Overview

糖尿病神经病变是一种神经损伤,如果你患有糖尿病. High blood sugar (glucose) can injure nerves throughout your body. Diabetic neuropathy most often damages nerves in your legs and feet.

Depending on the affected nerves, 糖尿病神经病变的症状可以从腿部和双脚的疼痛和麻木到消化系统的问题, urinary tract, blood vessels and heart. Some people have mild symptoms. But for others, diabetic neuropathy can be quite painful and disabling.

糖尿病神经病变是一种严重的糖尿病并发症,可影响多达50%的糖尿病患者. 但你通常可以通过持续的血糖管理和健康的生活方式来预防糖尿病神经病变或减缓其进展.

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Symptoms

There are four main types of diabetic neuropathy. You can have one type or more than one type of neuropathy.

Your symptoms will depend on the type you have and which nerves are affected. Usually, symptoms develop gradually. 在神经受到严重损伤之前,你可能不会注意到有什么不对劲.

Peripheral neuropathy

这种类型的神经病变也可称为远端对称周围神经病. It's the most common type of diabetic neuropathy. It affects the feet and legs first, followed by the hands and arms. 周围神经病变的体征和症状通常在夜间加重,包括:

  • Numbness or reduced ability to feel pain or temperature changes
  • Tingling or burning sensation
  • Sharp pains or cramps
  • 增加对触摸的敏感性——对一些人来说,即使是床单的重量也会感到疼痛
  • Serious foot problems, such as ulcers, infections, and bone and joint pain

Autonomic neuropathy

自主神经系统控制着你的心脏、膀胱、胃、肠、性器官和眼睛. Diabetes can affect nerves in any of these areas, possibly causing:

  • 对低血糖缺乏认识(低血糖不认识)
  • Bladder or bowel problems
  • 胃排空缓慢(胃轻瘫),引起恶心、呕吐和食欲不振
  • Changes in the way your eyes adjust from light to dark
  • Decreased sexual response

Proximal neuropathy (diabetic polyradiculopathy)

这种类型的神经病变也被称为糖尿病性肌萎缩症,通常影响大腿神经, hips, buttocks or legs. It can also affect the abdominal and chest area. 症状通常发生在身体的一侧,但也可能扩散到另一侧. You may have:

  • Severe pain in a hip and thigh or buttock
  • Eventual weak and shrinking thigh muscles
  • Difficulty rising from a sitting position
  • Severe stomach pain

Mononeuropathy (focal neuropathy)

There are two types of mononeuropathy — cranial and peripheral. Mononeuropathy refers to damage to a specific nerve. Mononeuropathy may also lead to:

  • Difficulty focusing or double vision
  • Aching behind one eye
  • Paralysis on one side of your face (Bell's palsy)
  • 手或手指麻木或刺痛,小指除外
  • Weakness in your hand that may cause you to drop things

When to see a doctor

Call your doctor for an appointment if you have:

  • A cut or sore on your foot that is infected or won't heal
  • Burning, tingling, 手脚无力或疼痛,影响日常活动或睡眠
  • Changes in digestion, urination or sexual function
  • Dizziness and fainting

美国糖尿病协会建议,糖尿病神经病变的筛查应在某人被诊断为2型糖尿病后立即开始, and five years after diagnosis for someone with type 1 diabetes. After that, screening is recommended annually.

Causes

The exact cause of each type of neuropathy is unknown. Researchers think that over time, 不受控制的高血糖会损害神经,干扰它们发送信号的能力, leading to diabetic neuropathy. 高血糖还会削弱为神经提供氧气和营养的毛细血管壁.

Risk factors

Anyone who has diabetes can develop neuropathy. But these risk factors make you more likely to get nerve damage:

  • Poor blood sugar control. 不受控制的血糖会使你面临各种糖尿病并发症的风险,包括神经损伤.
  • Diabetes history. Your risk of diabetic neuropathy increases the longer you have diabetes, especially if your blood sugar isn't well controlled.
  • Kidney disease. Diabetes can damage the kidneys. Kidney damage sends toxins into the blood, which can lead to nerve damage.
  • Being overweight. 身体质量指数(BMI)大于等于25可能会增加你患糖尿病神经病变的风险.
  • Smoking. 吸烟会使动脉变窄、硬化,减少流向腿部和脚部的血液. 这使得伤口更难愈合,并损害周围神经.

Complications

Diabetic neuropathy can cause a number of serious complications, including:

  • Hypoglycemia unawareness. 血糖水平低于70毫克/分升(mg/dL)通常会引起颤抖, sweating and a fast heartbeat. But if you have autonomic neuropathy, you may not notice these warning signs.
  • Loss of a toe, foot or leg. Nerve damage can make you lose feeling in your feet, so even minor cuts can turn into sores or ulcers without your realizing it. In severe cases, an infection can spread to the bone or lead to tissue death. Removal (amputation) of a toe, foot or even the lower leg may be necessary.
  • Urinary tract infections and urinary incontinence. 如果控制膀胱的神经受损,你可能无法完全排空膀胱. 细菌会在膀胱和肾脏积聚,导致尿路感染. 神经损伤也会影响你的排尿感觉或控制排尿肌肉的能力, leading to leakage (incontinence).
  • Sharp drops in blood pressure. 控制血液流动的神经受损会影响身体调节血压的能力. This can cause a sharp drop in pressure when you stand after sitting, which may lead to dizziness and fainting.
  • Digestive problems. 如果你的消化道受到神经损伤,你可能会便秘或腹泻,或两者都有. Diabetes-related nerve damage can lead to gastroparesis, a condition in which the stomach empties too slowly or not at all, which causes bloating and indigestion.
  • Sexual dysfunction. Autonomic neuropathy often damages the nerves that affect the sex organs. Men may experience erectile dysfunction. Women may have difficulty with lubrication and arousal.
  • Increased or decreased sweating. 神经损伤会破坏汗腺的工作方式,使你的身体难以适当地控制温度.

Prevention

你可以通过密切控制你的血糖和照顾好你的脚来预防或延迟糖尿病神经病变及其并发症.

Blood sugar management

美国糖尿病协会建议糖尿病患者每年至少做两次糖化血红蛋白检测. 这个测试估计你在过去两到三个月的平均血糖水平.

A1C goals may need to be individualized, but for many adults, the American Diabetes Association recommends an A1C of less than 7%. If your blood sugar levels are higher than your goal, you may need changes in your daily management, such as adding or adjusting your medications or changing your diet.

Foot care

Foot problems, including sores that don't heal, ulcers and even amputation, are common complications of diabetic neuropathy. 但是你可以通过每年至少一次彻底的足部检查来预防这些问题, 每次去诊所都让医生检查你的脚,在家也要照顾好你的脚.

Follow your doctor's recommendations for good foot care. To protect the health of your feet:

  • Check your feet every day. 检查是否有水泡,割伤,瘀伤,皮肤开裂和脱皮,发红和肿胀. 使用镜子或让朋友或家人帮助检查你的脚上很难看到的部分.
  • Keep your feet clean and dry. Wash your feet every day with lukewarm water and mild soap. Avoid soaking your feet. Dry your feet and between your toes carefully.
  • Moisturize your feet. This helps prevent cracking. 但是不要在脚趾间涂抹润肤露,因为这可能会促进真菌的生长.
  • Trim your toenails carefully. Cut your toenails straight across. File the edges carefully to avoid sharp edges.
  • Wear clean, dry socks. 选择棉质或吸湿纤维制成的袜子,不要有紧带或厚接缝.
  • Wear cushioned shoes that fit well. Always wear shoes or slippers to protect your feet. Make sure your shoes fit properly and allow your toes to move. 足部医生可以教你如何购买合适的鞋子,预防鸡眼和老茧等问题. 如果你有资格申请医疗保险,你的计划每年可以支付至少一双鞋的费用.

March 03, 2020
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