Diabetes

What is the impact of elevated levels of glucose within cells?

Elevated levels of glucose within cells cause a non-enzymatic covalent bonding withproteins, which alters their structure and inhibits their function. Some of these glycosylated proteins have been implicated in the pathology of diabetic neuropathy and other long-term complications of diabetes.
What is nervous system wise neuropathy?
Sensory-motor polyneuropathy
Longer nerve fibers are affected to a greater degree than shorter ones because nerve conduction velocity is slowed in proportion to a nerve’s length. In this syndrome, decreased sensation and loss of reflexes occurs first in the toes on each foot, then extends upward. It is usually described as a glove-stocking distribution of numbness, sensory loss, dysesthesia and night time pain. The pain can feel like burning, pricking sensation, achy or dull. A pins and needles sensation is common. Loss of proprioception, the sense of where a limb is in space, is affected early. These patients cannot feel when they are stepping on a foreign body, like a splinter, or when they are developing a callous from an ill-fitting shoe. Consequently, they are at risk of developing ulcers and infections on the feet and legs, which can lead to amputation. Similarly, these patients can get multiple fractures of the knee, ankle or foot, and develop a Charcot joint. Loss of motor function results in dorsiflexion, contractures of the toes, loss of the interosseous muscle function that leads to contraction of the digits, so-called hammer toes. These contractures occur not only in the foot but also in the hand where the loss of the musculature makes the hand appear gaunt and skeletal. The loss of muscular function is progressive.
Autonomic neuropathy
The autonomic nervous system is composed of nerves serving the heart, lungs, blood vessels, bones, adipose tissue, sweat glands, gastrointestinal system and genitourinary system. Autonomic neuropathy can affect any of these organ systems. The most commonly recognized autonomic dysfunction in diabetics is orthostatic hypotension, or fainting when standing up. In the case of diabetic autonomic neuropathy, it is due to the failure of the heart and arteries to appropriately adjust heart rate and vascular tone to keep blood continually and fully flowing to the brain. This symptom is usually accompanied by a loss of respiratory sinus arrythmia – the usual change in heart rate seen with normal breathing. These two findings suggest autonomic neuropathy.
GI tract manifestations include gastroparesis, nausea, bloating, and diarrhoea. Because many diabetics take oral medication for their diabetes, absorption of these medicines is greatly affected by the delayed gastric emptying. This can lead to hypoglycemia when an oral diabetic agent is taken before a meal and does not get absorbed until hours, or sometimes days later when there is normal or low blood sugar already. Sluggish movement of the small intestines can cause bacterial overgrowth, made worse by the presence of hyperglycemia.This leads to bloating, gas and diarrhoea.
Urinary symptoms include urinary frequency, urgency, incontinence and retention. Again, because of the retention of urine,urinary tract infections are frequent. Urinary retention can lead to bladder diverticulae, stones,reflux nephropathy.
Cranial neuropathy
When cranial nerves are affected, neuropathies of the oculomotor nerve (cranial nerve 03) are most common. The oculomotor nerves control all the muscles that move the eyes except for the lateral rectus and superior oblique muscles. It also serves to constrict the pupil and open the eyelid. The onset of a diabetic third nerve palsy is usually abrupt, beginning with frontal or periorbital pain and then diplopia. All the oculomotor muscles innervated by the third nerve may be affected, but those that control pupil size are usually well-preserved early on. This is because the parasympathetic nerve fibers within CN 03 that influence pupillary size are found on the periphery of the nerve (in terms of a cross-sectional view), which makes them less susceptible to ischemic damage (as they are closer to the vascular supply). The sixth nerve, the abducens nerve, which innervates the lateral rectus muscle of the eye (moves the eye laterally), is also commonly affected but fourth nerve, the trochlear nerve, (innervates the superior oblique muscle, which moves the eye downward) involvement is unusual. Mononeuropathies of the thoracic or lumbar spinal nerves can occur and lead to painful syndromes that mimic myocardial infarction, inflammation of gall bladder or appendicitis. Diabetics have a higher incidence of entrapment neuropathies, such as carpal tunnel syndrome.

How Diabetic Neuropathy is diagnosed?

Diabetic peripheral neuropathy is the most likely diagnosis for someone with diabetes who has pain in a leg or foot, although it may also be caused by vitamin B12 deficiency or osteoarthritis.The physician typically assesses the appearance of the feet, presence of ulceration, and ankle reflexes. Nerve conduction tests may show reduced functioning of the peripheral nerves, but seldom correlate with the severity of diabetic peripheral neuropathy and are not appropriate as routine tests for the condition.

What are the Classifications of Diabetic Neuropathy?

Diabetic neuropathy encompasses a series of different neuropathic syndromes which can be categorised in the following way:
Focal and multifocal neuropathies:
1. Mononeuropathy
2. Amyotrophy, radiculopathy
3. Multiple lesions “mononeuritis multiplex”
4. Entrapment (e.g. median, ulnar, peroneal)
Symmetrical neuropathies:
5. Acute sensory
6. Autonomic
7. Distal symmetrical polyneuropathy (DSPN), also known as diabetic peripheral neuropathy (DPN) (most common presentation)

What are the treatment medications of Diabetic Neuropathy with Yamuna Pharmacy?
Except for tight glucose control with Yamuna Madhumehnil capsule, treatments are for reducing pain and other symptoms.
Options for pain control include Yamuna Azaraqi capsule,Yamuna Ashwagandha choorna and Yamuna Dynogesic liniment for local application .
Aazaraqi capsule and Ashwagandha choorna systematically subside the neuralgic pains and improve the pain tolerance threshold.

What is the dosage regimen of Madhumehnil capsule,Azaraqi capsule and Ashwagandha choorna?
Madhumehnil capsule gives appropriate blood sugar levels in dosage of 1 to 2 capsules 3 to 4 times a day subject to regular tests and glucose checkups till satisfactory feel good experience and attainment of glucose levels within normal range suiting the individual patient.
Azaraqi capsule is used in dose 1 to 2 capsules 3 times a day with lukewarm water for containing pains of nerves affected by diabetes mellitus for a period of 3 to 4 months.
Ashwagandha choorna the powder of Withania somnifera is famously pronounced as Indian ginseng and provides nutrition to weakened nerves and imparts anti neuralgic effect on nerves and muscles.

Yamuna Dynogesic liniment is massaged on affected parts as per required quantity for attaining pain relief.

What other measures are beneficial for the care of patients with Diabetic Neuropathy?

In addition to medications patients suffering from Diabetic Neuropathy feel pain relief from Physical therapy as an alternative treatment from expert physical therapists
What is the Prognosis of Diabetic Neuropathy?
The mechanisms of diabetic neuropathy are poorly understood. At present, treatment alleviates pain and can control some associated symptoms, but the process is generally progressive.
As a complication, there is an increased risk of injury to the feet because of loss of sensation culminating to condition of diabetic foot. Small infections can progress to ulceration and this may require severance or amputation of foot.