Guide: Diabetes peripheral neuropathy (DPN) is one of the most common chronic complications of diabetes, and it is also a common cause of foot ulcer and amputation in patients with diabetic patients. Because DPN has a certain latent, and about 50%of patients do not have obvious symptoms, they are easily ignored and missed the best intervention time until irreversible nerve injuries occur. Studies have shown that early diagnosis and treatment of DPN can significantly reduce the incidence of diabetic foot ulcers by 60%, and the amputation rate will be reduced by 85%, reminding doctors and diabetic patients to pay attention to DPN examination.
Characteristic characteristics
DPN can develop at any age. The survey results show that the prevalence of DPN has increased accordingly with the increase of the patient’s age and the extension of the diabetic disease, but the disease does not show a significant gender difference. Studies have shown that the incidence of DPN is higher in DPN.
DPN classification and clinical characteristics
According to different parts of peripheral nerve suffering, DPNs are mainly divided into remote symmetry of diabetes and multiple neuropathy (DSPN), diabetic autonomic neuropathy (DAN), diabetic single neuropathy or multiple single neuropathy, diabetic nerve root nerve plexus lesions, etc. Among them, DSPN and DAN are the most common.
1. Diabetes remote symmetry multiple neuropathy (DSPN)
DSPN often starts to develop from the front end of the toe. Since then, both feet have symmetrical pain and numbness, and gradually develop to the body. When numbness develops near the knee joint, similar symptoms have appeared with both hands. The disease process is affected by age, cardiovascular disease, and degenerative diseases (such as cervical and lumbar spondylosis). Because the clinical manifestations of patients may have a large difference, symptoms such as numb pain in the lower limbs of patients may be symmetrical or asymmetric, or they can be based on one side, or only hand symptoms.
The clinical manifestations of the nervous system are mainly sensitivity and lack of sensation. Among them, sensitivity may already exist in the early stages of diabetes.
Feeling allergies: Due to the damage to the autonomic nerve of the skin sweat glands, most patients are accompanied by dry keratinization of the skin and itching; due to abnormal skin metabolism of the patient, the nerve peripheral is easily damaged, so it may be accompanied by ant climbing, acupuncture, acupuncture It is painful; if the effects of other factors, the sensitivity of sensitivity will increase and cause pathological pain, but most of these pains are mild, and the lower limbs are mostly. However, if the patient’s blood sugar fluctuates violently in the short term, there may also be systemic pain, and the degree of pain may be more serious.
Lack of feeling: Lack of feeling is the most common clinical manifestation. Patients will have a decrease in temperature, tactile, and vibration, including pain, and continuous development will appear numb.
2. Diabetic autonomic neuropathy (DAN)
DAN usually hides on disease, develops slowly, and can affect multiple systems, with different clinical manifestations.
DPN diagnosis
Because a considerable part of the patients have DPNs during the T2DM diagnosis, it is recommended that the first diagnosis of T2DM patients and T1DM patients who have more than 5 years of medical history do DPN examinations each year. At the same time, due to the extensive scope of DPN, the severity of the symptoms is large and does not have obvious specificity, carefully collection and related examinations should be performed carefully, and the results should be comprehensively analyzed.
1. History of medical history
2. Physical examination
(1) General examination: Patients with DPN usually show that the skin color, poor elasticity, dryness, scarce sweat, low skin temperature, etc., can be accompanied by skin ulcers and cracks.
(2) A sensory examination: Carefully check whether the patient is accompanied by pain, tactile sensation, temperature loss, and pain allergies, whether it is accompanied by the decline of the joint position and the vibration of the sound fork, and the positive symptoms of Romberg.
(3) Exercise examination: Patients with late DPN may experience foot or small muscles in the hand. Therefore, pay attention to check the patient’s remote muscle strength of the patient. The muscle strength or thumb is exchanged and straightened slightly, and the impedance is given to observe the long muscle strength of the thumb.
(4) Tendon reflection test: Tip reflex can usually occur or disappear, especially the ankle reflexes. This result is also one of the main signs of DPN.
(5) Autonomous nerve function test.
3. Auxiliary inspection
Auxiliary examinations include biochemical examination, neuropsychological examination, skin biopsy, MRI examination, neurological biopsy, etc.
DPN is sure to diagnose standards
The DPN is determined to meet the following 3 points: 1) Determination of diabetes; 2) evidence of clinical manifestations of peripheral neuropathy and/or electronic physiological examination, that is, patients have NCV test slowdown items ≥2, vibration conscious abnormalities, temperature consciousness Abnormal, ankle reflex disappearance, and two or more in the feet feel decreased. 3) Exclude other causes of peripheral neuropathy.
“Guidelines for the Management of Diabetes peripheral neuropathy layer diagnosis and treatment management (2019 edition)” mentioned that diabetic patients need to start DPN prevention and control as soon as possible. Considering the differences in the examination conditions of different medical institutions, it is recommended that the symptoms and/or/or/or/or/or or/or or/or or/or or/or or/or or/or/or diabetics patients are recommended When signs (symptoms and signs any manifestations), grassroots doctors can consider clinical diagnosis of DPN and start DPN -related treatment. During the treatment, the effectiveness and safety need to be closely observed. It is recommended to transfer further treatment for further treatment.
DPN treatment
Practical and strict control of blood sugar and stability are the most important measures to prevent and treat DPN. The earlier the treatment effect, the more obvious the effect of treatment. The treatment of DPN includes the following aspects:
(1) General treatment: correct risk factors, conduct regular screening and disease evaluation, and take care of them.
(2) Treatment of the cause: control blood sugar, nerve repair (methamphetamine, growth factor, etc.).
(3) Treatment of mechanism: antioxidant stress (such as sulfuric acid, etc.), improve microcirculation (such as prostaglandin E1, sodium shellin, Sirozazo, hexylococo base, pancreatic ilcomyl enzyme, calcium antagonism, calcium antagonism, calcium antagonism, calcium antagonism Agent and blood circulation and blood stasis Chinese medicine), improved metabolic disorders (such as alda sugar restoration enzyme inhibitors, Epham, etc.).
(4) Pain management: anticulmonic drugs, antidepressants, opioids.
The combination of two different mechanisms of different effects can often improve the efficacy and ensure sufficient treatment.
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Summary of this article
DPN is a common cause of foot ulcers and amputation in patients with diabetes. It is latent and can affect multiple systems of the human body and diversify clinical symptoms. Early diagnosis and treatment of DPN is conducive to delay in the progress of the disease, reducing the risk of complications of diabetes, and improving the quality of life of patients.
