early half of people with diabetes suffer from nerve damage at some point in their lives, and these symptoms are usually not diagnosed at the right time and form. The incidence of diabetes, especially the second type (not dependent on insulin), is very high, and peripheral nerve infections are the most affected by diabetes, especially the peripheral nerves of the lower limbs and feet, but the real risk is that what was hidden was greater. Peripheral nerve infections lead to a weak feeling in the feet, which leads to exposure to various injuries without the patient feeling anything abnormal. We know very well that glucose is a highly reactive compound, and if it is not metabolized, it will interact with the tissues of the body where increased levels of sugar, such as those that occur in diabetes, activate the alternative biochemical pathways, which leads to a decrease in glutathione and an increase in free oxygen molecules. The path depends on The enzyme inhibition enzyme, while most cells in the body require insulin to enter glucose into the cell, the cells of the retina, kidneys and nervous system do not depend on insulin. Therefore there is a free exchange of glucose from inside to outside the cell, regardless of insulin action, in the eye, kidneys and nerve cells. Cells use glucose to obtain energy normally, and any amount of glucose not used for energy will enter the polyol pathway to convert it into sorbitol. This exchange does not cause any problems with the normal levels of glucose in the blood, because the rate of attraction of the enzyme inhibiting aldose to glucose is little in normal concentrations, and we summarize the main causes of neuritis in diabetics in three factors, which are hardening of the arteries supplying the nerves, and lack of vitamin B1, 6 and 12 due to Frequent urination and increased secretion of ketoacids that destroy nerves (keto acids are caused by metabolism in the cells of diabetic patients). Diabetic neuropathy is a neurological disorder associated with diabetes. It is believed that these disorders are caused by microvascular injury as a result of diabetes, including the small blood vessels that supply the nerves (nerve vessels), in addition to large vascular injuries that peak with diabetic neuropathy. Cases associated with diabetic polyneuropathy include third nerve palsy, mononeuropathy; multiple neuropathy; diabetic muscular dystrophy; painful polyneuropathy; autonomic neuropathy, and esophageal and thoracic neuropathy. Diabetic neuropathy affects all peripheral nerves: pain fibers, motor neurons, and autonomic nerves. Therefore, it can affect all body systems and organs as they are all nourished. There are several specific syndromes that are challenged on the basis of the affected organs and organs, but this is exclusive, as the patient may develop sensory neuropathy and autonomic neuropathy together or any other pathogenic compound. Symptoms vary depending on the affected nerve or nerves and may include symptoms other than those listed, and symptoms usually develop gradually over years, and symptoms may include numbness and tingling in the upper and lower extremities, dyslexia (a decrease or loss of sensation in part of the body), diarrhea Erectile dysfunction, urinary incontinence (loss of control of the bladder), impotence, drooping of the face, mouth, and eyelids, visual changes, dizziness, muscle weakness, difficulty swallowing, impaired speech, stiffness (muscle cramps), lack of orgasm, pain such as burning or electrical flow

As for the first and most important symptoms caused by diabetes, it is a loss of sensation of heat and pain, where a lack of a sense of extremities in changes in the external temperature is a prominent sign in diabetes, and although we are not exposed to severe cold episodes, we often find some diabetics subject to burns Severe in the feet as a result of sitting adjacent to the heat in the winter, as the lack of a sense of heat leads to damage to the tissues of the body without causing any pain, also a diabetic patient can walk the feet on the hot sand in the summer without feeling any pain and therefore should avoid walking without proper shoes under All circumstances, as is the sense of the great mother blessings that God has bestowed on us. Without feeling a mother, we lose an important characteristic that alerts us to danger and prompts us to avoid. Therefore, we find that many diabetics suffer from various injuries without feeling it. The diabetic patient may be pricked with a needle or nail prick without feeling it. Also, foreign bodies may infiltrate the patient’s shoe, and the diabetic patient may wear shoes without feeling these objects. The result is serious foot injuries that would have been very easy to avoid if the patient had examined the shoes inside from before each use. It is worth noting that symptoms can affect a diabetic patient or a pre-diabetic patient or at risk of diabetes, and inflammation often begins in one nerve, and the effect is more in terms of sensory (sensation) more than it is from movement, and begins as a pain in the muscles of a man Then the loss of the feeling of the muscles, and the loss of the feeling is in the form of gloves and scarves (the areas of the feeling of the feeling are the hand to the middle of the arm and the foot almost to the middle of the leg) and there are other symptoms such as: sexual impotence, lack of control in the urine, a feeling of urination without the ability to do so Difficulty digestion, hair loss, ulcers on the skin, and diabetic diarrhea This type of diarrhea may come at any time during the day or night, which is sometimes embarrassing, thus changing the speed at which food passes through the intestine causes a random change in the number of sugar. And now we move to an annoying symptom of peripheral neuritis patients where many complain of burning foot pain that ranges between light and superficial that can be treated easily, including serious and deep and that require more tests and medical follow-up, and there are many factors feeling the burning foot pain which is more common when Those over 50, but it also affects younger people. Also, a large percentage of those with a burning foot suffer from diabetes, as it occurs as part of the surrounding neuropathy that occurs as a result of high blood sugar. In many cases, the burning foot causes excruciating and persistent pain that may make the patient unable to sleep. Burning charcoal, “as some patients say, and many feel burning after a long and arduous day, and this happens especially with obese people and those who require their work.

Standing for long periods, which is a type of mechanical overload that results from loading a certain part of the body more than its energy, accompanied by heat and sweating and this is also related to the problem of mechanical overload, with the surrounding neuropathy in diabetics, and allergies to certain chemicals in the socks or Footwear known as friction dermatitis. Another topic is not less important and is impotence, but how does diabetes affect sexual ability? One of the most common diseases that lead to sexual dysfunction is diabetes mellitus, which many suffer from, with treatment neglected and high blood sugar for long periods, the complaint begins with the complications of this disease is the occurrence of a slight weakness in the erection of the organ, but it is soon to repeat this weakness , And with the passage of time it increases gradually until the patient reaches a stage where he may completely lose the ability to have an erection of the penis, despite his unchanging sense of sexual desire, which causes psychological suffering for the patient, and this occurs as a result of a chronic inflammation of the peripheral nerves of the body, which includes the nerves feeding the penis The same and through which he responds As a result of sexual stimuli, besides that, the patient complains of numbness in the extremities of the arms and legs, or perhaps (skepticism) or a burning sensation, and after a while, he may completely lose the feeling of pain or touch, and that the body’s weakness and weight loss, which diabetics are exposed to, which leads to a weak ability Nationality is part of poor public health, and impotence may arise as a result of taking medications to treat other diseases associated with diabetes, such as high blood pressure medications, most of which lead to erectile dysfunction 0 Here treatment is easier as soon as these types change to other types not It affects the sexual ability, the patient is depressed B psychological because of his long suffering with illness or any other reason, and this is indicated by loss of appetite and lack of focus and a sense of sadness and regret, and the poor health of the diabetic patient leads to an opportunity to develop microbial infections, so prostatitis or the vesicle can affect sexual ability. And now we turn to prevention and treatment and it is worthy of reference to the measures that must be taken to provide more protection for the feet and from them do not walk barefoot even inside your home, check the foot on a daily basis to discover anything abnormal early, check the foot sock well and make sure that it is clean Fit and fit for the foot size, choose the right shoe carefully. Inadequate shoes are the reason behind many foot problems. Check inside the shoe before each use. Patients who suffer from severe lack of sensation in the feet should avoid exercising extreme sports, wash the feet at least twice daily and dry them immediately after washing, especially between the toes, Pruning the toes nails so that wounds or scratches do not occur in the adjacent toes, not wearing tight socks and changing them daily, not wearing tight shoes so as not to make it difficult for blood to reach all parts of the foot, massaging the feet and legs from time to time so that the blood can reach it, not using water It is very hot and must be hot Moderate, there Ointments special pedicures consult your doctor around. As for the diabetic patient’s shoes, he has conditions that must be met, among them being wide, comfortable, flexible, and thick, that it is lined from the inside, such as sports shoes, and it does not contain any harsh materials in the base (the sole) of the shoe, unless

The shoe leaves no traces of pressure or redness on the tips of the toes or the bones of the foot, not being pointed at the front, especially for women, avoiding wearing high-heeled shoes open from the front and back, prefer shoes that use laces or adhesive tape so that they can be expanded in the event of swollen feet When buying shoes – shoes are preferred from detail shops, especially if the patient has deformities in the bones of the foot or joints. Buy or tailor the shoes late in the day because the feet are swollen at the end of the day. Check the feet 10 minutes after wearing the shoe in order to make sure No redness or excess pressure , Not to wear slippers or sandals, you must soften the new shoe by a family member and not to wear it for more than two hours by the patient and then wear it until Tliynh, make sure that there is no foreign body inside the shoe every day. As for the socks of the diabetic patient, they should be: wide – cotton – soft – dry, with no bends in the socks inside the shoe and away from nylon. Shoes should not be worn without socks, and there are important warnings such as not to use chemicals on the market to remove cracks and calluses. Rather, the doctor should be consulted, the man’s ironing in folk doctors, not using herbal medicines unless after consulting a doctor and knowing the water temperature before Use it. Finally, we turn to the treatment that requires attention to keep blood sugar levels at the normal limits for diabetics, helps protect nerves from damage and adjust the level of vitamins in the event of their deficiency, improves many cases and in the case of pernicious anemia, the injection of vitamin B-12 with additional support For other vitamins and good nutrition, they are beneficial and control the degree of response of the immune system in the case of autoimmune disorders and removal of the source of pressure on the nerve with surgery, then treat the resulting inflammation and stop immediately taking the substances or toxic drugs that cause neuropathy It prevents progression of the disease, especially medications that are taken for long periods without a prescription and have side effects including peripheral nerve inflammation and nerve stimulation with skin tingling, although it is a safe and painless method, it benefits some and not all types of pain, hypnosis and relaxation methods relieve tension Muscles, and despite progress in understanding the metabolic causes of neuropathy, attempts to stop these processes are still limited. Thus, with the exception of tight control of glucose levels, treatments are aimed at reducing pain and other symptoms. Treatments available for pain control include tricyclic antidepressants, serotonin reuptake inhibitors and antiepileptic drugs. A systematic review concluded that tricyclic antidepressants and conventional antiepileptic drugs are better for short-term pain relief than the newer generation of anti-seizure drugs and the combination of these drugs may be better than one, and recently the FDA approved only two medications to treat peripheral neuropathy They are the antidepressant doloxetine and anti-convulsive pregabalin. Patients with localized peripheral diabetic neuropathy can relieve their pain by lidocaine patches before using drugs that affect the entire body.

Tricyclic antidepressants Tricyclic antidepressants include imipramine and amitriptyline. These drugs are effective in reducing pain symptoms but have many side effects that depend on the dose of the drug. One notable side effect is cardiac toxicity, which can lead to an irregular heartbeat. Toxicity is rare in low doses used for neuropathy, but complications are more common when increasing doses. Amitriptyline is widely used in this case, but they have fewer side effects. Serotonin reuptake inhibitors Serotonin reuptake inhibitors include fluoxetine, paroxetine, sertraline, and citalopram. These drugs were not approved by the FDA to treat painful neuropathy because their effectiveness did not exceed the effectiveness of placebo in several controlled trials. The side effects of this type are rarely serious, and they do not cause any permanent impairments. But it causes numbness and weight gain, which reduces the ability to control blood sugar. It can be used in dosages to relieve symptoms of depression, associated with diabetic neuropathy. Diloxetine is approved to treat diabetic neuropathy, a type of norepinephrine and SSNRI reuptake inhibitor. By targeting both serotonin and norepinephrine, it targets painful symptoms of diabetic neuropathy, and also treats depression if present. Typical doses are between 60 mg and 120 mg. Epilepsy medications Like epilepsy drugs, especially gabapentin and pregabalin, is a first line of treatment for painful neuropathy. Effectively, the two gabapentin is amitriptyline, but it is safer. One of its most important side effects is numbness, which does not decrease over time and may get worse. It must be taken three times daily, and sometimes it causes weight gain, which reduces the ability to control blood sugar for diabetics. Carbamazepine is effective but not necessarily safe for treating diabetic neuropathy. It is considered the first metabolism of carbamazine which is, effective and safe in other neurological disorders, but has not been studied in diabetic neuropathy. Topperm has not been studied as a treatment for diabetic neuropathy, but its beneficial side effect is loss of appetite and weight loss, which makes it beneficial according to anecdotally. Conventional analgesics The previous three categories of drugs fall under the heading atypical drugs, adjuvants, and potential drugs and are often combined with opioids and / or anti-inflammatory drugs, and the outcome is usually better than the sum of their parts. There is a common prescription in case diabetic neuropathy is a cofactor for increasing pain in cases of chronic debilitating pain and this prescription includes (doloxetine + extended-acting morphine morphine ± naproxen hydroxyzine and sometimes amitriptyline is more effective than doloxetine. Opioids that require revitalization should be used. The pathway of cytochrome B 450 (such as codeine and dihydrocodeine) with cofactors not related chemically to serotonin reuptake inhibition drugs because these drugs can affect absorption, distribution, metabolism, and the method of disposal of drugs such as morphine, hydromorphone, and Oxymorphon.

Other treatments Percutaneous nerve stimulation may be effective in treating pain caused by diabetic neuropathy. Alpha lipoic acid, which is an antioxidant and dietary supplement – does not require prescription to dispense – showed a good result in a randomized controlled trial that compared a dose of 600 mg to 1,800 mg orally once a day with a placebo, although nausea occurred in the case of high doses. Methylcobalamin, a form of vitamin B12 present in the spinal fluid, has shown a significant effect in treating diabetic neuropathy, whether taken orally or by injection, C. Peptide has shown promising results in the treatment of complications of diabetes, including neuropathy, although it is not Currently available on the market. It was once thought that it is a useless byproduct of insulin byproduct, but it helps to improve and reverse the main symptoms of diabetes, and energy imaging devices have become widely used in recent years to treat neurological symptoms. These devices emit near-infrared radiation (near infrared therapy) with a wavelength of 880 nm. It is believed that this wave stimulates the release of nitric oxide into the bloodstream, which is a relaxant factor derived from the endothelium, thereby expanding the veins and capillaries in the microvascular system. This increased blood appears effective in various clinical studies in reducing pain in patients with diabetes and others. It appears that therapeutic imaging devices for energy address the underlying problem of neuropathies, which is poor blood circulation, causing pain and numbness of the extremities. Satifex, a cannabis dependent drug, has not been shown to be effective in treating diabetic neuropathy. There was experimental work to test the efficacy of a drug called sildenafil (Viagra), but this study described itself as a limited report and indicated the need for more clinical trials. Tight glucose control Treatment of early symptoms of multiple motor neuropathy requires improved blood sugar control. Tightly controlled glucose can reverse changes in diabetic neuropathy, but only if diabetic neuropathy and diabetes are initially present. Conversely, painful symptoms of diabetic neuropathy tend to subside as the disease progresses and the feeling of numbness increases. And we end up with the fate of the disease and report that the mechanisms of diabetic neuropathy remain shrouded in mystery. , At the present time, treatment relieves pain, and can control some of the symptoms associated with the disease, but the disease generally progresses, and there is an increased risk of injury to the feet due to loss of sensation as complications of the disease (diabetic foot). The infection can increase to become ulceration, and this may sometimes require amputation. We also have to carry out a regular blood glucose test at least twice a year so that we avoid complications before the onset of the disease, may God forgive us and you are the evil of diseases and ills.

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