1、 Pathophysiology of DiabeticNeuropathyZhijie Xi,MDGuanghua Hospital Affiliated to Shanghai University of Traditional Chinese MedicineDiabetic Peripheral Neuropathy Can Progress Over TimeSymptoms(numbness,prickling,pain)ReflexesPressure Sensation(Monofilament)Vibratory SensationNerve Conduction Abnor
2、malitiesSubclinicalClinicalTimeSignsOnset ofClinical DiseasesSymptoms may occur any time and intermittentlyPatients may or may not have symptoms of diabetic peripheral neuropathyPatients frequently do not report symptoms to their physicians until the symptoms are severeThe majority of signs of diabe
3、tic peripheral neuropathy are not evident at the onset of diabetesSymptoms and Signs of Diabetic Peripheral NeuropathySymptoms Numbness or loss of feeling(asleep or“bunched up sock under toes”sensation)Prickling/Tingling Aching Pain Burning Pain Lancinating Pain Unusual sensitivity or tenderness whe
4、n feet are touched(allodynia)Signs Diminished vibratory perception Decreased knee and ankle reflexes Reduced protective sensation such as pressure,hot and cold,pain Diminished ability to sense position of toes and feetSymptoms and signsprogress from distal to proximal over timeDiabetic Peripheral Di
5、abetic Peripheral Neuropathy Severity ScaleNeuropathy Severity ScaleRatingDescription0No neuropathy1Subclinical diabetic peripheral neuropathy2aClinical diabetic peripheral neuropathy with symptoms,mild to moderate2bClinical diabetic peripheral neuropathy insensate foot,loss of feeling/negative symp
6、toms3Disability/late stageEffects of Diabetic Effects of Diabetic Peripheral NeuropathyPeripheral NeuropathyNeuropathyMotorSensoryAutonomic nociception Proprioception,Unawarenessof foot positionReduced sweatingDry skinFissures andcracksMuscle wastingFoot weaknessPostural deviationDeformities,stressa
7、nd shear pressuresTraumaStress on bones&jointsPlantar pressureCallus formationInfectionUlcerSimple Tests of Large-Fiber Function The PNS is comprised of both neurons and SCs Pathways Implicated in Diabetic Neuropathy PathogenesisBioenergetic Mechanisms of Nerve Injury in Diabetes Peripheral Mechanisms Contributing to Neuropathic Pain in Diabetic Neuropathy
