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Encyclopedia > Diabetic neuropathy
Diabetic neuropathy
Classification & external resources
ICD-10 E10.4, E11.4, E12.4, E13.4, E14.4
ICD-9 250.6

Diabetic neuropathies are neuropathic disorders that are associated with diabetes mellitus. These conditions are thought to result from diabetic microvascular injury involving small blood vessels that supply nerves (vasa nervorum). Relatively common conditions which may be associated with diabetic neuropathy include third nerve palsy; mononeuropathy; mononeuropathy multiplex; diabetic amyotrophy; a painful polyneuropathy; autonomic neuropathy; and thoracoabdominal neuropathy. The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following codes are used with International Statistical Classification of Diseases and Related Health Problems. ... The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... Neuropathy, strictly speaking, is any disease that affects the nervous system. ... For the disease characterized by excretion of large amounts of severely diluted urine, see diabetes insipidus. ... The arterial system The blood vessels are part of the circulatory system and function to transport blood throughout the body. ... Mononeuropathy (or mononeuritis) is a type of neuropathy that only affects a single peripheral or cranial nerve. ... This article or section is in need of attention from an expert on the subject. ... For other uses, see Pain (disambiguation). ... Anatomy and Physiology of the A.N.S. In contrast to the voluntary nervous system, the involuntary or autonomic nervous system is responsible for homeostasis, maintaining a relatively constant internal environment by controlling such involuntary functions as digestion, respiration, and metabolism, and by modulating energy needed to cope with stressful...

Contents

Epidemiology

Diabetes mellitus
Types of Diabetes
Diabetes mellitus type 1
Diabetes mellitus type 2
Gestational diabetes

Pre-diabetes:
Impaired fasting glycaemia
Impaired glucose tolerance For the disease characterized by excretion of large amounts of severely diluted urine, see diabetes insipidus. ... Diabetes mellitus type 1 is a form of diabetes mellitus. ... See diabetes mellitus for further general information on diabetes. ... Gestational diabetes is a form of diabetes found in pregnant women. ... Impaired fasting glycaemia (IFG) is a pre-diabetic state of dysglycemia, associated with insulin resistance and increased risk cardiovascular pathology, although of lesser risk than Impaired glucose tolerance (IGT). ... Impaired glucose tolerance (IGT) is a pre-diabetic state of dysglycemia, that is associated with insulin resistance and increased risk of cardiovascular pathology. ...

Disease Management
Diabetes management:
Diabetic diet
•Anti-diabetic drugs
Conventional insulinotherapy
Intensive insulinotherapy
Other Concerns
Cardiovascular disease

Diabetic comas:
Diabetic hypoglycemia
Diabetic ketoacidosis
Nonketotic hyperosmolar To meet Wikipedias quality standards, this article or section may require cleanup. ... The diet recommended for people who suffer from diabetes mellitus is one that is high in dietary fibre, especially soluble fibre, but low in fat (especially saturated fat) and sugar. ... An anti-diabetic drug or oral hypoglycemic agent is used to treat diabetes mellitus. ... Conventional insulinotherapy is a therapeutic regimen for diabetes mellitus treatment. ... Intensive insulinotherapy or flexible insulin therapy is a therapeutic regimen for diabetes mellitus treatment. ... Cardiovascular disease refers to the class of diseases that involve the heart and/or blood vessels (arteries and veins). ... Diabetic coma is a medical emergency in which a person with diabetes mellitus is comatose (unconscious) because of one of three acute complications of diabetes: Severe diabetic hypoglycemia Advanced diabetic ketoacidosis advanced enough to result in unconsciousness from a combination of severe hyperglycemia, dehydration and shock, and exhaustion Hyperosmolar nonketotic... Diabetic hypoglycemia describes low blood glucose (hypoglycemia) occurring in a person with diabetes mellitus. ... Diabetic ketoacidosis (DKA) is one consequence of untreated diabetes mellitus (chronic high blood sugar, or hyperglycemia), and is linked to an impaired glucose cycle. ... Nonketotic hyperosmolar coma is a type of diabetic coma associated with a high mortality seen in diabetes mellitus type 2. ...


Diabetic myonecrosis
Diabetic nephropathy
Diabetic neuropathy
Diabetic retinopathy Please wikify (format) this article or section as suggested in the Guide to layout and the Manual of Style. ... Photomicrography of nodular glomerulosclerosis in Kimmelstein-Wilson syndrome. ... Diabetic retinopathy is retinopathy (damage to the retina) caused by complications of diabetes mellitus, which could eventually lead to blindness. ...


Diabetes and pregnancy For women with diabetes mellitus, pregnancy can present some particular challenges for both mother and child. ...

Blood tests
Fructosamine
Glucose tolerance test
Glycosylated hemoglobin

Diabetes is the leading cause of neuropathy in developed countries, and neuropathy is the most common complication and greatest source of morbidity and mortality in diabetes patients. It is estimated that the prevalence of neuropathy in diabetes patients is approximately 20%. Diabetic neuropathy is implicated in 50-75% of nontraumatic amputations. Fructosamine, also known as Glycated Serum Protein (GSP) or Glycated Albumin, is used primarily to identify the plasma glucose concentration over time and so assess diabetic control . ... A glucose tolerance test in medical practice is the administration of glucose to determine how quickly it is cleared from the blood. ... Glycosylated (or glycated) hemoglobin (hemoglobin A1c, Hb1c , HbA1c or HgA1c) is a form of hemoglobin used primarily to identify the plasma glucose concentration over time. ... In medicine, epidemiology and actuarial science, the term morbidity can refer to the state of being diseased (from Latin morbidus: sick, unhealthy), the degree or severity of a disease, the prevalence of a disease: the total number of cases in a particular population at a particular point in time, the... In epidemiology, the prevalence of a disease in a statistical population is defined as the ratio of the number of cases of a disease present in a statistical population at a specified time and the number of individuals in the population at that specified time. ... Partial hand amputation For the song Amputations by Death Cab for Cutie, see You Can Play these Songs with Chords Amputation is the removal of a body extremity by trauma (also referred to as avulsion) or surgery. ...


The main risk factor for diabetic neuropathy is hyperglycemia. In the DCCT (Diabetes Control and Complications Trial, 1995) study, the annual incidence of neuropathy was 2% per year, but dropped to 0.56% with intensive treatment of Type 1 diabetics. The progression of neuropathy is dependent on the degree of glycemic control in both Type 1 and Type 2 diabetes. Duration of diabetes, age, cigarette smoking, hypertension, height and hyperlipidemia are also risk factors for diabetic neuropathy. Hyperglycemia or High Blood Sugar is a condition in which an excessive amount of glucose circulates in the blood plasma. ... It has been suggested that Longevity genes be merged into this article or section. ... A lit filtered cigarette will burn to ash from one end. ... For other forms of hypertension, see Hypertension (disambiguation). ... Hypercholesterolemia (literally: high blood cholesterol) is the presence of high levels of cholesterol in the blood. ...


Pathology and pathogenesis

There are four factors thought to be involved in the development of diabetic neuropathy:

  1. Microvascular disease,
  2. Advanced Glycation Endproduct,
  3. Protein kinase C, and the
  4. Polyol pathway.

Microvascular disease is a disease of any small blood vessels in the body. ... It has been suggested that this article or section be merged with Glycation#Exogenous. ... A protein kinase is an enzyme that can transfer a phosphate group from a donor molecule (usually ATP) to an amino acid residue of a protein. ... To meet Wikipedias quality standards, this article or section may require cleanup. ...

Microvascular disease

Vascular and neural diseases are closely related and intertwined. Blood vessels depend on normal nerve function, and nerves depend on adequate blood flow. The first pathological change in the microvasculature is vasoconstriction. As the disease progresses, neuronal dysfunction correlates closely with the development of vascular abnormalities, such as capillary basement membrane thickening and endothelial hyperplasia, which contribute to diminished oxygen tension and hypoxia. Neuronal ischemia is a well-established characteristic of diabetic neuropathy. Vasodilator agents (e.g., angiotensin-converting-enzyme inhibitors, α1-antagonists) can lead to substantial improvements in neuronal blood flow, with corresponding improvements in nerve conduction velocities. Thus, microvascular dysfunction occurs early in diabetes, parallels the progression of neural dysfunction, and may be sufficient to support the severity of structural, functional, and clinical changes observed in diabetic neuropathy. The arterial system The blood vessels are part of the circulatory system and function to transport blood throughout the body. ... Blood flow is the flow of blood in the cardiovascular system. ... The blood vessels are part of the circulatory system and function to transport blood throughout the body. ... Hypoxia is a pathological condition in which the body as a whole (generalised hypoxia) or region of the body (tissue hypoxia) is deprived of adequate oxygen supply. ... Vasodilation is where blood vessels in the body become wider following the relaxation of the smooth muscle in the vessel wall. ... Blood flow is the flow of blood in the cardiovascular system. ... Nerve conduction velocity (NCV) is a measurement made during a Nerve conduction study (NCS), a test commonly used to evaluate function of the motor and sensory nerves of the body. ...


Advanced glycated end products

Elevated intracellular levels of glucose cause a non-enzymatic covalent bonding with proteins, which alters their structure and destroys their function. Certain of these glycosylated proteins are implicated in the pathology of diabetic neuropathy and other long term complications of diabetes. Glucose (Glc), a monosaccharide (or simple sugar), is the most important carbohydrate in biology. ... Covalent bonding is a description of chemical bonding that is characterized by the sharing of pairs of electrons between atoms. ... A representation of the 3D structure of myoglobin, showing coloured alpha helices. ...


Protein kinase C (PKC)

PKC is implicated in the pathology of diabetic neuropathy. Increased levels of glucose cause an increase in intracellular diacylglycerol, which activates PKC. PKC inhibitors in animal models will increase nerve conduction velocity by increasing neuronal blood flow. PKC, see PKC (disambiguation) Public-key cryptography is a form of modern cryptography which allows users to communicate securely without previously agreeing on a shared secret key. ... Diacylglycerol (DAG) is a second messenger molecule made by phospholipase C (a membrane-bound enzyme), together with inositol triphosphate. ... Animal model refers to a non-human animal with a disease that is similar to a human condition. ...


Polyol pathway

Also called the Sorbitol/Aldose Reductase Pathway, the Polyol Pathway may be implicated in diabetic complications that result in microvascular damage to nervous tissue, and also to the retina and kidney which also have lots of microvasculature themselves. To meet Wikipedias quality standards, this article or section may require cleanup. ...


Glucose is a highly reactive compound, and it must be metabolized or it will find tissues in the body to react with. Increased glucose levels, like those seen in Diabetes, activates this alternative biochemical pathway, which in turn causes a decrease in glutathione and an increase in reactive oxygen radicals. The pathway is dependent on the enzyme aldose reductase. Inhibitors of this enzyme have demonstrated efficacy in animal models in preventing the development of neuropathy. In biochemistry, a metabolic pathway is a series of chemical reactions occurring within a cell, catalyzed by enzymes, resulting in either the formation of a metabolic product to be used or stored by the cell, or the initiation of another metabolic pathway (then called a flux generating step). ... Skeletal formula of glutathione 3D model of glutathione Glutathione (GSH), whose IUPAC name is 2-amino-5-{[2-[(carboxymethyl)amino]- 1-(mercaptomethyl)-2-oxoethyl]amino}-5-oxopentanoic acid, is γ-glutamylcysteinylglycine, a tripeptide. ... The introduction to this article provides insufficient context for those unfamiliar with the subject matter. ...


While most body cells require the action of insulin for glucose to gain entry into the cell, the cells of the retina, kidney and nervous tissues are insulin-independent. Therefore there is a free interchange of glucose from inside to outside of the cell, regardless of the action of insulin, in the eye, kidney and neurons. The cells will use glucose for energy as normal, and any glucose not used for energy will enter the polyol pathway and be converted into sorbitol. Under normal blood glucose levels, this interchange will cause no problems, as aldose reductase has a low affinity for glucose at normal concentrations.


However, in a hyperglycemic state (Diabetes), the affinity of aldose reductase for glucose rises, meaning much higher levels of sorbitol and much lower levels of NADPH, a compound used up when this pathway is activated. The sorbitol can not cross cell membranes, and when it accumulates, it produces osmotic stresses on cells by drawing water into the cell. Fructose does essentially the same thing, and it is created even further on in the chemical pathway.


The NADPH, used up when the pathway is activated, acts to promote nitric oxide and glutathione production, and its conversion during the pathway leads to reactive oxygen molecules. Glutathione deficiencies can lead to hemolysis caused by oxidative stress, and we already know that nitric oxide is one of the important vasodilators in blood vessels. NAD+, which is also used up, is necessary to keep reactive oxygen species from forming and damaging cells.


In summary, excessive activation of the Polyol pathway leads to increased levels of sorbitol and reactive oxygen molecules and decreased levels of nitric oxide and glutathione, as well as increased osmotic stresses on the cell membrane. Any one of these elements alone can promote cell damage, but here we have several acting together.


Experimental evidence has yet to confirm that the polyol pathway actually is responsible for microvasculature damage in the retina, kidney and/or neurons of the body. However, physiologists are fairly certain that it plays some role in neuropathy.


Clinical manifestations

Diabetic neuropathy affects all peripheral nerves: pain fibers, motor neurons, autonomic nerves. It therefore necessarily can affect all organs and systems since all are innervated. There are several distinct syndromes based on the organ systems and members affected, but these are by no means exclusive. A patient can have sensorimotor and autonomic neuropathy or any other combination. Symptoms vary depending on the nerve(s) affected and may include symptoms other than those listed. Symptoms usually develop gradually over years. The term symptom (from the Greek syn = con/plus and pipto = fall, together meaning co-exist) has two similar meanings in the context of physical and mental health: Strictly, a symptom is a sensation or change in health function experienced by a patient. ...


Usual symptoms may be:

Categories: Possible copyright violations ... Types 5-7 on the Bristol Stool Chart are often associated with diarrhea Diarrhea (in American English) or diarrhoea (in British English) is a generally unpleasant condition in which the sufferer has frequent watery, loose bowel movements (from the ancient Greek word διαρροή = leakage; literally meaning to run through). Acute infectious... Constipation or irregularity, is a condition of the digestive system where a person (or animal) experiences hard feces that are difficult to eliminate; it may be extremely painful, and in severe cases (fecal impaction) lead to symptoms of bowel obstruction. ... This article or section is not written in the formal tone expected of an encyclopedia article. ... Impotence or, more clinically, erectile dysfunction is the inability to develop or maintain an erection of the penis for satisfactory sexual intercourse regardless of the capability of ejaculation. ... // Pre-syncope is a sensation of feeling faint. ... Dysphagia (, not to be confused with dysphasia) is a medical term defined as difficulty swallowing. It derives from the Greek root dys meaning difficulty or disordered, and phagia meaning to eat. It is a sensation that suggests difficulty in the passage of solids or liquids from the mouth to the... This article or section does not cite its references or sources. ... A fasciculation (or muscle twitch) is a small, local, involuntary muscle contraction (twitching) visible under the skin arising from the spontaneous discharge of a bundle of skeletal muscle fibres. ...

Sensorimotor polyneuropathy

Longer nerve fibers are affected to a greater degree than shorter ones, because nerve conduction velocity is slowed in proportion to a nerve's length. In this syndrome, decreased sensation and loss of reflexes occurs first in the toes bilaterally, then extends upward. It is usually described as glove-stocking distribution of numbness, sensory loss, dysesthesia and nighttime pain. The pain can feel like burning, pricking sensation, achy or dull. Pins and needles sensation is common. Loss of proprioception, that is, the sense of where a limb is in space, is affected early. These patients cannot feel when they are stepping on a foreign body, like a splinter, or when they are developing a callous from an ill-fitting shoe. Consequently, they are at risk for developing ulcers and infections on the feet and legs, which can lead to amputation. Similarly, these patients can get multiple fractures of the knee, ankle or foot, and develop a Charcot joint. Loss of motor function results in dorsiflexion contractures of the toes, loss of the interosseous muscle function and leads to contraction of the digits, so called hammertoes. These contractures occur not only in the foot but also in the hand where the loss of the musculature makes the hand appear gaunt and skeletal. The loss of muscular function is progressive. Categories: Possible copyright violations ... Proprioception (from Latin proprius, meaning ones own and perception) is the sense of the relative position of neighbouring parts of the body. ... Endoscopic images of a duodenal ulcer. ... Partial hand amputation For the song Amputations by Death Cab for Cutie, see You Can Play these Songs with Chords Amputation is the removal of a body extremity by trauma (also referred to as avulsion) or surgery. ... Neuropathic osteoarthropathy refers to progressive degeneration of a weight-bearing joint, a process marked by bony destruction, bone resorption, and eventual deformity. ... Contracture can refer to: Dupuytrens contracture Volkmanns contracture Capsular contracture This is a disambiguation page: a list of articles associated with the same title. ... In podiatry, a hammertoe is the lay description of contracted digits of the foot. ...


Autonomic neuropathy

The autonomic nervous system is composed of nerves serving the heart, gastrointestinal system and urinary-genital system. Autonomic neuropathy can affect any of these organ systems. The most commonly recognized autonomic dysfunction in diabetics is orthostatic hypotension, or the uncomfortable sensation of fainting when a patient stands up. In the case of diabetic autonomic neuropathy, it is due to the failure of the heart and arteries to appropriately adjust heart rate and vascular tone to keep blood continually and fully flowing to the brain[failure of the sensitivty of the baroreceptors]. This symptom is usually accompanied by a loss of sinus respiratory variation, that is, the usual change in heart rate seen with normal breathing. When these 2 findings are present, cardiac autonomic neuropathy is present. This article or section is in need of attention from an expert on the subject. ... The heart and lungs, from an older edition of Grays Anatomy. ... For the Physics term GUT, please refer to Grand unification theory The gastrointestinal or digestive tract, also referred to as the GI tract or the alimentary canal or the gut, is the system of organs within multicellular animals which takes in food, digests it to extract energy and nutrients, and... Autonomic neuropathy is a disease of the non-voluntary, non-sensory nervous system affecting mostly the internal organs such as the bladder muscles, the cardiovascular system, the digestive tract, and the genital organs. ... In physiology and medicine, hypotension refers to an abnormally low blood pressure. ... The term Faint redirects here. ... For more specific information about the human brain, see its main article at human brain A sketch of the human brain by artist Priyan Weerappuli, imposed upon his sketch of the profile of Michaelangelos David In animals, the brain, or encephalon (Greek for in the head), is the control...


GI tract manifestations include delayed gastric emptying, gastroparesis, nausea, bloating, and diarrhea. Because many diabetics take oral medication for their diabetes, absorption of these medicines is greatly affected by the delayed gastric emptying. This can lead to hypoglycemia when an oral diabetic agent is taken before a meal and does not get absorbed until hours, or sometimes days later, when there is normal or low blood sugar already. Sluggish movement of the small instestine can cause bacterial overgrowth, made worse by the presence of hyperglycemia. This leads to bloating, gas and diarrhea. Gastroparesis, also called delayed gastric emptying, is a disorder in which the stomach takes too long to empty its contents. ... For other uses, see Nausea (disambiguation). ... Bloating is any abnormal general swelling, or increase in diameter of the abdominal area. ... Types 5-7 on the Bristol Stool Chart are often associated with diarrhea Diarrhea (in American English) or diarrhoea (in British English) is a generally unpleasant condition in which the sufferer has frequent watery, loose bowel movements (from the ancient Greek word διαρροή = leakage; literally meaning to run through). Acute infectious... Hypoglycemia (hypoglycæmia in the UK) is a medical term referring to a pathologic state produced by a lower than normal amount of sugar (glucose) in the blood. ... Phyla Actinobacteria Aquificae Chlamydiae Bacteroidetes/Chlorobi Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Lentisphaerae Nitrospirae Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Verrucomicrobia Bacteria (singular: bacterium) are unicellular microorganisms. ... Hyperglycemia or High Blood Sugar is a condition in which an excessive amount of glucose circulates in the blood plasma. ... Bloating is any abnormal general swelling, or increase in diameter of the abdominal area. ... Types 5-7 on the Bristol Stool Chart are often associated with diarrhea Diarrhea (in American English) or diarrhoea (in British English) is a generally unpleasant condition in which the sufferer has frequent watery, loose bowel movements (from the ancient Greek word διαρροή = leakage; literally meaning to run through). Acute infectious...


Urinary symptoms include urinary frequency, urgency, incontinence and retention. Again, because of the retention of sweet urine, urinary tract infections are frequent. Urinary retention can lead to bladder diverticula, stones, reflux nephropathy. This article or section is not written in the formal tone expected of an encyclopedia article. ... This article or section is in need of attention from an expert on the subject. ... A urinary tract infection is an infection of the urinary tract. ...


Cranial neuropathy

When cranial nerves are affected, oculomotor (3rd) neuropathies are most common. The oculomotor nerve controls all of the muscles that move the eye with the exception of the lateral rectus and superior oblique muscles. It also serves to constrict the pupil and open the eyelid. The onset of a diabetic third nerve palsy is usually abrupt, beginning with frontal or periorbital pain and then diplopia. All of the oculomotor muscles innervated by the third nerve may be affected, except for those that control pupil size. This is because pupillary function within CNIII is found on the periphery of the nerve (in terms of a cross sectional view), which makes it less susceptible to ischemic damage (as it is closer to the vascular supply). The sixth nerve, the abducens nerve, which innervates the lateral rectus muscle of the eye (moves the eye laterally), is also commonly affected but fourth nerve, the trochlear nerve, (innervates the superior oblique muscle, which moves the eye downward) involvement is unusual. Mononeuropathies of the thoracic or lumbar spinal nerves can occur and lead to painful syndromes that mimic myocardial infarction, cholecystitis or appendicitis. Diabetics have a higher incidence of entrapment neuropathies, such as carpal tunnel syndrome. Cranial nerves are nerves which start directly from the brainstem instead of the spinal cord. ... The oculomotor nerve () is the third of twelve paired cranial nerves. ... A human eye. ... The lateral rectus muscle is a muscle in the orbit that abducts the eyeball (makes it move outwards). ... The superior oblique muscle is a muscle in the orbit that causes the eye to look downwards when it is already directed medially (looking towards the nose). ... The human eye The pupil is the central transparent area (showing as black). ... Diplopia, commonly known as double vision, is the perception of two images from a single object. ... The sixth of twelve cranial nerves, the abducens nerve is a motor nerve that innervates the lateral rectus muscle and therefore controls each eyes ability to abduct (move away from the midline). ... The fourth of twelve cranial nerves, the trochlear nerve controls the function of the superior oblique muscle, which rotates the eye away from the nose and also moves the eye downward. ... The term spinal nerve generally refers to the mixed spinal nerve, which is formed from the dorsal and ventral roots that come out of the spinal cord. ... Acute myocardial infarction (AMI or MI), commonly known as a heart attack, is a disease state that occurs when the blood supply to a part of the heart is interrupted. ... Cholecystitis is inflammation of the gallbladder. ... Appendicitis (or epityphlitis) is a condition characterized by inflammation of the appendix[1]. While mild cases may resolve without treatment, most require removal of the inflamed appendix, either by laparotomy or laparoscopy. ... It has been suggested that Carpal tunnel be merged into this article or section. ...


Treatment

Treatment of early manifestations of sensorimotor polyneuropathy involves improving glycemic control. Tight control of blood glucose can reverse the changes of diabetic neuropathy, but only if the neuropathy and diabetes is recent in onset. Conversely, painful symptoms of neuropathy in uncontrolled diabetics tend to subside as the disease and numbness progress. Of course, these uncontrolled patients are at great risk for diabetic foot ulcers and amputation because of neuropathy.


Despite advances in the understanding of the metabolic causes of neuropathy, treatments aimed at interrupting these pathological processes have been limited by side effects and lack of efficacy. Thus, treatments are symptomatic and do not address the underlying problems. Agents for pain caused by sensorimotor neuropathy include tricyclic antidepressants (TCAs), serotonin reuptake inhibitors (SSRIs) and antiepileptic drugs (AEDs). None of these agents reverse the pathological processes leading to diabetic neuropathy and none alter the relentless course of the illness; again, they just treat the pain. Chemical structure of the tricyclic antidepressant amitriptyline. ... Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants. ...


TCAs include imipramine, amitriptyline, desipramine and nortriptyline. These drugs are effective at decreasing painful symptoms but suffer from multiple side effects that are dosage dependent. One notable side effect is cardiac toxicity, which can lead to fatal arrhythmias. At low dosages used for neuropathy, toxicity is rare, but if symptoms warrant higher doses, complications are more common. Among the TCAs, amitriptyline is most widely used for this condition, but desipramine and nortriptyline have fewer side effects. This article or section does not cite its references or sources. ... Amitriptyline hydrochloride is an antidepressant drug from the tricyclic antidepressant group, which is sold under the trade names Elavil®, Tryptanol® or Endep®. It is a white, odorless, crystalline compound which is freely soluble in water. ... Desipramine is a tricyclic antidepressant (TCA) that inhibits the reuptake of norepinephrine. ... Nortriptyline is a tricyclic antidepressant marketed under the tradenames Aventyl® and Pamelor®. It is used to treat depression. ... A cardiac arrhythmia, also called cardiac dysrhythmia, is a disturbance in the regular rhythm of the heartbeat. ... // Toxic and Intoxicated redirect here – toxic has other uses, which can be found at Toxicity (disambiguation); for the state of being intoxicated by alcohol see Drunkenness. ... Adverse effect, in medicine, is an abnormal, harmful, undesired and/or unintended side-effect, although not necessarily unexpected, which is obtained as the result of a therapy or other medical intervention, such as drug/chemotherapy, physical therapy, surgery, medical procedure, use of a medical device, etc. ...


SSRIs include fluoxetine, paroxetine, sertraline and citalopram. They are less effective that TCAs in relieving pain, but are better tolerated. Side effects are rarely serious, and do not cause any permanent disabilities. They cause sedation and weight gain, which can worsen a diabetic's glycemic control. They can be used at dosages that also relieve the symptoms of depression, a common concommitent of diabetic neuropathy. SSRI is an acronym that stands for several things: It is a class of antidepressants called selective serotonin reuptake inhibitor SSRI also is used as the stock symbol for Silver Standard Resources Inc. ... Fluoxetine hydrochloride is an antidepressant drug used medically in the treatment of depression, body dysmorphic disorder, obsessive-compulsive disorder, bulimia nervosa, premenstrual dysphoric disorder, hypochondriasis and panic disorder. ... Paroxetine or paroxetine hydrochloride is a selective serotonin reuptake inhibitor (SSRI) antidepressant. ... Sertraline hydrochloride (also labeled under numerous brand names: Zoloft, Sertralin, Lustral, Apo-Sertral, Asentra, Gladem, Serlift, Stimuloton, Xydep, Serlain, Concorz) is a popular orally administered antidepressant of the selective serotonin reuptake inhibitor (SSRI) type. ... Citalopram is an antidepressant drug used to treat depression associated with mood disorders. ... Clinical depression (also called major depressive disorder, or sometimes unipolar when compared with bipolar disorder) is a state of intense sadness, melancholia or despair that has advanced to the point of being disruptive to an individuals social functioning and/or activities of daily living. ...


The SSNRI duloxetine (Cymbalta) is approved for diabetic neuropathy. By targeting both serotonin and norepinephrine, it targets the painful symptoms of diabetic neuropathy, and also treats depression if it exists. Typical dosages are between 60mg and 120mg. Serotonin norepinephrine reuptake inhibitors (SNRIs) are a class of antidepressant used in the treatment of clinical depression and other affective disorders. ... Duloxetine hydrochloride (brand names: Cymbalta/Yentreve and in parts of Europe known as Xeristar or Ariclaim) is a drug that primarily targets major depressive disorders (MDD), pain related to diabetic peripheral neuropathy and in some countries stress urinary incontinence (SUI). ...


AEDs, especially gabapentin and the related pregabalin, are emerging as first line treatment for painful neuropathy. Gabapentin compares favorably with amitriptyline in terms of efficacy, and is clearly safer. Its main side effect is sedation, which does not diminish over time and may in fact worsen. It needs to be takes three times a day, and it sometimes causes weight gain, which can worsen glycemic control in diabetics. Carbamazepine (Tegretol®) is effective but not necessarily safe for diabetic neuropathy. Its first metabolite, oxcarbazepine, is both safe and effective in other neuropathic disorders, but has not been studied in diabetic neuropathy. Topiramate has not been studied in diabetic neuropathy, but has the beneficial side effect of causing mild anorexia and weight loss, and is anecdotally beneficial. The anticonvulsants, sometimes also called antiepileptics, belong to a diverse group of pharmaceuticals used in prevention of the occurrence of epileptic seizures. ... Gabapentin (brand name: Neurontin®) was initially synthesized to mimic the structure of GABA for the treatment of epilepsy. ... Pregabalin (brand name: Lyrica®) is a new anticonvulsant drug indicated as an add on therapy for partial onset seizures and for certain types of neuropathic pain. ... Carbamazepine (sold under the brand-names Biston, Calepsin, Carbatrol, Epitol, Equetro, Finlepsin, Sirtal, Stazepine, Tegretol, Telesmin, Timonil) is an anticonvulsant and mood stabilizing drug, used primarily in the treatment of epilepsy and bipolar disorder. ... Topiramate (brand name: Topamax®) is an anticonvulsant drug produced by Ortho-McNeil Neurologics, a division of Johnson & Johnson. ... Anorexia (deriving from the Greek α(ν)- (a(n)-, a prefix that denotes absence) + όρεξη (orexe) = appetite) is the decreased sensation of appetite. ... Weight loss, in the context of medicine or health, is a reduction of the total body weight, which can mean loss of fluid, muscle or bone mass, or fat. ...


Methylcobalamin, a special form of Vitamin B12, is being studied now for treatment of neuropathy, both injected and oral. Initial studies[1] and anecdotal evidence in cats[2] have been very encouraging.[3]. Chemical structure of Vitamin B12 The term vitamin B12 (or B12 for short) is used in two different ways. ... Cobalamin or vitamin B12 is a chemical compound that is also known as cyanocobalamine. ...


Prognosis

The mechanisms of diabetic neuropathy are poorly understood. At present, treatment alleviates pain and can control some associated symptoms, but the process is generally progressive.


As a complication, there is an increased risk of injury to the feet because of loss of sensation (see diabetic foot). Small infections can progress to ulceration (skin and soft tissue breakdown) and this may require amputation. In addition, motor nerve damage can lead to muscle breakdown and imbalance. Diabetic foot is an umbrella term for foot problems in patients with diabetes mellitus. ... An infection is the detrimental colonization of a host organism by a foreign species. ... Endoscopic images of a duodenal ulcer. ... It has been suggested that this article or section be merged with Epidermis (skin). ... Partial hand amputation For the song Amputations by Death Cab for Cutie, see You Can Play these Songs with Chords Amputation is the removal of a body extremity by trauma (also referred to as avulsion) or surgery. ... A top-down view of skeletal muscle Muscle (from Latin musculus little mouse[1]) is contractile tissue of the body and is derived from the mesodermal layer of embryonic germ cells. ...


See also

This article is about the disease that features high blood sugar. ... Neuropathy, strictly speaking, is any disease that affects the nervous system. ...

References

  • The Diabetes Control and Complications Trial Research Group. The effect of intensive diabetes therapy on the development and progression of neuropathy. Ann Intern Med 1995;122:561-8. PMID 7887548.

External links

  • Diabetic Nerve Problems. MedlinePlus' extensive reference list of pertinent sites.
  • Diabetic Neuropathy. Medical Encyclopedia, Medline Plus (US government public domain site, partially used here)
  • Diabetic Neuropathy: An Intensive Review in Medscape from WebMD (partially used in summarized form).
  • Diabetic Polyneuropathy in Medscape from WebMD (partially used in summarized form).
  • National Diabetes Information Clearinghouse

  Results from FactBites:
 
Diabetic neuropathy - definition of Diabetic neuropathy in Encyclopedia (1614 words)
Diabetic neuropathy is implicated in 50-75% of nontraumatic amputations.
PKC is implicated in the pathology of diabetic neuropathy.
Diabetic Polyneuropathy (http://www.medscape.com/viewprogram/705) in Medscape from WebMD (summarized, not plagiarized).
MedlinePlus Medical Encyclopedia: Diabetic neuropathy (629 words)
Diabetic neuropathy is a common complication of diabetes mellitus in which nerves are damaged as a result of hyperglycemia (high blood sugar levels).
The goals of treating diabetic neuropathy are to prevent progression and reduce the symptoms of the disease.
The mechanisms of diabetic neuropathy are poorly understood.
  More results at FactBites »

 
 

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