Medical history: type and duration of diabetes, family history of diabetes, history of smoking, history of alcohol consumption, past medical history, etc.
1.Distal symmetrical polyneuropathy: the disease is insidious and progresses slowly: the main symptoms are numbness, tingling and abnormal sensation at the end of the limbs, usually in a glove or garter-like distribution, mostly starting from the lower limbs, occurring symmetrically and in a length-dependent manner. The symptoms increase at night. Physical examination: dull skin color of the foot, sparse sweat hair, low skin temperature; hyperalgesia, hyperalgesia or absence of vibration sensation, normal or only mildly diminished ankle reflex, and basically intact motor function.
2. Focal mononeuropathy: It mainly involves the median nerve, ulnar nerve, radial nerve and the third, fourth, sixth and seventh cranial nerves. The incidence of facial palsy is also higher in diabetic patients than in non-diabetic patients. Most of them heal spontaneously after several months.
3. Asymmetrical multiple focal neuropathy: The onset is rapid, with predominant motor deficits, muscle weakness and atrophy, and diminished ankle reflexes, most of which will resolve spontaneously after several months.
4, multiple nerve root lesions: lumbar segment multiple nerve root degeneration onset more acute, mainly seen in the lower extremity proximal muscle group involvement, patients usually show a single affected limb proximal muscle pain, weakness, pain is deep persistent dull pain, heavy at night, muscle atrophy within 2-3 weeks, progressive progression, and after 6 months to reach the plateau.
5, autonomic neuropathy: cardiovascular autonomic symptoms: upright hypotension, syncope, abnormal coronary diastolic function, painless myocardial infarction, cardiac arrest or sudden death. Autonomic symptoms of the digestive system: constipation, diarrhea, epigastric fullness, stomach discomfort, dysphagia, erratic reflux, etc. Autonomic symptoms of the genitourinary system: urination disorder, urinary retention, urinary incontinence, urinary tract infection, decreased libido, impotence, menstrual disorders, etc. Other autonomic symptoms: such as abnormalities in thermoregulation and sweating, manifested by reduced or no sweating, which leads to dry and cracked hands and feet, prone to secondary infections. In addition, due to the lack of capillary tone, the veins are dilated, which can easily form local “microvascular tumors” and cause secondary infections. The reaction to hypoglycemia cannot be perceived normally, etc.
8. Diagnostic criteria of diabetic peripheral neuropathy.
1. A clear history of diabetes mellitus;
2.Neuropathy appearing at or after the diagnosis of diabetes mellitus;
3, clinical symptoms and signs consistent with the manifestations of DPN;
4, DPN is diagnosed if 2 or more of the following 5 tests are abnormal.
a. Abnormal temperature sensation;
b, nylon wire examination, reduced or absent sensation in the foot;
c. Abnormal vibration sensation;
d. Loss of ankle reflex;
e. 2 or more slowed nerve conduction velocity (NCV)
f, exclude other pathologies (such as cervical and lumbar spine pathology, cerebral infarction, Grinbarr’s syndrome, etc.): exclusion diagnosis: VitB12 deficiency, hypothyroidism, alcoholism, uremia, chronic inflammatory demyelinating polyneuropathy (CIDP), tumor compression, inflammation.
IX. Prevention of diabetic peripheral neuropathy
Control blood sugar, correct dyslipidemia, and control hypertension. Enhance foot care. Regular screening and disease evaluation: all patients should be screened for DPN at least once a year after diagnosis of diabetes; for patients with a long duration of diabetes or combined with microvascular complications such as fundopathy and nephropathy, they should be reviewed every 3-6 months
X. Treatment of diabetic peripheral neuropathy.
1.Causal treatment: active control of hyperglycemia is the most fundamental and important means to prevent and treat DPN
2, blood sugar control, nerve repair: such as methylcobalamin, anti-oxidative stress: such as alpha-lipoic acid, improve microcirculation: such as prostaglandin E2, improve metabolic disorders: such as aldose reductase inhibitors, other: such as neurotrophy
3, symptomatic treatment: mainly for the treatment of pain:.
4, treatment order: methylcobalamin and alpha-lipoic acid → traditional anticonvulsants → new generation anticonvulsants → duloxetine → tricyclic antidepressants → opioid painkillers, etc.
5.Symptomatic treatment
a. Methylcobalamin and alpha-lipoic acid: can be used as the first step of symptomatic treatment.
b.Traditional anticonvulsant drugs: mainly sodium valproate and carbamazepine
c. New generation anticonvulsants: mainly pregabalin and gabapentin
d, tricyclic antidepressants (TCA): the most commonly used amitriptyline, promethazine and selective 5-hydroxytryptamine reuptake inhibitors (SSRIs) such as ciprofloxacin
e. Opioid analgesics: mainly oxycodone and tramadol, etc.
f. Local analgesic treatment: mainly used in cases where the pain area is relatively limited
Isosorbide nitrate spray, glyceryl trinitrate patch can make the patient’s local pain and burning sensation be reduced, capsaicin can reduce the release of painful substances, and the local application of 5% lidocaine patch can also relieve painful symptoms.