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Diabetes mellitus is the disease associated with the elevatedblood sugar. It can be caused by the genetically predisposed lack of the insulin orby the body unresponsiveness to insulin. Untreated diabetes may cause severe healthcomplications, one of which is the neuropathy (or more precise neuropathicdisorders).

Diabetes damages the blood vessels, causing micro- and macro-vascularinjuries, leading to diabetic neuropathy. Conditions commonly caused bydiabetic neuropathy are: mononeuropathy, mononeuropathy multiplex, amyotrophy, thirdnerve palsy, polyneuropathy and autonomic and thoracoabdominal neuropathy.

There are several factors included in the development andprogress of the neuropathy in diabetic patients, including: microangiopathy, proteinkinase C, glycosylated proteins and increased levels of sorbitol and reactiveoxygen radicals.

Symptoms

Diabetes damages all peripheral nerves and because of thatcan affect all organs and systems in the body. There are no specific symptoms associatedwith diabetic neuropathy, and a patient may experience many various symptoms. Inmost cases, first signs of peripheral neuropathy are numbness and tingling inthe fingers and/or toes, or any other part of the limbs.

People affected by diabetic nephropathy may also experience burning,or electric pain, gradual decrease of sensations in some parts of the body(dysesthesia), drooping of the mouth, face or eyelids, swallowing difficultiesor speech problems.

Some patients can suffer from muscle weakness, involuntarymuscle contractions (fasciculation), diarrhea, urinary problems and dizzinessand vision problems. Diabetic patients may also experience various sexualproblems, such as impotence, erectile dysfunction or anorgasmia.

Cranial neuropathy is associated with third nerve palsy, and is characterized by the frontal or pain behind the eyes and also diplopia (visionproblems). If the neuropathy involves thoracic or lumbar spine nerves patient’ssymptoms might resemble heart attack, appendicitis or cholecystitis(inflammation of the appendix and gall bladder).

Treatment of Diabetic Neuropathy

The therapy can’t do much about the cause of the diabeticneuropathy, but can only manage the blood glucose level and relieve some of thesymptoms and the pain. The FDA (Food and Drug Administration) has approved onlyduloxetine and pregabalin for the treatment of diabetic neuropathy. Localized symptomscan also be treated with patches of lidocaine.

The most commonly used medications are tricyclicantidepressants (TCAs), like: imipramine, amitriptyline, desipramine andnortriptyline. These drugs are efficient, but their use is connected to severe heart-relatedside effects, especially in high doses.

Serotonin reuptake inhibitors (SSRIs) fluoxetine,paroxetine, sertraline and citalopram are also used in the treatment of diabeticneuropathy.

Antiepileptic medications, especially gabapentin andpregabalin also have the role in the diabetic neuropathy treatment, sometimescombined with other drugs, like amitriptiline.

Pain killers like opioids and non-steroidalanti-inflammatory drugs (NSAIDs) are used to treat the diabetic neuropathypains. Some newer treatments might include: alpha lipoic acid,methylcobalamain, C-peptide, TENS (transcutaneous electric nerve stimulation)or photo energy therapy.

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