half of the calves. Serotonin and norepinephrine reuptake inhibitors (SNRIs) are another type of antidepressant that can help relieve nerve pain and have fewer side effects. Duloxetine is recommended by the ADA (Cymbalta, Drizalma Sprinkle) as a first treatment.
Another one that can be used is venlafaxine (Effexor XR). Possible side effects include nausea, drowsiness, dizziness, decreased appetite, and constipation. DSPN is the most common form of diabetic neuropathy. Clinically, it is primarily sensory neuropathy that depends on length, and significant distal weakness is rare.
However, as with cryptogenic distal sensory neuropathy (CSPN), there is often electrophysiological evidence of subclinical motor impairment. In fact, the clinical and electrophysiological findings in cryptogenic and diabetic distal sensory and sensorimotor neuropathy are very similar 84. However, since diabetic patients are often closely monitored before they develop symptoms of neuropathy, the first signs of neuropathy may be a decrease in distal vibration, touch and pain, and a loss of the ankle reflex during the exam. The first symptoms are usually a decrease in sensation or tingling in the toes. Dysesthesia, usually burning pain, may occur, although most diabetic patients with distal sensory neuropathy do not complain of significant discomfort.
In a population of 382 diabetic subjects treated with insulin, 41 (10.7%) had painful symptoms 85 In a two-phase cross-sectional descriptive study of patients with type 2 diabetes (postal survey followed by history and neurological examination), up to 27% of diabetics experienced neuropathic pain or mixed pain that had a significant negative effect on quality of life 86 Sensory symptoms may eventually progress to the ankles and knees and reach the fingers, hands and forearms. If the sensory loss extends to the elbows, patients may develop a symmetric midline zone of sensory loss shaped like a trunk wedge, 87. If you have diabetes, you can develop nerve problems at any time. Sometimes, neuropathy may be the first sign of diabetes. Significant nerve problems (clinical neuropathy) can occur within the first 10 years after a diagnosis of diabetes.
The risk of developing neuropathy increases the longer you have diabetes. About half of people with diabetes have some form of neuropathy. Modified scheme of the pathogenesis of diffuse diabetic neuropathy with the inclusion of insulin signaling. According to this point of view, the disease process begins before the deterioration of glucose metabolism becomes apparent.
The alteration of insulin signaling in the PNS triggers and maintains neuropathy at this stage. Postprandial and chronic hyperglycemia is not the least important factor in PND, but they appear in relatively advanced stages of PND. C-peptide and IGF insufficiency represents another important set of pathogenic mechanisms; however, the role of these mechanisms in the early phase of DPN remains undetermined. Aminoguanidine, an advanced glycation inhibitor, has been used in experimental animal models of diabetes and is currently being studied in humans.
Your healthcare provider will determine the best target range for you based on factors such as your age, how long you have had diabetes, and your general health. Painful diabetic peripheral neuropathy occurs in approximately 25% of patients with diabetes mellitus who receive in-office treatment and significantly affects quality of life. When treating advanced diabetic neuropathy, it is essential to prioritize personalized care and manage well-being proactively. Chronic inflammatory demyelinating polyneuropathy (CIDP) can occur in diabetic patients79 to 81 years of age, but these cases are not thought to be related to underlying diabetes. Physicians should carefully consider the patient's goals and functional status and the potential adverse effects of medication when choosing treatment for painful diabetic peripheral neuropathy.
To evaluate diabetic neuropathy, equipment has been developed to detect sensory loss, such as computerized quantitative sensory tests, and both simple and complex classification systems, which are primarily useful for including patients in research protocols, and are not clinically necessary in most patients. In the Rochester diabetic neuropathy study, none of the 380 diabetics had disabling polyneuropathy, even after follow-up for many years. Metabolic, vascular, and immune theories have been proposed for the pathogenesis of diabetic neuropathy. Review of the efficacy and safety of 40 to 60 mg of duloxetine once daily in patients with diabetic peripheral neuropathic pain.
The treatment of diabetic neuropathy must begin with the initial diagnosis of diabetes and primarily requires strict and stable glycemic control. Recently, there has been interest in nerve growth factor (NGF) therapy as a treatment for diabetic neuropathy. In addition, doctors should be aware of a muscle disorder, diabetic muscle infarction, which may occur in diabetic patients. Non-diabetic types of neuropathy, on the other hand, refer to nerve damage that isn't caused by diabetes.
