TABLE 2 Symptoms of Diabetic Neuropathy Sensorimotor neuropathy Muscular symptoms: muscle weakness (not fatigue), atrophy, balance problems,

ata xic gait Sensory symptoms: pain, paresthesia, numbness, paralysis, cramping, nighttime fa lls, antalgic gait Autonomic neuropathy Cardiovascular symptoms: exercise intolerance, fatigue, sustained heart rate, sy ncope, dizziness, lightheadedness, balance problems Gastrointestinal symptoms: dysphagia, bloating, nausea and vomiting, diarrhea, c onstipation, loss of bowel control Genitourinary symptoms: loss of bladder control, urinary tract infection, urinar y frequency or dribbling, erectile dysfunction, loss of libido, dyspareunia, vag inal dryness, anorgasmia Sudomotor (sweat glands) symptoms: pruritus, dry skin, limb hair loss, calluses, reddened areas Endocrine symptoms: hypoglycemic unawareness Other symptoms: difficulty driving at night, depression, anxiety, sleep disorder s, cognitive changes Physical examination Vital signs and pain index Supine and standing blood pressure for postural hypotension Cardiovascular examination to look for arrhythmias, absent or diminished pulses, edema, or delayed capillary refilling Cutaneous examination to look for extremity hair loss, skin or nail changes (inc luding callus), and pretrophic (red) areas, especially between toes Neurologic examination using the 5.07 Semmes-Weinstein (10-g) nylon filament tes t (10-g monofilament test) Inspection of feet for asymmetry, loss of arch height, or hammer toes Evaluation of all positive screening findings Annual diabetes evaluation

Kidney failure provoked by glomerulosclerosis leads to fluid filtration deficits and other disorders of kidney function. There is an increase in blood pressure (hypertension) and fluid retention in the body plus a reduced plasma oncotic pre ssure causes edema. Other complications may be arteriosclerosis of the renal art ery and proteinuria. Throughout its early course, diabetic nephropathy has no symptoms. They develop in late stages and may be a result of excretion of high amounts of protein in th e urine or due to renal failure: edema: swelling, usually around the eyes in the mornings; later, general body sw elling may result, such as swelling of the legs foamy appearance or excessive frothing of the urine (caused by the proteinuria) unintentional weight gain (from fluid accumulation) anorexia (poor appetite) nausea and vomiting malaise (general ill feeling) fatigue headache frequent hiccups The first laboratory abnormality is a positive microalbuminuria test. Most often , the diagnosis is suspected when a routine urinalysis of a person with diabetes shows too much protein in the urine (proteinuria). The urinalysis may also show glucose in the urine, especially if blood glucose is poorly controlled. Serum c reatinine and BUN may increase as kidney damage progresses. A kidney biopsy confirms the diagnosis, although it is not always necessary if t he case is straightforward, with a documented progression of proteinuria over ti me and presence of diabetic retinopathy on examination of the retina of the eyes ., As diabetic nephropathy progr

Your kidneys cannot clear toxins or drugs from your body as well. And your kidne ys cannot balance the chemicals in your blood very well. You may: Lose more protein in your urine (macroalbuminuria, also known as overt nephropat hy). Have higher blood pressure. Have higher cholesterol and triglyceride levels. You may have symptoms if your nephropathy gets worse. These symptoms include: Swelling (edema), first in the feet and legs and later throughout your body. Poor appetite. Weight loss. Weakness. Feeling tired or worn out. Nausea or vomiting. Trouble sleeping. Chronic kidney disease is also called chronic renal failure or chronic renal ins ufficiency. What causes chronic kidney disease? Chronic kidney disease is caused by damage to the kidneys. The most common cause s of this damage are: High blood pressure. High blood sugar (diabetes). Other things that can lead to chronic kidney disease include: Kidney diseases and infections, such as polycystic kidney disease, pyelonephriti s, and glomerulonephritis, or a kidney problem you were born with. A narrowed or blocked renal artery. The renal artery carries blood to the kidney s. Long-term use of medicines that can damage the kidneys. Examples include nonster oidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) and celecoxib (Celebrex). What are the symptoms? You may start to have symptoms only a few months after your kidneys begin to fai l. But most people don't have symptoms early on. In fact, many don't have sympto ms for as long as 30 years or more. This is called the "silent" phase of the dis ease. How well your kidneys work is called kidney function. As your kidney function ge ts worse, you may: Urinate less than normal. Have swelling from fluid buildup in your tissues. This is called edema (say "ihDEE-muh"). Feel very tired or sleepy. Not feel hungry, or you may lose weight without trying. Often feel sick to your stomach (nauseated) or vomit. Have trouble sleeping. Have headaches or trouble thinking clearly. How is chronic kidney disease diagnosed? Symptoms common to many types of anemia include the following: Easy fatigue and loss of energy Unusually rapid heart beat, particularly with exercise Shortness of breath and headache, particularly with exercise Difficulty concentrating Dizziness Pale skin

Leg cramps Insomnia Other symptoms are associated with specific forms of anemia. Passing of foamy urine Diabetic retinopathy Peripheral vascular occlusive disease Hpn Cad