Diabetic neuropathy (मधुमेही न्यूरोपैथी) is a nerve-damaging disorder associated with diabetes mellitus. These conditions are thought to result from a diabetic microvascular injury involving small blood vessels that supply nerves in addition to macrovascular conditions that can accumulate in diabetic neuropathy. Relatively common conditions which may be associated with diabetic neuropathy include third, fourth, or sixth cranial nerve palsy; mononeuropathy; mononeuropathy multiplex; diabetic amyotrophy; a painful polyneuropathy; autonomic neuropathy; and thoracoabdominal neuropathy. Being diabetes mellitus of complicated nature, Siddha Spirituality of Swami Hardas Life System considers our readers to know about in detail about diabetic neuropathy.
Diabetic neuropathy is a type of nerve damage that can occur if you have diabetes. High blood sugar (glucose) can injure nerves throughout your body. Diabetic neuropathy most often damages nerves in your legs and feet.
Diabetic neuropathy Symptoms (मधुमेह न्यूरोपैथी के लक्षण)
The diabetic neuropathy can affect all organs and systems, as all are innervated. There are several distinct syndromes based on the organ systems and members affected, but these are by no means exclusive. Signs and symptoms vary depending on the nerve (s) affected and may include symptoms other than those listed. Symptoms usually develop gradually over years.
Symptoms may include the following:
- Trouble with balance
- Numbness and tingling of extremities
- Abnormal sensation to a body part (Dysesthesia)
- Erectile dysfunction
- Loss of bladder control (Urinary incontinence)
- Facial, mouth and eyelid drooping
- Vision changes
- Muscle weakness
- Difficulty swallowing
- Speech impairment
- Muscle contractions (Fasciculation)
- Retrograde ejaculation (in males)
- Burning or electric pain
Diabetic neuropathy Pathogenesis (मधुमेह न्यूरोपैथी रोगजनन)
The following factors are thought to be involved in the development of diabetic neuropathy:
Microvascular disease (सूक्ष्म रोग)
The first pathological change in the small blood vessels is narrowing of the blood vessels. As the disease progresses, neuronal dysfunction correlates closely with the development of blood vessel 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.
Blood vessel opening agents can lead to substantial improvements in neuronal blood flow, with corresponding improvements in nerve conduction velocities. Thus, small blood vessel 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.
Advanced glycated end products (उन्नत ग्लाइकेटेड अंत उत्पाद)
Elevated levels of glucose within cells cause a non-enzymatic covalent bonding with proteins, which alters their structure and inhibits their function. Some of these glycated proteins have been implicated in the pathology of diabetic neuropathy and other long-term complications of diabetes.
Polyol pathway (पॉलोल मार्ग)
Sensorimotor polyneuropathy (ज्ञानेन्द्रिय पोलीन्यूरोपैथी)
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 on each foot, then extends upward. It is usually described as a glove-stocking distribution of numbness, sensory loss, dysesthesia, and nighttime pain.
The pain can feel like:
- Prickling sensation
- Achy or dull
Pins and needles sensation is common. Loss of proprioception, 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 of 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 that leads to contraction of the digits, so-called hammertoes. These contractures occur not only in the foot but also in the hand.
Autonomic neuropathy (ऑटोनोमिक न्यूरोपैथी)
The autonomic nervous system is composed of nerves serving the:
- Blood vessels
- Adipose tissue
- Sweat glands
- Gastrointestinal system
- Genitourinary system
Autonomic neuropathy can affect any of these organ systems. The most commonly recognized autonomic dysfunction in diabetics is orthostatic hypotension, or becoming dizzy and possibly fainting when standing up due to a sudden drop in blood pressure.
GI tract manifestations include 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.
Cranial neuropathy (क्रेनियल न्यूरोपैथी)
When cranial nerves are affected, neuropathies of the oculomotor nerve are most common. The oculomotor nerve controls all the muscles that move the eye except for 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.
Diabetic neuropathy Diagnosis (मधुमेह न्यूरोपैथी निदान)
Diabetic neuropathy encompasses a series of different neuropathic syndromes which can be schematized in the following way:
- Focal and multifocal neuropathies:
- Amyotrophy, radiculopathy
- Multiple lesions “mononeuritis multiplex”
- Entrapment (e.g. median, ulnar, peroneal)
- Symmetrical neuropathies:
- Acute sensory
- Distal symmetrical polyneuropathy (DSPN), the diabetic type of which is also known as diabetic peripheral neuropathy
Diabetic neuropathy Treatment (मधुमेह न्यूरोपैथी का उपचार)
Except for tight glucose control, treatments are for reducing pain and other symptoms.
Medication options for pain control include:
- Antiepileptic drugs (AEDs)
- Serotonin-norepinephrine reuptake inhibitors (SNRIs)
- Tricyclic antidepressants (TCAs)
- Capsaicin cream, about 10% of people who use capsaicin cream have a large benefit
A systematic review concluded that “Tricyclic antidepressants and Traditional anticonvulsants are better for short term pain relief than newer generation anticonvulsants.”
The only three medications approved by the United States’ Food and Drug Administration for Diabetic Peripheral Neuropathy (DPN) are the antidepressant duloxetine, the anticonvulsant pregabalin, and the long-acting opioid tapentadol ER. Before trying a systemic medication, some doctors recommend treating localized diabetic peripheral neuropathy with lidocaine patches.
Antiepileptic drugs (एंटीपीलेप्टिक दवाएं)
Multiple guidelines from medical organizations such as the American Association of Clinical Endocrinologists, American Academy of Neurology, European Federation of Neurological Societies, and the National Institute of Clinical Excellence recommend AEDs, such as Pregabalin, as first-line treatment for painful diabetic neuropathy.
Pregabalin is supported by low-quality evidence as to more effective than placebo for reducing diabetic neuropathic pain but its effect is small.
Serotonin-norepinephrine reuptake inhibitors (सेरोटोनिन-नॉरपेनेफ्रिन अवरोध करनेवाला)
As above, the Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) duloxetine and venlafaxine are recommended in multiple medical guidelines as first or second-line therapy for DPN.
Selective serotonin reuptake inhibitor (चयनात्मक सेरोटोनिन-नॉरपेनेफ्रिन अवरोध करनेवाला)
SSRIs include Fluoxetine, Paroxetine, Sertraline, and Citalopram have been found to be no more efficacious than placebo in several controlled trials and therefore are not recommended to treat painful diabetic neuropathy. Side effects are rarely serious and do not cause any permanent disabilities.
Tricyclic antidepressants (ट्राइसाइक्लिक एंटीडिप्रेसेंट्स)
TCAs include Imipramine, Amitriptyline, Desipramine, and Nortriptyline. They are generally regarded as a first or second-line treatment for DPN. Of the TCAs, Imipramine has been the best studied. These medications are effective at decreasing painful symptoms but suffer from multiple side effects that are dose-dependent.
Opioids (नशीले पदार्थ)
Typical opioid medications, such as Oxycodone, appear to be no more effective than placebo. In contrast, low-quality evidence supports a moderate benefit from the use of atypical opioids e.g., Tramadol and Tapentadol, which also have SNRI properties. Opioid medications are recommended as a second or third-line treatment for DPN.
Topical agents (सामयिक एजेंट)
Capsaicin applied to the skin in a 0.075% concentration has not been found to be more effective than placebo for treating pain associated with diabetic neuropathy. There is insufficient evidence to draw conclusions for more concentrated forms of Capsaicin, Clonidine or Lidocaine applied to the skin.
Diabetic neuropathy Medical devices (मधुमेह न्यूरोपैथी चिकित्सा उपकरण)
Monochromatic infrared photo energy treatment (MIRE) has been shown to be an effective therapy in reducing and often eliminating pain associated with diabetic neuropathy. The studied wavelength of 890 nm is able to penetrate into the subcutaneous tissue where it acts upon a specialized part of the cell called the cytochrome C. The infrared light energy prompts the cytochrome C to release nitric oxide into the cells.
The nitric oxide, in turn, promotes vasodilation which results in increased blood flow that helps nourish damaged nerve cells. Once the nutrient-rich blood is able to reach the affected areas (typically the feet, lower legs, and hands) it promotes the regeneration of nerve tissues and helps reduce inflammation thereby reducing and/or eliminating pain in the area.
Physical therapy for Diabetic neuropathy (मधुमेह न्यूरोपैथी के लिए भौतिक चिकित्सा)
Physical therapy may help reduce dependency on pain-relieving drug therapies. Certain physiotherapy techniques can help alleviate symptoms brought on from diabetic neuropathy such as:
- Deep pain in the feet and legs
- Tingling or burning sensation in extremities
- Muscle cramps
- Muscle weakness
- Sexual dysfunction
- Diabetic foot
Gait training, posture training, and teaching these patients the basic principles of off-loading can help prevent and/or stabilize foot complications such as foot ulcers.
Exercise programs, along with manual therapy, will help to prevent muscle contractures, spasms, and atrophy. These programs may include general muscle stretching to maintain muscle length and a person’s range of motion.
Aerobic exercise such as swimming and using a stationary bicycle can help peripheral neuropathy, but activities that place excessive pressure on the feet e.g. walking long distances, running may be contraindicated.
Heat, therapeutic ultrasound, hot wax are also useful for treating diabetic neuropathy. Pelvic floor muscle exercises can improve sexual dysfunction caused by neuropathy.
Tight glucose control (तंग ग्लूकोज नियंत्रण)
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 are recent in onset.
Diabetic neuropathy Prognosis (मधुमेही न्यूरोपैथी रोग का निदान)
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 the loss of sensation. Small infections can progress to ulceration and this may require amputation.
Diabetic neuropathy Epidemiology (मधुमेह न्यूरोपैथी महामारी विज्ञान)
Globally diabetic neuropathy affects approximately 132 million people as of 2010 (1.9% of the population).
Diabetes is the leading known cause of neuropathy in developed countries. Neuropathy is the most common complication and greatest source of morbidity and mortality in diabetes.
Diabetic neuropathy is implicated in 50–75% of nontraumatic amputations.
Diabetic neuropathy Risk factors (मधुमेह न्यूरोपैथी जोखिम कारक)
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.
Home remedies for diabetic neuropathy (मधुमेह न्यूरोपैथी के लिए घरेलू उपचार)
There are also a number of natural home treatments to help reduce symptoms:
Some cases of diabetic neuropathy are related to vitamin deficiencies. Vitamin B is essential for nerve health. A deficiency can lead to significant nerve damage.
While you can get vitamin B from your meals, your doctor may also recommend taking a supplement. Stick to the recommended dose to prevent toxicity and worsening symptoms.
Vitamin D can also help prevent nerve pain. Your skin typically produces vitamin D in response to sunlight. A deficiency can cause neuropathy pain. Taking a supplement can help reduce the symptoms of neuropathy.
Cayenne pepper (लाल मिर्च)
Cayenne pepper contains capsaicin, an ingredient in hot peppers that makes them spicy. Capsaicin has been used in topical creams for pain relief properties. It decreases the intensity of pain signals sent through the body.
Incorporating cayenne pepper in your diet or taking a capsaicin supplement can help to reduce neuropathy pain.
Topical capsaicin ointments can also be used on the body. Although it may initially burn, continued use will gradually reduce neuropathy sensations.
Quit smoking (धूम्रपान छोड़ना)
Smoking affects your blood circulation. The blood vessels narrow and less oxygenated blood can get through. Without proper blood circulation, you may experience increased numbness and pain from your diabetic neuropathy. Eliminating smoking habits can help to improve your symptoms. Let this motivate you to make positive changes.
A warm bath (गरम स्नान)
Taking a warm bath can be soothing and can also alleviate pain symptoms from neuropathy. Warm water increases blood circulation throughout the body, decreasing pain symptoms from numbness.
Regular exercise can help to combat pain and improve your overall health. Being active can reduce your blood sugar, which, in turn, can reduce or slow down nerve damage. Exercise also increases blood flow to your arms and legs and reduces stress. These are all factors that help to reduce discomfort and pain.
Essential oils (आवश्यक तेल)
Some essential oils, including chamomile and Roman lavender, help to increase circulation in the body. They also have pain-relieving and anti-inflammatory properties that could boost healing.
Dilute essential oils (a few drops) in 1 ounce of carrier oil such as olive oil. Applying these diluted oils to the affected area can reduce stinging and tingling pains from diabetic neuropathy.
Meditation techniques can help people struggling with neuropathy symptoms live through their pain. It can help to lower stress, improve your coping skills, and decrease your pain intensity. Taking a mind-body approach is a noninvasive technique that provides you with more control over your condition.
Acupuncture promotes natural healing by stimulating the body’s pressure points. This technique triggers the nervous system to release chemicals that can change the pain experience or threshold. Acupuncture helps to provide an energy balance to the body that can affect your emotional well-being.
Diabetic neuropathy & Free Siddha Energy Remedies (मधुमेह न्यूरोपैथी और नि:शुल्क सिद्ध ऊर्जा उपचार)
As there are no treatments to cure any type of diabetes, one may resort to other sources e.g. Ayurveda, Homeopathy, Yoga, Home remedies, which depends on the choice of the sufferer. One may also try the free Siddha energy remedies mentioned in the article named diabetes mellitus. Desirous persons can undergo training of Swami Hardas Life System, just learn the methods and apply instantly. The benefits are sure.
Training of Swami Hardas Life System (स्वामी हरदास लाइफ सिस्टम का प्रशिक्षण)
Any problem with regard to health, peace, and progress can be solved independently without money and medicines by undergoing training of Swami Hardas Life System. Any person irrespective of religion, caste, creed, faith, sex, and age can undergo this unique training.
In view of the above, I am confident that you have learned about diabetic neuropathy, definition, classification, risk factors, management, treatment, medication, and also learned free Siddha energy remedies. Now, you have become self-sufficient. Hence its right time to use your acquired knowledge for solving problems as per the provision available in Siddha Spirituality of Swami Hardas Life System.
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