What is diabetic neuropathy?

Neuropathy is a complication of diabetes that can lead to problems throughout the body. 糖尿病会影响控制运动、感觉和其他功能的神经.

If you have diabetes, you can develop nerve problems at any time. Sometimes, neuropathy can be the first sign of diabetes. 显著的神经问题(临床神经病变)可在糖尿病诊断后的前10年内发展. 患糖尿病的时间越长，患神经病变的风险就越大. About half of people with diabetes have some form of neuropathy.

What causes diabetic neuropathy?

Although the exact causes of diabetic neuropathy are unknown, several factors may contribute to the disorder, including:

• High blood sugar (glucose). 高血糖会引起神经的化学变化，损害神经传递信号的能力. 它还会损害向神经输送氧气和营养物质的血管.
• Metabolic factors. In addition to glucose levels, 高甘油三酯和胆固醇水平也与神经病变的风险增加有关. 超重或肥胖的患者患神经病变的风险也会增加.
• Inherited factors. 有一些遗传特征可能使一些人比其他人更容易患神经疾病.

What are the symptoms and types of diabetic neuropathy?

糖尿病神经病变的症状取决于神经病变的类型以及受影响的神经的种类和数量.

Focal Neuropathy (Diabetic Mononeuropathy)

This type of diabetic neuropathy affects one nerve at a time, and the symptoms depend on which nerve is affected. For example, 它可以影响胸部神经(胸神经)，引起胸壁麻木和疼痛 angina, heart attack or appendicitis.

Other types of focal neuropathy can cause:

• Pain in the thighs.
• Severe pain in lower back or pelvis.
• Pain in the chest, stomach or flank.
• Aching behind the eyes.
• Inability to focus the eyes.
• Double vision.
• Paralysis on one side of the face.
• Hearing problems.

Diabetic Polyneuropathy

糖尿病多发性神经病变(DPN)影响从脊髓分支到手臂的多个外周感觉和运动神经, hands, legs and feet. 通常，最长的神经——从脊柱延伸到脚的神经——受影响最大.

DPN can cause:

• 不寻常的感觉(感觉异常)，如刺痛、灼烧或刺痛.
• Numbness and pain in the hands, legs and feet.
• Weakness of the muscles in the feet and hands.
• Sharp pains or cramps.
• Extreme sensitivity to touch.
• Insensitivity to pain or temperature changes.
• 失去平衡或协调性，在凹凸不平的地面上行走困难.

Because it inhibits the ability to sense problems, DPN can put a person at risk for injuries of the feet and toes, and lead to the development of ulcers, wounds and chronic infections in the feet.

Some mild cases of DPN may go unnoticed for years, 但神经损伤的恶化会导致严重的疼痛，并使最简单的日常活动——比如睡觉或走路——变得非常不舒服.

If left untreated, DPN can result in further nerve damage to other parts of the body, such as the eyes, digestive tract and sexual organs. It also is the primary cause of amputations, 导致美国几乎每五分半钟就有一例病例.

DPN有两种不同的类型:糖尿病自主神经病变和近端神经病变.

Diabetic Autonomic Neuropathy

糖尿病自主神经病变主要影响服务于内脏器官的自主神经, processes, and systems of the heart, digestive system, sexual organs, urinary tract and sweat glands.

This kind of diabetic polyneuropathy can cause symptoms such as:

• Persistent nausea and vomiting.
• Diarrhea, constipation.
• Sweating abnormalities.
• Sexual dysfunction.
• Digestive problems.
• Low blood pressure.
• Impaired perception of pain.
• Hypoglycemia.

Proximal Neuropathy (Diabetic Amyotrophy)

Proximal neuropathy is known by many names, 这是一种相对罕见的糖尿病神经病变，发生在约1%的2型糖尿病患者中. It tends to affect older adults, 并且可以袭击那些最近确诊或控制良好的糖尿病患者.

主要症状是神经疼痛，从一条腿的大腿上部开始，可累及臀部和下背部. 体重减轻是约35%的近端神经病变患者的症状, 大约18%的人除了疼痛外，还会感到受影响的部位虚弱. Rarely, proximal neuropathy can occur in the arm.

As the condition progresses over months, 疼痛可扩散到双腿的上部和下部. After several months, symptoms tend to ease up, but patients can be left with lasting disability, including foot drop and recurrence of symptoms.

糖尿病神经病变的症状可能类似于其他疾病或医学问题. Always consult your doctor for a diagnosis.

How is diabetic neuropathy diagnosed?

糖尿病神经病变的早期诊断为患者提供了最佳的有效治疗机会. But since not all foot or limb pain means diabetic neuropathy, accurate diagnosis is important to ensure appropriate treatment.

Diagnosis of diabetic neuropathies is based on history, clinical examination and supporting laboratory tests. Your doctor may:

• Check muscle strength and reflexes.
• 检查肌肉对位置、振动、温度和轻触的敏感度.
• Request additional tests, such as:
• 用超声波来确定泌尿道的功能.
• 肌电图测定肌肉对电脉冲的反应.
• 神经传导研究检查电流通过神经的流动.
• Skin biopsies to evaluate cutaneous nerve innervation.
• Nerve and muscle biopsies for histopathological evaluation.

A comprehensive evaluation — including a review of blood pressure, 胆固醇和血糖筛查-结合更高级的筛查, helps the doctor rule out other causes and identify the core problem.

What is the treatment for diabetic neuropathy?

糖尿病神经病变的治疗包括两个阶段:改变生活方式，有时使用药物来达到最佳的糖尿病控制, and symptomatic control of pain and other complications.

Controlling Blood Glucose Levels

控制血糖水平不能逆转神经损伤，但可以防止进一步损伤的发生. Your doctor will give you specific blood sugar goals. 控制这些水平包括吃健康的饮食高蛋白和低碳水化合物. 当你吃碳水化合物时，尽量选择纤维含量较高的食物，避免薯片和苏打水.

定期锻炼可以通过增加胰岛素敏感性来帮助控制血糖水平, meaning you’ll need to take less insulin each day. 充足的睡眠也很重要，因为我们经常在过度疲劳时渴望高碳水化合物食物.

Improving Other Risk Factors

虽然控制血糖很重要，但这可能还不够. 同样重要的是控制其他风险因素，如高甘油三酯或胆固醇, treat high blood pressure and quit smoking. 每日有氧运动被证明可以保护神经并改善神经病变的结果. Losing weight is also important if a patient is obese or overweight.

Managing Pain and Other Complications

糖尿病神经病变可引起慢性疼痛和胃肠道问题等并发症, dizziness and weakness, and urinary or sexual problems. There are a variety of treatments that can help, including:

• Pain medications.
• Anti-seizure medications.
• Antidepressants.
• Topical creams.
• Transcutaneous electronic nerve stimulation (TENS) therapy.
• Hypnosis.
• Relaxation training.
• Biofeedback training.
• Acupuncture.

治疗将根据你的具体症状和神经病变的严重程度而有所不同.

每天检查脚上的问题也很重要，比如脚趾甲向内生长, blisters and sores, especially if you have peripheral neuropathy. 由于与神经病变相关的麻木，你可能感觉不到这些情况的发展. 保持脚的清洁和覆盖可以帮助保护他们免受伤害，防止进一步的并发症，如感染.