Diabetic Neuropathy

Diabetic Neuropathy
Diabetic Neuropathy is really a condition that damages the nerves in your body. The exact mechanism isn't known. Research is still on but there are some theories going around. High sugar levels affects the way in which nerves use glucose, resulting in an accumulation of a sugar called sorbitol and depletion of the substance called myoinositol inside the nerves. High blood sugar levels modify the amount of Nitric Oxide within the blood. Nitric Oxide helps you to dilate the small arteries carrying oxygen towards the nerves. Low levels of Nitric oxide supplement lead to constriction of arteries supplying to the nerve, adding to nerve damage.

Signs and Symptoms…
Diabetic neuropathy affects all peripheral nerves including pain fibers, motor neurons and also the autonomic nervous system. It therefore can impact all organs and systems, as each one is innervated. There are several distinct syndromes based on the organ systems and members affected, however these are by no means exclusive. Someone can have sensorimotor and autonomic neuropathy or other combination. Symptoms vary with respect to the nerve(s) affected and could include symptoms apart from those listed. Symptoms usually develop gradually over years.
Symptoms can include:

• Numbness and tingling of extremities
• Dysesthesia (abnormal sensation to some body part)
• Diarrhea
• Erectile dysfunction
• Urinary incontinence (lack of bladder control)
• Facial, mouth and eyelid drooping
• Vision changes
• Dizziness
• Muscle weakness
• Difficulty swallowing
• Speech impairment
• Fasciculation (muscle contractions)
• Anorgasmia
• Burning or electric pain 

Effects on nerve types  
Different nerves may take a hit in different ways
Sensorimotor polyneuropathy
Longer nerve fibers may take a hit to a greater degree than shorter ones, because nerve conduction velocity is slowed compared to a nerve's length. Within this syndrome, decreased sensation and lack of reflexes occurs first within the toes on each foot, then extends upward. It is almost always described as glove-stocking distribution of numbness, sensory loss, dysesthesia and evening pain. The pain can seem to be like burning, pricking sensation, achy or dull. Tingling sensation is common. Loss ofproprioception, the feeling of where a limb is within space, is affected early. These patients cannot feel when they're stepping on a foreign body, just like a splinter, or when they are creating a callous from an ill-fitting shoe.
Autonomic neuropathy
The autonomic central nervous system is composed of nerves serving one's heart, lungs, blood vessels, bone, adipose tissue, sweat glands, gastrointestinal system and genitourinary system. Autonomic neuropathy can impact any of these organ systems. Probably the most commonly recognized autonomic dysfunction in diabetics is orthostatic hypotension, orfainting when standing. In the case of diabetic autonomic neuropathy, it's due to the failure from the heart and arteries to appropriately adjust heartbeat and vascular tone to help keep blood continually and fully flowing towards the brain. Urinary symptoms include urinary frequency, urgency, incontinence and retention. Again, due to the retention of urine, bladder infections are frequent. Urinary retention can result in bladder diverticula, stones, reflux nephropathy.
Cranial neuropathy
When cranial nerves may take a hit, oculomotor (3rd) neuropathies are most typical. The oculomotor nerve controls all the muscles that move the attention with the exception of the lateral rectus and superior oblique muscles. Additionally, it serves to constrict the pupil and open the eyelid. The start of a diabetic third nerve palsy is generally abrupt, beginning with frontal or periorbital pain after which diplopia. All of the oculomotor muscles innervated through the third nerve might be affected, but the ones that control pupil size are often well-preserved early on. This is because the parasympathetic nerve fibers within CNIII that influence pupillary size are located on the periphery of the nerve (when it comes to a cross sectional view), causing them to be less susceptible to ischemic damage (because they are closer to the vascular supply). The sixth nerve, the abducens nerve, which innervates the lateral rectus muscle from the eye (moves the attention laterally), is also commonly affected but fourth nerve, the trochlear nerve, (innervates the highest oblique muscle, which moves the attention downward) involvement is unusual. Mononeuropathies from the thoracic or lumbar spinal nerves can happen and lead to painful syndromes that mimic myocardial infarction, cholecystitis or appendicitis. Diabetics possess a higher incidence of entrapment neuropathies, for example carpal tunnel syndrome.
Diabetic Neuropathy Physical rehabilitation Treatment
Diabetic neuropathy manifests itself diversely. Tingling, burning and lack of sensation in your hands or feet would be the result of nerve damage, also known as peripheral neuropathy. There is a strong correlation between high sugar levels and diabetic neuropathy. Lowering blood sugar levels can help prevent and perhaps reverse some the signs of diabetic neuropathy. Physical therapy is yet another treatment that can help restore balance and sensation you will probably have lost.
Physiotherapy
Diabetic neuropathy is really a painful condition, therefore the thought of physiotherapy might not seem appealing, because it involves movement. However, physical rehabilitation will help you regain motions you will probably have lost or enhance your balance when walking. A customized course of treatment will first analyze what physical rehabilitation is best for you. This might include the use of braces and splints in addition to exercise machines. Then, you'll receive a progressive plan for treatment.
Treatments will concentrate on maintaining and enhancing your range of motion, as well as strengthening parts of your muscles. For example, something as simple as finding out how to stand without getting dizzy can be a part of diabetic neuropathy physical rehabilitation. You will also learn how to maneuver over different surfaces to prevent tripping and falling when you are about your everyday activities. Enhancing your balance, which may have worsened with neuropathy, may also be included in your physical therapy.
Splints and braces can also be included as part of your physical rehabilitation. Using wrist splints can assist you to learn and use proper techniques when choosing up or grabbing objects. Your physiotherapist may wish to fit you having a back brace to boost correct posture to assist combat pain brought on by nerve damage.
Improving Standard of living
o One of the main goals of physical rehabilitation is to improve your standard of living, alleviating the the signs of diabetic neuropathy. Improved flexibility and balance will grant you to be more active and independent. The earlier you seek physical rehabilitation, the more likely it is that the condition will improve. Therefore, speak to your doctor as soon as possible should you start to feel tingling or burning with you or feet or develop problems walking and grasping objects. Cutting your blood glucose levels will help you to avoid further complications. Since muscles burn glucose a lot more efficiently than fat, physical rehabilitation that includes resistance weight training can help you achieve lower blood sugars.
• Physiotherapists prescribe exercise, heat, electrotherapy, massage, along with other means to provide holistic treatment. They work one-on-one with patients regularly.
Lifestyle Changes
• In the same way that changes in lifestyle are important in the protection against diabetes, they are also essential to its treatment. Establishing proper nutrition and use habits is one of the most significant things physiotherapists do within the treatment of diabetes.
Excercises
• Physiotherapists train patients to do specific exercises to bolster muscles and improve circulation in areas which are especially problematic in diabetes, like the feet.
Massage and Electrotherapy
• Physiotherpists also employ massage and electrical devices to focus on specific musculoskeletal problems present with diabetics.
Emotional Support
• Perhaps probably the most significant roles from the physiotherapist in the management of diabetes is the bonding which comes when the patient works alongside a therapist toward the aim of a healthy lifestyle. Often, physiotherapists might help provide the emotional support required to face a chronic disease like diabetes.