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DIABETIC NEUROPATHY

Diabetic Neuropathy is a condition in which nerves get injured due to high blood sugar levels (diabetes). The increase in the blood sugar level can damage nerve fibres throughout the body. Diabetic Neuropathy is of four types that include peripheral neuropathy, autonomic neuropathy, proximal neuropathy, and focal neuropathy. Peripheral neuropathy is the most common type of diabetic neuropathy.

Diabetic neuropathy is caused due to a constant increase in the blood glucose levels, which inhibits signals transmission by the nerves. It also affects the walls of the capillaries by reducing its capacity to supply oxygen and nutrients.

SIGNS AND SYMPTOMS

The signs and symptoms vary for different types of diabetic neuropathy.

In peripheral neuropathy, the most affected body parts are feet, legs, hands and arms. The following are the symptoms of peripheral neuropathy:

  • Numbness
  • Burning sensation
  • Cramps
  • Joint pain
  • Loss of coordination
  • Foot ulcers
  • Muscle weakness

In autonomic neuropathy, the most affected organs are heart, bladder, lungs, stomach, intestine, sex organs and eyes. The following are the symptoms of autonomic neuropathy:

  • Heartburn
  • Difficulty in swallowing
  • Bloating
  • Diarrhoea
  • Constipation
  • Vomiting
  • Nausea
  • Vaginal dryness
  • Urinary retention

In proximal neuropathy, the most affected body parts are thighs, hips, or buttocks. The following are the symptoms of proximal neuropathy:

  • Legs pain
  • Pain in the lower limbs, buttocks
  • Muscle weakness

In focal neuropathy, the most affected body parts are head and leg. The following are the symptoms of focal neuropathy:

  • Double vision
  • Lower back pain
  • Chest pain
  • Abdominal pain
  • Paralysis on one side of the face

CAUSES

The causes of diabetic neuropathy are:

  • High cholesterol levels
  • Mechanical injury
  • Smoking
  • Alcohol consumption
  • Vitamin B-12 deficiency

RISK FACTORS & COMPLICATIONS

 The following are the factors that may increase the risk of developing nerve damage:

  • Poor blood sugar level
  • Kidney disease
  • Being overweight
  • Cigarette smoking

The following are the complications of diabetic neuropathy:

  • Diabetic foot ulcer.
  • Urinary tract infection.
  • Sexual impairment.
  • Severe constipation or diarrhoea.

DIAGNOSIS

The following are the diagnostic tests:

  • Electromyography test is performed to study the health of muscle cells and nerve cells by detecting the electrical potential generated by muscle cells.
  • Nerve conduction studies are performed to evaluate the function and ability of electrical conduction of motor and sensory nerves of the human body.
  • Quantitative sensory testing is a method used to access damage to the small nerve endings, which detects vibrations and changes in temperature.
  • Filament testing is performed to check the touch sensation by thin nylon filament rubbing against the sole.

TREATMENT

Diabetic neuropathy cannot be cured completely. However, the severity of the condition can be reduced by consulting a neurologist.

The following are the treatment options for diabetic neuropathy:

  • Monochromatic infrared photo energy treatment helps in regeneration of nerve tissues. This further helps in reducinginflammation and pain in the area.
  • Physical therapy helps in improving the range of motion and also nourishes the muscles.

PREVENTION

The following are the few tips to prevent diabetic neuropathy:

  • Monitor the blood sugar levels on a regular basis.
  • Always keep the feet clean and dry.
  • Examine the foot regularly.
  • Wear soft and comfortable footwear.

Dialysis

Kidneys are the important organs in the body responsible for excretion of waste, toxic materials, and extra fluid from the body. Sometimes, the kidneys don’t work efficiently, causing accumulation of fluids, and metabolic wastes in the body. This accumulation of chemical can reach a toxicity levels, making the person sick. These patients may require dialysis- a treatment that purifies the blood by removing the waste, toxic materials, extra salts, and fluids from the body.

Types of dialysis

The two types of dialysis are:

  1. Hemodialysis
  2. Peritoneal dialysis

Hemodialysis: This type of dialysis is the most common type of dialysis, and involved purification of blood outside the body with the help of a machine. During the procedure, a dialysis machine, and a special filter called artificial kidney or dialyzer are used to purify the blood. The dialysis is usually performed three times per week, each session may last upto four hours.

Peritoneal dialysis: This type of dialysis involves purification of blood inside the body. A special fluid (dialysate) is passed through a catheter placed in the inside of the abdomen lining (peritoneum). This fluid absorbs waste materials that pass through the small blood vessels in the abdominal cavity. The fluid is drained out after some time, and again replaced with another set of fresh fluid. Peritoneal dialysis is performed at night with the help of a machine, usually while sleeping. This type of dialysis needs to be performed every day.

The two types of peritoneal dialysis are:

  1. CAPD (Continuous ambulatory peritoneal dialysis)
  2. APD (Automated peritoneal dialysis)

Continuous ambulatory peritoneal dialysis: The dialysis is performed without any machines, and by the patient himself. The patient puts about two quarts (bag) of dialysate into the peritoneal cavity and then drains this dialysate after a period of 3 to 4 hours time. This is called as an exchange and the patient needs a new bag of dialysate for each exchange. This procedure is performed continuously.

Automated peritoneal dialysis:  This type of dialysis is done at home using a machine called cycler. The number of cycles (exchanges) is more than CAPD. Exchanges last for a period of 1 to 2 hours and must be done continuously.

Indications for dialysis

Dialysis may be needed in patients with:

  • Chronic kidney disease
  • Kidney failure
  • End-stage renal disease
  • Failed kidney transplant

Pre-requisites for a dialysis

It is necessary to have laboratory tests done to assess the need for dialysis, and an intravenous access for hemodialysis.

Diagnostic tests that confirm the need for dialysis may include serum creatinine levels, glomerular filtration rate test, blood urea nitrogen test, and creatinine clearance test. A kidney biopsy is done to find the extent of damage to the kidney.

Intravenous access

The patient may need a minor surgery to create a direct access to the bloodstream. It is done prior to the start of the dialysis in the initial stage. Surgery is done through any one of the following:

  • Arteriovenous fistula or A-V fistula or fistula

An artery and vein are joined together under the skin in the patient’s arm and this requires around six weeks of time to heal. This can be used for a long-term treatment period.

  • Arteriovenous graft or A-V graft or graft

A plastic tube is used to join the artery and the vein under the skin of the patient. This takes less time to heal, around 2 weeks of time. Hemodialysis can be started faster in graft than the fistula procedure. A-V graft has many risks associated, as it can lead to infections. Another graft may be needed after few years.

  • Central venous catheter

This method is the fastest method to start hemodialysis. A flexible tube (catheter) is placed into the vein of the neck, below the collarbone, or groin region. This is a temporary access.

In the case of peritoneal dialysis, an incision is placed into the belly button region, and a catheter is placed into the peritoneum. The dialysate is exchanged through this catheter.

Dialyzer

It is special equipment, also called as an artificial kidney, comprised of multiple, very thin, hollow fibers made up of a semipermeable membrane. Blood enters into it and gets filtered through these fibers that have minute pores. All major components of blood remain back, as they can’t pass through these pores. Only urea, creatinine, and salts can pass through. All the waste and toxic materials get filtered through these pores.

Dialysate

The dialysate fluid flows through the opposite side of the pores and collects the waste material. This fluid contains water and added substances that aid in the removal of excess salts, wastes, and fluid from the blood during dialysis. The physician prescribes the solution based on the patient’s health conditions.

Needles

The hospital nurse inserts two needles that aid in the dialysis. Two needles are inserted into a vein, usually into the arm, where one needle is used for collecting the blood and the other to supply filtered blood.

Tests confirming dialysis efficiency

After dialysis, the patient may feel much better as there is an increase in appetite and the energy levels. There are tests that confirm the adequacy of a dialysis treatment and are done once in a month. These tests are:

  • URR (urea reduction ratio) is a measurement of the efficiency of the dialysis treatment. It measures the reduction of urea from the body due to dialysis.
  • Kt/V where K means dialyzer clearance, t stands for time, and V is the volume of water a patient body contains.

Dialysis Risks

There are risks associated with both the types of dialysis. The risks associated are:

  • Peritonitis (infection of peritoneum)
  • Abdominal muscle weakening
  • Pericarditis (inflammation of pericardium)
  • Infections in and around catheter
  • Weight gain
  • Hypotension
  • Nausea
  • High blood potassium levels
  • Fatigue
  • Anemia
  • Muscle cramps
  • Itching skin
  • Skin becomes fragile
  • Depression
  • Insomnia
  • Anxiety
  • Sepsis
  • Erectile dysfunction and loss of libido
  • Amyloidosis
  • Hernia

Self-management

A patient undergoing dialysis must follow certain instructions to prevent complications:

  • Consuming foods with less salt and phosphorus content
  • Limiting the fluids as instructed
  • Eating high-quality protein foods
  • Adding vitamins and minerals supplements to the diet
  • Maintaining an ideal weight
  • Quitting alcohol consumption, smoking, and use of illicit drugs
  • Keeping the bandage that covers the catheter, clean and dry
  • Exercising regularly and doing exercises such as flexibility exercise, strengthening exercise, and cardiovascular exercises
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