Beruflich Dokumente
Kultur Dokumente
Leticia Pickering
15 April 2007
Diabetes mellitus is a disease that affects the body in many devastating ways. Of
the potential side effects, diabetic neuropathy is the most dangerous, as it often exhibits
shown to be associated with glucose intolerance and may be, in fact, used as a diagnostic
symptom for diabetes mellitus (Freeman et al 333). “Diabetes may affect both the central
and peripheral nervous systems” and may be exhibited in one of four ways: chronic
diabetic radiopathy and mononeuropathy (Macleod et al 126). Before delving into the
carbohydrate, fat, and protein metabolism, which is clinically diagnosed on the basis of
classified into Type I and Type II. Type I, or insulin dependent diabetes, is either caused
diabetes requires that the hormone insulin be injected into the body. One might wonder
why insulin might not be taken orally. The insulin must be injected because of its
chemical structure. Hormones are composed of protein structures, which are sensitive to
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activity. If the hormone were ingested, the delicate protein structure would be denatured
in the acidic environment of the stomach before it could be absorbed into the blood
resistance. Unlike Type I diabetes, Type II patients typically produce sufficient amounts
of insulin. Rather, the insulin does not effectively bond to the glucose molecules in the
blood, therefore does not maintain blood glucose at consistent levels. Type II patients
generally do not require insulin therapy but it is often controlled with a nutritious diet and
exercise regimen (Barb et al 137). If needed, an oral medication can be taken in order to
improve the insulin’s ability to bind to the glucose molecules in the blood, therefore
maintaining blood glucose at a safe level. Diabetes, when left uncontrolled carries serious
risks including retinopathy, nephropathy, renal disease, and neuropathy. While each
complication takes a different toll on the body, few affect the body like the peripheral
When it becomes clear that neuropathy has begun to develop, it is imperative that
its etiology, or underlying cause, be determined. This means classifying the neuropathy
chronic. Its prevalence increases to approximately fifty percent twenty five years after
initial diagnosis, but is also attributed to older age, height, genetic history, history of
smoking, and long term retinopathy (Freeman 333). The risk for neuropathy also appears
to be greater for those patients with Type II diabetes and may have an association to
obesity.
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and unmyelinated nerve fibers are affected, which can seriously impair the speed at
which electrical impulses are conducted along the nerves. A condition known as chronic
and studies show that the illness’ symptoms might be accelerated in diabetic patients
(Freeman et al 335). This problem is further aggravated by the fact that nerve growth
and temperature changes. This type of neuropathy is tested with a small vibrator applied
to the sole of the foot and is usually accompanied by difficulty with balance and loss of
involuntary reflexes. “When a patient with diabetes has significant weakness, diagnostic
Proximal neuropathy is a rare condition, and occurs in less than one percent of
diabetic patients. This facet of diabetic neuropathy shows prevalence in men with Type II
diabetes, and is often preceded by significant weight loss and, in extreme cases, anorexia.
The characteristic weight loss makes diagnosis difficult, as this usually causes blood
glucose levels to stabilize. Symptoms generally include thigh and back pain, distal
muscle weakness, and an absence of the knee jerk reflex. Symptoms often do not occur
symmetrically, but rather begin on one side and progress to the other. Treatment options
include prescribed anti-inflammatory drugs. Another option is to regain the weight lost as
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These neuropathies are most often associated with acute pain, and occur many years after
coincided with unusual weight loss and, in the case of adult onset diabetes, be used as
Because of the many different problems diabetes can cause for the nervous
system, along with its contribution to the morbidity of diabetic patients, there is a great
deal of research concerning diabetic neuropathy. One study, conducted in Japan on a set
diabetes, could be in altering the function of the brain. It is becoming increasingly evident
that hyperglycemia may be directly toxic to the nerve cells by prompting the conversion
of glucose into the sugar alcohol sorbitol as a means of restoring normal blood glucose
levels. This is possible because sugar alcohols do not cause a rapid increase in blood
reaction could cause a reduction in adenosine triphosphate (ATP) which would cause all
of the major systems of the body to shut down. Neurotrophins, including nerve growth
were closely observed and measured in this experiment. While the scientists monitored
the change in all of the major neurotrophins, they paid particular attention to the levels of
al 61). In order to judge the effect of peripheral neuropathy on the brain’s activity and the
nervous system, the scientists evaluated the rats based on five stages of experimentation:
During the first phase of the experiment, the researchers induced diabetes in the
Wistar rats by injecting streptozotocin, a chemical commonly used to induce diabetes for
experimental purposes. The rats were diagnosed after four weeks of careful observation
and lab tests. A control group of non-treated rats was similarly monitored (Furukawa et al
63). After confirming that the streptozotocin successfully induced the diabetes, the
scientists examined the rats’ behavior as they were placed in a Y-Maze composed of gray
wood. Their movement was observed and recorded in order to measure short term
memory. This test revealed a reduced capacity for short term memory in the diabetic rats
Following the Y-Maze task, the scientists examined the rats’ hippocampus by
extracting the protein membrane and washing it in a solution with anti- calbindin, anti-
synapatophysin, and anti- syntaxin antibodies. This allowed each protein to be observed.
the diabetic hippocampus. These proteins are synaptospme- associated proteins, and
of crucial functions in the body, including but not limited to memory and pleasure. The
has been illustrated by researchers who have observed that the occurrence of diabetes in
Alzheimer’s patients is relatively high. It has been suggested that a diet sufficient in
choline, along with its cofactor lethicin, might help to compensate for this deficiency.
Additionally, the BDNF mRNA expressions in the hippocampus were measured. In the
diabetic rats, these levels were found to be significantly lower when compared to the
After realizing the potential for devastation caused by diabetic neuropathy, one
might wonder; what can be done to treat these side effects of diabetes? As with any
neuropathy development is, of course, management of the diabetes. To do this, the patient
must be aware of blood glucose testing methods and should be instructed in proper
diabetic nutrition by a registered dietician. This will allow the patient to achieve and
maintain healthy blood glucose levels. When treating diabetes the key to success is
consistency of diet, exercise, and medication, when necessary. Sadly, despite careful
treatment of diabetes, the condition can sometimes worsen and lead to neuropathy. While
there is no cure, a variety of treatments are available to treat the symptoms. In order to
treat the pain that occurs as a result of damaged nerves, doctors can prescribe trycyclic
antidepressants. The pain relieving effects of the drugs usually begin within forty eight
hours and generally precede the antidepressant function of the drug (Macleod et al 136).
neuropathy. This type of neuropathy occurs in less than forty percent of patients, and is
characterized by interference with the vital organs and other regulatory functions of the
body. This type of neuropathy can be treated in a variety of ways. For example,
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disruption of the bowel movement might be addressed with a high fiber diet eaten in
gastroparesis, they should consider eating a diet low in fiber. Complications involving the
urinary tract should be addressed with antibiotics in order to prevent a urinary tract
hypertension, or high blood pressure, can be easily treated with oral medications.
peripheral neuropathy is the meticulous care of the feet. While it may seem an
insignificant step in treatment, the diabetic foot is an area that demands careful attention.
Any injury at all could lead to serious consequences; something as small as a paper cut,
or even an ingrown toenail can lead to an emergency amputation of the foot. Does this
seem a bit extreme? Examining the physiology of the foot can allow for a better
understanding. When the circulation of blood becomes limited, as with diabetic patients,
the nerve endings begin to die, leaving an area of neurons that no longer function. The
next time the foot incurs a small injury, the patient may assume that the wound will heal
on its own, when in fact the foot no longer has this capability. If not treated immediately,
the tissues of the foot will begin to be destroyed. “The diabetic foot can be divided into
two entities: the neuropathic foot in which neuropathy predominates and there is a good
circulation, and the neuroischaemic foot where there is both neuropathy and absence of
foot pulses” (Edmonds et al 149). If an ulcer does develop, treatment is a three step
process. First, the callus should be removed and an antibiotic ointment should be applied.
Secondly, and most importantly, the infection must be treated and healed. Finally, weight
and pressure should be removed from the foot, and the patient should limit stress on the
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foot until it is fully healed. If these steps are not taken, the possibility for damage is
almost endless. Left untreated the ulcer will develop into gangrene, a condition in which
the nerves, capillaries, and blood vessels no longer function. If the gangrene affected foot
is not removed, the condition could spread to other parts of the body. Fortunately, with
the medical advances and research conducted in the diabetic field of medicine, this
Diabetes mellitus was once thought to be a disease solely concerned with dietary
control and its effects on the body’s blood glucose levels. While the control of blood
glucose levels is an integral part of diabetes, the problems it can cause extend to the other
systems of the body. The central nervous system is drastically affected by hyperglycemia,
and the symptoms of neuropathy can be painful and cause interference with patients’
lives. Not only is the nervous system affected on the peripheral level, the function of the
is clear that their effects on the body are complex and profound. The hyperglycemia that
is so characteristic of diabetes can actually cause the body to synthesize a substance that
is known to be directly toxic to nerve cells. With a reduced level of nerve growth
As discovered in the experiment with the lab rats, the hyperglycemia associated
with diabetes can have drastic effects on the function of the brain, especially in respect to
to short term memory as it relates to the etiology of Alzheimer’s disease, this information
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has the potential to prevent this devastating illness from seizing any more lives. Diabetes
is a disease, that, when regulated through proper diet and medication, can be controlled.