Peripheral Nerve Blocks in Patients with Diabetic Neuropathy and other Neuropathies: A Narrative Review.

Neuropathy, arising from different etiologies, can be a majordebilitating condition that leads to pain,reduces physicalmovement and amputation. Among all known neuropathyetiologies, diabetes mellitus is one of the significant causesthat results in peripheral and other type of neuropathies thatresult in physiological discomfort and mortality. Prolongedhyperglycemia-induced oxidative stress causes damage toneuron resulting in a range of symptoms to pain and internalorgan failure. Although treatment strategies exist to alleviatethe pain symptoms, there is no existing therapy to eliminatethe root cause of neuropathy. Presently, peripheral nerveblock by several anesthetic agents shows great promise inmanaging diabetes-induced neuropathy and neuropathiesof other etiologies. This article discusses different types ofneuropathies and their classifications with special emphasison diabetic neuropathy. The following section discusses theextent of severity of the condition in terms of its epidemiologyand associated complications. The article provides an elaborateidea on different anesthetic agents used in peripheral nerveblock in diabetic neuropathy and other neuropathic conditions.Peripheral nerve block shows a potential efficiency whensingle and combination doses of anesthetics are used. Differentadjuvants are also used in combination with anesthetics toprolong and enhance the effect of analgesia. Looking at theseverity, physiological, psychosocial and economic burden ofthe neuropathic disease, more in-depth studies and discussionshould be initiated to strengthen the use of peripheral nerveblock in the management of diabetic and other neuropathies.

A case of treatment-induced neuropathy in an adolescent with type 1 diabetes

Treatment-induced neuropathy (TIN) in diabetes is an acute and painful yet completely reversible small fiber neuropathy precipitated by a rapid improvement in glycemic control. TIN is rare in children. A 16-year-old girl developed symmetrical painful neuropathy of the foot, autonomic neuropathy, and retinopathy 5 weeks after the diagnosis of type 1 diabetes. All causative workups were negative except for a drop-in hemoglobin A(1c) (HbA(1c)) from 17.4% to 7%, which fit with a diagnosis of TIN. Following symptomatic management, her neuropathy and retinopathy completely resolved in 2 months. Currently, she is 18 years old and doing well (HbA(1c), 7.4%) without any recurrence of TIN. TIN should be suspected in any child presenting with recent-onset type 1 diabetes and acute onset neuropathy. Our case represents an unreported scenario of the rapid progression in TIN. Awareness among clinicians about this rare but completely reversible condition is necessary to ensure proper management and adherence to glycemic control.

Research progress of p38 MAPK in painful diabetic peripheral neuropathy / 中国医师杂志

Diabetic peripheral neuropathy is a common complication of diabetes mellitus,can occur in some patients with painful diabetic peripheral neuropathy.The occurrence of PDPN is related to many factors,such as long term severe hyperglycemia and metabolic disorders,deficiency of neurotrophic factors, disorder of microcirculation,increase of oxygen free radicals in oxidative stress and disorder of immune func-tion.Mitogen activated protein kinase (MAPK)is a kind of serine /tyrosine protein kinase ,which can widely expressed in cell,and can be involved in the pathophysiological process of stress,inflammation,cell cycle and apoptosis through increased nuclear transcription factors.P38MAPK signaling pathway is an im-portant branch of the MAPK,this overview focuses on the research progress of p38MAPK signaling pathway in the pathogenesis of PDPN.

Five cases of acute painful neuropathy induced by rapid glycaemic control with insulin and literature review / 中华内分泌代谢杂志

[Summary] The characteristics ot clinical data and relevant inspection (quantitative sensory and electrophysiological studies) in 5 patients hospitalized with acute painful neuropathy following rapid glycaemic control with insulin from 2010 to 2012 in our hospital were analyzed.The results showed that 5 patients were all males,aged 31-49 years,with lower body mass index,and diagnosed as latent autoimmune diabetes of adults (LADA) or type 2 diabetes.Glycaemic control was poor before application of insulin.When insulin was used,the hyperglycemia was rapidly corrected in a short time,with recurrent episodes of hypoglycemia during insulin treatment.The painful neuropathic symptoms appeared within 2-4 weeks after application of insulin,and were relieved partially or completely after 2-6 months.Neuropathic symptoms manifested as tingling and tenderness,with worsening during night and after insulin injection.The neuropathic symptoms were not significantly alleviated after application of neurotrophic drugs such as methycobal,protogen,and prostaglandin.These patients often suffered from severe anxiety.Nerve electromyogram examination showed slowed or normal motor conduction velocity of tibial and fibular nerves,and normal feeling threshold.