Diabetic neuropathy
Diabetic neuropathy is the most common complication of diabetes.
Already at the discovery of diabetes about 14 - 30% of patients have some form of damage to the peripheral nervous system and after 25 years of the disease more than 50% of patients have diabetic neuropathy. About 13% of patients has painful diabetic polyneuropathy. Diabetic polyneuropathy implies damage to the peripheral nervous system as part of diabetes. In principle, we differentiate painful and painless (asymptomatic) polyneuropathy. Painful diabetic neuropathy disturbs the patient's sleep and functioning which can cause anxiety and depression and lead to a decrease in working ability.
Peripheral polyneuropathy affects the motoric and sensory nerves and is most expressed on the legs and the symptoms are: distal paresthesias, pains at night, muscle spasms, burning in the legs and feet, hypersensitivity to touch, pain from the touch of blanket, insensitivity of the feet to heat and cold and dry skin. All complaints appear symmetrically, first on the toes then on the feet and then on the lower parts of the lower legs.
As the disease progresses, it affects the hands as well, spreading from the fingers to the forearm. The complaints are more expressed at rest and at night, so they disturb sleep. As the disease progresses on the lower parts of the limbs, especially the legs, it causes hypotrophy of small muscles with consequent muscle weakness. In order to determine the type and degree of nerve damage, electroneurography is performed which is a reliable and repeatable method.
Treatment is complex and prevention would include good regulation of glycemia, patient education about regular movement, targeted exercises for the muscles of the feet and lower legs and prevention of foot injuries. Symptomatic medical treatment of pain is carried out according to the guidelines of the Croatian Society for Pain Management. Physical therapy methods such as transcutaneous electrostimulation (TENS) can be used in the treatment of painful diabetic polyneuropathy due to its effect on reducing pain.
