Diabetes, Neuropathy, PNS Flashcards
What is diabetes and what types?
- Diabetes is a metabolic disease with a disruption in glucose regulation, causing hyperglycemia
- Type I: autoimmune disease where insulin production does not work
- Type II: a dysfunction of insulin receptors causing abnormal response to insulin of the cells
What affects risks of diabetes?
Type I:
- Genetics (autoimmune factor)
- Environmental factors like viruses
Typ II:
- Life style including bad diet, physical inactivity, and obisity
- Genetics
Artherosclerosis often co-exist since both are affected by same factors like diet and inactivity
What are some possible consequences of diabetes?
- Damage to walls of blood vessels leading to inflammation and scar tissue and can further lead to PAD
- Oedema
- Neuropathy due to insufficient nutrient supply to neurons
- Undetected ulcers due to neuropathy
- Vascular dysfunction leading to ischemia, necrosis and then amputation may be needed
What are some treatments for diabetes?
- Life style changes involving diet and physical activity
- Insulin therapy
- Monitoring blood sugar
What is neuropathy?
- Pathological change in neurons which disturbes most common afferent (sensory) but sometimes also efferent impulses
- Biggest and longest neurons are usually affected first like sensory neurons
What changes of neurons can be seen in neuropathy?
- Wallarian degeneration which is degeneration of myelin on distal axons due to injury of the cell body resulting in:
1. Proximally degeneration (neuron becomes shorter - towards cell body)
2. Loss of sensation
3. Difficulties with voluntary movements
4. Slower condution (due to change of myelin) - Changes of axons leading to stop of impulses
- Changes of cell body leading to disrupted protein synthesis and death of neuron
What fators causes neuropathy?
- Genetics
- Mechanical entrapment/compression like:
1. Peripheral nerve injury
2. Carpal tunnel syndrome
3. Sciatica
4. Mortons neuroma - Diabetes and alcoholism leading to metabolic neuroma (damage due to metabolism of neuron)
- Infections/inflammations like Gullian Barre syndrome and postpolio syndrome
What is carpal tunnel syndrome?
Compressed medial nerve leading to symptoms radiating to hand like:
- Pain during night time especially
- Numbness
- Weakness
Can be treated with night time orthotics, surgery, and manual mobilization and muscle extension
What is sciatica?
Damage to sciatic nerve due to herniated disc or injury, causing pain radiating from back to buttocks and legs
- Active rest and painkillers as treatment, severe cases may need surgery
What is Mortons neuroma?
Entrapment of common plantar digital nerves due to repetitive long time stress on ligaments, causing:
- radiating pain
- Numbness/tingeling sensation
- Instability
What is Gullian Barre Syndrome?
- Autoimmune progressive condition where immune system attacks our own nerves
- It can eventually paralyse the whole body and hospitalized care is needed
- Starts with tingeling/weakness of feet and legs that spreads to upper body
What is Postpolio syndrome?
- Happens decades after polio (virus infection)causing motor neurons to degenerate
- Symtoms are: muscle weakness, lack of stamina, pain in muscles and joints, atrophy
- It usually affects lower extremities but can affect upper as well causing ex. scoliosis
- Treated with orthotic devices (AFO, KAFO, hand orthotics, corsets)
What are the symptoms of neuropathy?
Diabetes, inflammation/infection = Symmetrical and distal symptoms
Motor dysfunction:
- Weakness and atrophy due to less conductivity
- Reduced tendon reflexes
Sensory dysfunction (most common):
- Diffuse sensations
- Tingeling and numbness
Autonomic dysfunction:
- Orthostatic hypotension due to
inability to vasoconstriction causing dizziness
Name most common consequence of neuropathy
Diabetes is the most common related disease, hence the same consequences as for diabetes:
- Ulcers
- Loss of sensation
How is neuropathy diagnosed?
- Anamnesis
- Clinical findings like ulcers
- Test sensation: Spinothalamatic tract for pain and temp. and Medial Lemeniscus tract for touch and proprioception
