Diabetic Neuropathy

Preventing by Risk Factor

Dr. Zamroni Sp.S

CME 53 FKIK UMY 2022
Pathophysiology Of Diabetes And Its
Complications
Painful Diabetic Neuropathy (PDN) :
Painful Consequences Of Diabetes
Mechanisms Of Neuropathic Pain In
PDN
Diagnosis and Management Of PDN
 Monitoring blood sugar
Keep your blood pressure
Healthy eating plan
How to Prevent Diabetic
Get regular physical activity
Neuropathy Event?
Lose weight if you’re overweight
Avoid alcohol consumption
Stop smoking
 • Glicated haemoglobin HbA1c used to
monitor the status of glucose. Levels
in previous 2 or 3 months

• Intensive glycemic control and lower

Monitoring level HbA1c < 7% => 60% incidenve

PDN
Blood Sugar • The elektrodiagnosis examination
found in patients with large fiber
neuropathy showed a heavier NDS
value compare small fiber
neuropathy
 • The mechanism of hypertension in
diabetic nephropathy is complex

• sodium retention, sympathetic nervous

system (SNS) and renin-angiotensin-

Keep Blood aldosterone system (RAAS)activation,

endothelial cell dysfunction (ECD), and
Pressure increased oxidative stress.

• Hypertension has varying effects on small

and large fibers

• Hypertension worsens deficits in NCS

 • Oxidative stress is thought to be a
major contributor to diabetic
neuropathy.

• Antioxidants may play a role in the

Healthy successful
neuropathy.
treatment of diabetic

Eating Plan • A dietary supplement that may

improve or prevent diabetic
neuropathy is nicotinamide riboside

• High levels of NAD+ can prevent

oxidative injury in neurons
 • Aerobic exercise beneficial effects on
many of the pathways that are adversely
affected by diabetes

• Exercise can improve three of the biggest

Get Regular risk factors for diabetic neuropathy:

Physical Activity insulin sensitivity and glucose control,

obesity, and dyslipidemia

• Exercise significantly improved HbA1c as

well as Michigan Neuropathy Symptom
Inventory and pain levels on a VAS.
 • Insulin resistance might be a key
regulator between obesity and DPN

• Insulin resistant status represents low

Lose weight if grade inflammation which influences

endothelial dysfunction and
you’re microvascular complications.

overweight • Total obesity and abdominal obesity were

associated with DPN, and insulin
resistance might mediate obesity and
DPN
 • Alcohol-induced neuropathy is thought to
be due to activation of spinal cord
microalga, oxidative stress, free radical
damage, activation of mGlu5-receptors in
Avoid Alcohol the spinal cord as well as activation of the

Consumption sympathoadrenal and hypo- thalamic-

pituitary axes

• Particularly of thiamine, and/or the direct

toxic effect of alcohol and its metabolites
(particularly acetaldehyde) on the nerve
damage
 • As a source of free radicals and oxidants,
cigarette smoke could induce cellular
oxidative stress in many organs, including
the nervous system and blood vessels,
leading to cellular damage and even
apoptosis
Stop Smoking • Smoking also restricts blood flow
• Bood sugar levels and increase your risk
of getting diabetes by 30% to 40%.
• Within two weeks of quitting smoking
lung function also increases as much as
30 percent, notes the University of
Michigan.
 • Diabetic neuropathy is a type of nerve damage that can occur DM
patien coused by micro and macroangiopathy

• Increased production of polyol pathways, AGEs and free radicals is the

TAKE HOME pathophysiology of PDN

MESSAGE • Monitoring blood sugar, hypertensi, healthy eating, physical activity,

ideal body weight, avoid alcohol consumption and smoking is a
strategy to control the progression of diabetic neuropathy

• Prevention is better than medication

Alhamdulillah
Thank you