Diabetes affects both brain and nerves in the all parts of the body.

BRAIN:

It is generally manifested as mental confusion, stupor, restlessness and coma. Usually presented as ketoacidosis or hyperosmolar nonketotic coma. Patient is dehydrated and fluid should be replaced slowly, otherwise cerebral edema develops.

Treatment mainly focuses on correcting high glucose levels, electrolytes, blood chemistry correction and fluid therapy.

PERIPHERAL NEUROPATHY:

Once caused it is not reversible. Atleast 50% of diabetics after 25 years of history are having peripheral neuropathy. Manifested in different clinical settings.

1. Distal symmetric polyneuropathy

2. Autonomic neuropathy

3. Focal or multifocal asymmetric neuropathy

What causes neuropathy?

* Hyperglycemia in nerves shunted through different polyol pathway. This leads to production of sorbitol and fructose in the nerves. These substances cause impaired axonal transport and nerve conduction. Also there will be damage to nerve fibers.

* The small capillaries in the nerves are damaged with thickening of basement membrane, formation of AGEs leading to thickening of the vessel wall. This leads to ischemia of nerves and damage.

1. Distal symmetric polyneuropathy:

Most common form affects both legs and hands like ‘Glove and stocking’ pattern of functional loss. Sensory involvement causes loss of sensations like touch, pain and temperature. Motor involvement causes loss of nerve supply to small muscles and causes clawing of toes and hands. Loss of pain sensations and altered pressures on foot because of muscle atrophy leads to callus formation and ulcers. Ulcers take long time to heal because of impaired wound healing in diabetes and immune mechanism.

2. Autonomic neuropathy:

Presentations may include orthostatic hypotension, resting tachycardia, loss of sweating, inability to empty the bladder, altered bowel habits, small pupils sluggishly reactive to light and impotence. There is no effective cure for these, but only symptomatic treatment towards the cause.

3. Focal or multifocal asymmetric neuropathy:

Sometimes single or multiple nerves are affected giving asymmetric distribution of peripheral neuropathy. These usually develop suddenly and recovery will be complete in most of the cases. These
are attributed to vascular ischemia and trauma to nerve. Examples for this type of neuropathy are cranial and femoral nerve involvement. If third cranial nerve is involved, ptosis, diplopia may occur. Treatment is directed to diabetic control and analgesia.

How to take care of your feet and hands?

* Check your hands and feet for any cuts, ulcers. If you see any, clean them properly and put some antibiotic.

* Use well fitted shoes. Tight ones may damage your skin giving blisters and ulcers.

* Regular exercise and physiotherapy to keep the muscles in action. This way you can also improve your muscle function.

* Good nutritious diet with well controlled blood glucose levels.

* Quit smoking. Smoking damages the blood vessels and leads to ischemia of the hands and feet. This further aggravate the pain of diabetic neuropathy and delays the healing.

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