18. diabetic neuropathy

7/27/2019 18. Diabetic Neuropathy

1/7

Diabetic neuropathy:

Diabetic neuropathy is a type of nerve damage that can occur when the patient has

diabetes. High blood sugar can injure nerve fibers throughout the body, but diabetic

neuropathy most often damages nerves in the legs and feet.

Depending on the affected nerves, symptoms of diabetic neuropathy can range from pain

and numbness in the extremities to problems with digestive system, urinary tract, blood

vessels and heart. For some people, these symptoms are mild; for others, diabetic

neuropathy can be painful, disabling and even fatal.

Diabetic neuropathy is a common serious complication of diabetes. Yet one can often

prevent diabetic neuropathy or slow its progress with tight blood sugar control and a

healthy lifestyle.

Causes of diabetic neuropathy:

metabolic factors, such as high blood glucose, long duration of diabetes, abnormalblood fat levels, and possibly low levels of insulin

neurovascular factors, leading to damage to the blood vessels that carry oxygenand nutrients to nerves

autoimmune factors that cause inflammation in nerves mechanical injury to nerves, such as carpal tunnel syndrome inherited traits that increase susceptibility to nerve disease lifestyle factors, such as smoking or alcohol use

Symptoms of diabetic neuropathy:

Symptoms depend on the type of neuropathy and which nerves are affected. Some peoplewith nerve damage have no symptoms at all. For others, the first symptom is oftennumbness, tingling, or pain in the feet. Symptoms are often minor at first, and becausemost nerve damage occurs over several years, mild cases may go unnoticed for a longtime. Symptoms can involve the sensory, motor, and autonomicor involuntarynervous systems. In some people, mainly those with focal neuropathy, the onset of pain

may be sudden and severe.

Symptoms of nerve damage may include

numbness, tingling, or pain in the toes, feet, legs, hands, arms, and fingers wasting of the muscles of the feet or hands indigestion, nausea, or vomiting diarrhea or constipation


2/7

dizziness or faintness due to a drop in blood pressure after standing or sitting up problems with urination erectile dysfunction in men or vaginal dryness in women weakness

Symptoms that are not due to neuropathy, but often accompany it, include weight lossand depression.

Types of diabetic neuropathy:

Peripheral neuropathy

Autonomic

Proximal

Focal

Peripheral neuropathy

The most common type of diabetic neuropathy, causes pain or loss of feeling inthe toes, feet, legs, hands, and arms.

Peripheral neuropathy, also called distal symmetric neuropathy or sensorimotor

neuropathy, is nerve damage in the arms and legs. Symptoms of peripheral neuropathy

may include

numbness or insensitivity to pain or temperature a tingling, burning, or prickling sensation sharp pains or cramps extreme sensitivity to touch, even light touch loss of balance and coordination

Peripheral neuropathy may also cause muscle weakness and loss of reflexes, especially atthe ankle, leading to changes in the way a person walks. Foot deformities, such ashammertoes and the collapse of the midfoot, may occur. Blisters and sores may appear onnumb areas of the foot because pressure or injury goes unnoticed. If foot injuries are nottreated promptly, the infection may spread to the bone, and the foot may then have to beamputated.

Autonomic neuropathy


3/7

It affects the

heart and blood vessels digestive system urinary tract

sex organs sweat glands eyes lungs

The heart and blood vessels are part of the cardiovascular system, which controls bloodcirculation. Damage to nerves in the cardiovascular system interferes with the bodysability to adjust blood pressure and heart rate. As a result, blood pressure may dropsharply after sitting or standing, causing a person to feel light-headed or even to faint.

Nerve damage to the digestive system most commonly causes constipation. Damage can

also cause the stomach to empty too slowly, a condition called gastroparesis. Severegastro paresis can lead to persistent nausea and vomiting, bloating, and loss of appetite.Gastro paresis can also make blood glucose levels fluctuate widely, due to abnormal fooddigestion.

Nerve damage to the esophagus may make swallowing difficult, while nerve damage tothe bowels can cause constipation alternating with frequent, uncontrolled diarrhea,especially at night. Problems with the digestive system can lead to weight loss.

Finally, autonomic neuropathy can affect the pupils of the eyes, making them lessresponsive to changes in light. As a result, a person may not be able to see well when a

light is turned on in a dark room or may have trouble driving at night.

Autonomic neuropathy often affects the organs that control urination and sexualfunction. Nerve damage can prevent the bladder from emptying completely, allowingbacteria to grow in the bladder and kidneys and causing urinary tract infections. Whenthe nerves of the bladder are damaged, urinary incontinence may result because a personmay not be able to sense when the bladder is full or control the muscles that release urine.

Autonomic neuropathy can also gradually decrease sexual response in men and women,although the sex drive may be unchanged. A man may be unable to have erections or mayreach sexual climax without ejaculating normally. A woman may have difficulty with

arousal, lubrication, or orgasm.

When nerve damage prevents the sweat glands from working properly, the body cannotregulate its temperature as it should. Nerve damage can also cause profuse sweating atnight or while eating.


4/7

Proximal neuropathy

Here it affects the thighs, hips, buttocks and legs and Causes pain in the same regionand leads to weakness in the legs.

Proximal neuropathy, sometimes called lumbosacral plexus neuropathy, femoralneuropathy, or diabetic amyotrophy, starts with pain in the thighs, hips, buttocks, orlegs, usually on one side of the body.

This type of neuropathy is more common in those with type 2 diabetes and in olderadults with diabetes. Proximal neuropathy causes weakness in the legs and theinability to go from a sitting to a standing position without help. Treatment forweakness or pain is usually needed. The length of the recovery period varies,depending on the type of nerve damage.

Focal neuropathy

Focal neuropathy appears suddenly and affects specific nerves, most often in the head,torso, or leg. Focal neuropathy may cause

inability to focus the eye double vision aching behind one eye paralysis on one side of the face, called Bells palsy severe pain in the lower back or pelvis pain in the front of a thigh pain in the chest, stomach, or side pain on the outside of the shin or inside of the foot chest or abdominal pain that is sometimes mistaken for heart disease, a heart

attack, or appendicitis

Focal neuropathy is painful and unpredictable and occurs most often in older adults withdiabetes. However, it tends to improve by itself over weeks or months and does not causelong-term damage.

People with diabetes also tend to develop nerve compressions, also called entrapmentsyndromes. One of the most common is carpal tunnel syndrome, which causes numbnessand tingling of the hand and sometimes muscle weakness or pain. Other nerves

susceptible to entrapment may cause pain on the outside of the shin or the inside of thefoot.

In Ayurvedic view,


5/7

In diabetic neuropathy, when symptoms such as burning sensation are present, treatmentforpittavrutha vatam should be given.

When symptoms such as numbness is present, kaphavrutha vata treatment should begiven

PITTVTA VTAM

Principle of treatment

Dhthugata jvara cikitsa Uttana vtarakta cikitsa Pitta prameha chikitsa Visarpa chikitsa

Kayam

Mah majidi kayam 60 ml twice daily before food Gudcydi kayam 60 ml twice daily before food (A.H. Gana prakarnam) Nisottamdi kayam 60 ml twice daily before food (A.H. Kushtam) Niui adakam kayam 60 ml twice daily before food Pachanamrutham 60 ml twice daily before food

Tailam

Krabala tailam 1 teaspoon with milk at bed time after food (A.H.) Narayana 1 teaspoon with milk at night after food Vatashini 1 teaspoon with milk at night after food

Gulika

Kaiora guggulu 2 tablets twice daily after food (SharangadharaSamhita/A.H)

Amta guggulu 2 tablets twice daily after food

Gokurdi guggulu 2 tablets twice daily after food

Rasa ouadi

Vasantha kusumkara rasam 1 tablet twice daily after food (Rasendra SaraSangraha)

Pravla pii 1 tablet twice daily after food


6/7

Candraprabha vai 1 tablet twice daily after food

Udvartanam

ragvadadi cam, (A.H. Gana prakarnam)

Gudci cam

amana sneha pnam

Mah tiktaka ghtam- 1 tsp twice daily after food (A.H. Kushta chikitsa) Tiktaka ghtam -1 tsp twice daily after food

Abhyagam

Naryaa tailam For external application (SahasraYogam/SarangadharaSamhita)

Pida tailam For external application (A.H. Vata raktam) Ketakimooladi Aranalam

Dhnymla dhra

Mdhutailika ypana vasti

Rasyanam

Triphala rasyanam 1 teaspoon bd after food. Amalaka choornam 15 gms bd with plain water

KAPHVTA VTAM (Supthi)

Kayam

Bhnimbdi kayam 60 ml twice daily before food Aavargam kayam 60 ml twice daily before food (Sahasra yogam) Landi kayam 60 ml twice daily before food Asandi kayam 60 ml twice daily before food (A.H.Sutra sthanam

Ganam) Vatsakdi kayam 60 ml twice daily before food Suibaldi kayam 60 ml twice daily before food (Sahasra yogam)


7/7

Cam

Gudci satvam 1 teaspoon twice daily Pancha sama choornam 1 teaspoon twice daily with kashayam before food

Tailam (internal)

Ja piyka tailam -1tsp with milk at night after food Dhnvantaram tailam-1 tsp with milk at night after food (A.H)

Udvartanam

Kolakulattdi cam (Charaka Samhita) Eldi cam (A.H. Gulma cikitsa)

Abhyagam

Prabajanam tailam (Sahasra yogam) Cicdi tailam (Sahasra yogam) Via garba tailam Via mui tailam Kottumchukkadi Karpasasthyadi tailam

Lekana vasti 600 ml

Rasyanam

iva gulika 1 tablet twice daily after food Vardhamna pippali prayogam 2 grams on first day. Increase by 2 grams

each day till the dose reaches 20 grams. Then start reducing the dose by 2grams each day

18. diabetic neuropathy

Documents