How it manifests itself
Symptoms are divided into “plus symptoms,” associated with nerve irritation, and “minus symptoms,” associated with loss of function. Usually they are combined.
- Burning, tingling, pins and needles sensation, lumbago - worse at night and at rest
- Numbness and decreased sensitivity in the feet, a feeling of “cotton” floor or “sand in the sock”
- Increased sensitivity: even the touch of a blanket hurts
- Cramps in the calf muscles, feeling of weakness in the feet, sloshing gait
- Unsteadiness in the dark - a person walks better under visual control
- If autonomic fibers are damaged: dryness or, conversely, sweating of the feet, dizziness when standing up, intestinal dysfunction
Ключевая опасность при диабете — потеря защитной чувствительности. Человек не чувствует камешек в обуви, мозоль или ожог, и небольшая ранка превращается в трофическую язву. Именно поэтому ежедневный осмотр стоп при диабете обязателен.
Reasons
- Diabetes mellitus is the most common cause; neuropathy may be the first manifestation of undiagnosed diabetes
- Vitamin B12 deficiency, including due to long-term use of metformin, strict vegetarianism, stomach diseases
- Chronic alcohol abuse
- Hypothyroidism, chronic kidney disease
- Chemotherapy and a number of other drugs
- Autoimmune processes, including Guillain-Barré syndrome and chronic inflammatory polyneuropathy
- Hereditary forms, infections, heavy metal poisoning
Survey
- Осмотр невролога с проверкой всех видов чувствительности, рефлексов и силы, обязательным осмотром стоп.
- Электронейромиография — подтверждает поражение нервов, определяет его тип (аксональный или демиелинизирующий) и распространённость.
- Глюкоза натощак и гликированный гемоглобин — обязательно всем.
- Витамин B12, фолиевая кислота, ТТГ, креатинин, печёночные показатели.
- При отсутствии очевидной причины — расширенный поиск: белок крови, аутоантитела, онкопоиск.
The type of lesion according to ENMG is of practical importance: the demyelinating variant is more often associated with autoimmune causes, which are treated with specific therapy, while the axonal variant is characteristic of diabetes and toxic effects.
Treatment
Treatment is based on two directions: eliminating the cause and alleviating symptoms. The first affects the prognosis, the second affects the quality of life, and both are necessary.
- Compensation for diabetes is the most important step: without normalizing sugar, any other therapy is ineffective
- Replenishment of vitamin B12 deficiency if confirmed
- Complete abstinence from alcohol in alcoholic form
- Correction of hypothyroidism, treatment of kidney disease
- For autoimmune forms - immunotherapy as prescribed by a specialist
- Drugs for neuropathic pain: conventional analgesics and NSAIDs have little effect on it
- Physical therapy, balance training, physiotherapy as prescribed by a doctor
Foot care for polyneuropathy
- Examine your feet every day, including the spaces between the toes and the soles (you can use a mirror)
- Check shoes by hand before putting them on
- Wash your feet with warm water, checking the temperature with your hand or thermometer, not your foot.
- Do not cut calluses yourself, do not use acid patches
- Wear seamless socks and comfortable shoes without narrow toes
- Do not warm your feet with a heating pad or near a heater - there is a risk of unnoticeable burns.
- For any wound, crack or change in color, consult a doctor immediately