Diabetisk nevropati: Symptomer
Det finnes ulike varianter av diabetisk nevropati, men ved den vanligste typen rammes overveiende følenervene (de sensoriske nervene). I første omgang oppstår problemer med tærne, etter hvert kan nerveskaden bre seg oppover foten og leggen. Typisk rammes begge beina nokså likt, og tilstanden øker sakte og går ikke tilbake.
Det er to hovedtyper av skader: følelsestap (sensibilitetstap) og smerter. Følelsestap er det vanligste, med nummenhet og/eller prikkende fornemmelser, av og til kuldefølelse. De fleste med følelsestap har ingen smerter, og mange med kroniske smerter har ikke følelsestap. Blandingstilstander er likevel vanlig.
Vanlige kjennetegn på smerten er at den føles brennende, verkende, prikkende eller kommer som elektriske støt. Smerter utløst av stimuli som normalt ikke gir smerter, er vanlig, likeledes kramper i føttene. Muskelsvinn og muskelsvakhet er sjeldnere. Hendene rammes som regel bare ved alvorlig og langtkommet sykdom.
Andre, men mer uvanlige tegn på nevropati, kan være svetteforstyrrelser, svimmelhet på grunn av lavt blodtrykk når du reiser deg opp og diaré - symptomer på autonom nevropati.
Dette dokumentet er basert på det profesjonelle dokumentet Diabetisk nevropati . Referanselisten for dette dokumentet vises nedenfor
- Helsedirektoratet. Nasjonale faglig retningslinje for diabetes. Sist faglig oppdatert: 16. mars 2021. helsedirektoratet.no
- Malik RA, Alam U, Azmi S. Diabetic neuropathy. BMJ Best Practice, last updated June 2019.
- Pop-Busui R, Boulton AJ, Feldman EL, et al. Diabetic neuropathy: a position statement by the American Diabetes Association. Diabetes Care. 2017 Jan;40(1):136-54. PubMed
- Callaghan BC, Cheng HT, Stables CL, et al. Diabetic neuropathy: clinical manifestations and current treatments. Lancet Neurol 2012; 11: 521-34. PubMed
- Feldman EL, Callaghan BC, Pop-Busui R, et al. Diabetic neuropathy. Nat Rev Dis Primers. 2019;5(1):42. Published 2019 Jun 13. PMID: 31197183 PubMed
- Mizrak HI, Hansen TW, Rossing P, et al. Declining Incidence Rates of Distal Symmetric Polyneuropathy in People With Type 1 and Type 2 Diabetes in Denmark, With Indications of Distinct Patterns in Type 1 Diabetes. Diabetes Care 2023; 46: 1997-2003. pmid:37647323 PubMed
- Snyder MJ, Gibbs LM. Treating painful diabetic peripheral neuropathy: an update. Am Fam Physician 2016; 94: 227-34. American Family Physician
- Garces-Sanchez M, Laughlin RS, Dyck PJ, et al. Painless diabetic motor neuropathy: A variant of diabetic lumbosacral radiculoplexus neuropathy?. Ann Neurol 2011; 69: 1043-54. PubMed
- Agashe S, Petak S. Cardiac Autonomic Neuropathy in Diabetes Mellitus. Methodist Debakey Cardiovasc J. 2018;14(4):251-256. PubMed
- Fan J, Peng T, Hui J, et al. Erectile Dysfunction in Type-2 Diabetes Mellitus Patients: Predictors of Early Detection and Treatment. Urol Int. 2021;105(11-12):986-992. PMID: 33951654 PubMed
- American Diabetes Association. Standards of medical care in diabetes - 2014. Diabetes Care. 2014;37:S14-S80.
- Callaghan BC, Little AA, Feldman EL, Hughes RA. Enhanced glucose control for preventing and treating diabetic neuropathy. Cochrane Database Syst Rev 2012; :CD007543. Cochrane (DOI)
- Selvarajah D, Kar D, Khunti K, et al. Diabetic peripheral neuropathy: advances in diagnosis and strategies for screening and early intervention. Lancet Diabetes Endocrinol. 2019;7(12):938-948. PubMed
- Griebeler ML, Morey-Vargas OL, Brito JP, et al. Pharmacologic interventions for painful diabetic neuropathy: An umbrella systematic review and comparative effectiveness network meta-analysis. Ann Intern Med 2014; 161: 639-49. doi:10.7326/M14-0511 DOI
- Tesfaye S, Sloan G, Petrie J, et al. Comparison of amitriptyline supplemented with pregabalin, pregabalin supplemented with amitriptyline, and duloxetine supplemented with pregabalin for the treatment of diabetic peripheral neuropathic pain (OPTION-DM): a multicentre, double-blind, randomised crossover trial. Lancet 2022. pmid:36007534 PubMed
- Price R, Smith D, Franklin G, et al. Oral and Topical Treatment of Painful Diabetic Polyneuropathy: Practice Guideline Update Summary: Report of the AAN Guideline Subcommittee. Neurology. 2022;98(1):31-43. PubMed
- Ziegler D, Fonseca V. From guideline to patient: a review of recent recommendations for pharmacotherapy of painful diabetic neuropathy. J Diabetes Complications. 2015;29(1):146–156.
- Griebeler ML, Morey-Vargas OL, Brito JP, et al. Pharmacologic interventions for painful diabetic neuropathy: an umbrella systematic review and comparative effectiveness network meta-analysis published corrections appear in Ann Intern Med. 2015;162(8):600, and Ann Intern Med. 2015;162(10)739. Ann Intern Med. 2014;161(9):639–649.
- Lunn MP, Hughes RA, Wiffen PJ. Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia. Cochrane Database Syst Rev. 2014;1:CD007115. PMID: 24385423 PubMed
- Kaur H, Hota D, Bhansali H, et al. A comparative evaluation of amitriptyline and duloxetine in painful diabetic neuropathy: A randomized, double-blind, cross-over clinical trial. Diabetes Care 2011; 34: 818-22. PubMed
- Waldfogel JM, Nesbit SA, Dy SM, et al. Pharmacotherapy for diabetic peripheral neuropathy pain and quality of life. Neurology 2017. doi:10.1212/WNL.0000000000003882 DOI
- Jingxuan L, Litian M, Jianfang F. Different Drugs for the Treatment of Painful Diabetic Peripheral Neuropathy: A Meta-Analysis. Front Neurol. 2021;12:682244. Published 2021 Oct 29. PMID: 34777192 PubMed
- Ko SH, Kwon HS, Yu JM, et al. Comparison of the efficacy and safety of tramadol/acetaminophen combination therapy and gabapentin in the treatment of painful diabetic neuropathy. Diabet Med 2010; 27: 1033-40. PubMed
- Tesfaye S, Wilhelm S, Lledo A, et al. Duloxetine and pregabalin: High-dose monotherapy or their combination? The ``COMBO-DN study`` - a multinational, randomized, double-blind, parallel-group study in patients with diabetic peripheral neuropathic pain. Pain 2013. doi:10.1016/j.pain.2013.05.043 DOI
- McNicol ED, Midbari A, Eisenberg E. Opioids for neuropathic pain. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD006146. DOI: 10.1002/14651858.CD006146.pub2. DOI
- Vinik AI, Shapiro DY, Rauschkolb C, et al. A randomized withdrawal, placebo-controlled study evaluating the efficacy and tolerability of tapentadol extended release in patients with chronic painful diabetic peripheral neuropathy. Diabetes Care. 2014;37(8):2302–2309.
- Simpson DM, Robinson-Papp J, Van J, et al. Capsaicin 8% Patch in Painful Diabetic Peripheral Neuropathy: A Randomized, Double-Blind, Placebo-Controlled Study. J Pain. 2017; 18: 42-53. PMID: 27746370 PubMed
- Nøkleby K, Julsrud Berg T. Diabetisk nevropati - en klinisk oversikt. Tidsskr Nor Lægeforen 2005; 125: 1646-9. PubMed
- Feldman EL. Management of diabetic neuropathy. UpToDate, last updated Aug 30, 2022. UpToDate
- Thour A, Marwaha R. Amitriptyline. In: StatPearls. Treasure Island (FL): StatPearls Publishing; May 15, 2022. PMID: 30725910 PubMed