Spinal cord disease caused by diabetes

　　How is spinal cord disease caused by diabetes? Briefly described as follows:

　　The basic etiology of this disease is uncontrolled diabetes leading to spinal cord lesions. Current research believes that metabolic disorder is the root cause of various complications, including the following aspects:

　　1. Disordered glucose metabolism.The damage to nerve cells is most severe due to the deposition of sorbitol and the reduction of inositol.

　　2. Microvascular lesions.Diabetic atherosclerosis causes narrowing of the vascular lumen and impairment of microcirculation.

　　3. Secondary changes in blood components after diabetesIf plasma fibrinogen levels increase, platelet activation is enhanced, platelet adhesion to the vascular wall is increased, and the chance of platelet aggregation increases, ischemic infarction can occur.

　　Diabetic complications are numerous and can coexist. When diabetes is complicated with spinal cord lesions, clinical symptoms such as paraplegia, urinary disorders, and other peripheral autonomic nerve dysfunction may occur, such as anhidrosis of the lower limbs and compensatory hyperhidrosis of the head and hands.

　　What are the symptoms of spinal cord disease caused by diabetes? Briefly described as follows:

　　1. Diabetic ataxia

　　Diabetic ataxia is mainly due to damage to the posterior root and fasciculus of the spinal cord. It presents with the disappearance of patellar reflexes, loss of deep sensation including position sense and vibration sense, unstable gait in patients, and a decrease in bladder tone. Sometimes, there are lightning-like pains in both lower limbs.

　　2. Diabetic muscular atrophy

　　Diabetic muscular atrophy is more common in elderly patients, characterized by progressive muscle atrophy, with more severe muscle atrophy in the proximal limbs than in the distal limbs, presenting as asymmetric or unilateral muscle pain, weakness, and atrophy, mainly in the pelvic belt and quadriceps femoris, with a few cases of scapular belt and upper arm muscle atrophy. Pathological findings show the disappearance of anterior horn cells in the spinal cord, which is often caused by retrograde damage due to damage to the anterior root and motor nerves.

　　3. Diabetic spinal cord softening

　　The occurrence of spinal cord softening is mainly related to diabetic arteriosclerosis. It causes occlusion and ischemia of spinal cord vessels, and in severe cases, it can cause small amounts of bleeding. If the anterior spinal artery is occluded, it can cause widespread softening in the 2/3 of the supply area of the artery on the ventral side of the spinal cord, which is manifested clinically as paraplegia, sensory loss, and disorders of the anal and urinary sphincters. Since the posterior column of the spinal cord is supplied by the posterior spinal artery, and the collateral circulation of the posterior spinal artery is rich, it can remain undamaged and maintain normal position sense and vibration sense.

　　4. Diabetic amyotrophic lateral sclerosis syndrome

　　This condition is more common in adults with a long history of diabetes, characterized by muscle atrophy in the distal upper limbs, which can be symmetrically distributed, with obvious general 'muscle jumping' and hyperreflexia. The progression of the disease is very slow, lasting for 10 years, but the muscle atrophy is still relatively mild, so it is different from amyotrophic lateral sclerosis in degenerative diseases. Electromyography shows the disappearance of the H reflex and the prolongation of the sensory conduction velocity of the peroneal nerve.

         The main prevention of spinal cord disease caused by diabetes is the prevention and treatment of diabetes. The focus of primary prevention is reasonable diet, moderate exercise, blood sugar control, and prevention of complications. Once blood sugar fluctuations are found, they must be controlled in a timely manner.

　　What examinations should be done for spinal cord disease caused by diabetes? Briefly described as follows:

　　1. Blood glucose and glucose tolerance tests.

　　2. Other blood tests, including liver function, kidney function, routine erythrocyte sedimentation rate tests; rheumatoid factor series, immunoglobulin electrophoresis, and other serological tests related to autoimmune diseases.

　　3. Cerebrospinal fluid examination.

　　4. Electromyography and neuroelectrophysiological examination.

　　5. Spinal cord MRI examination.

　　What should be paid attention to in the dietary health care of spinal cord disease caused by diabetes? Briefly described as follows:

　　One, Diet

　　Dietary health care focuses on controlling diabetes, which is the same as the therapy for diabetes. The principles of dietary control are as follows:

　　1. Break the wrong concept that 'eating more hypoglycemic drugs can eat more food'.

　　2. Eat less and more frequently. This ensures the supply of calories and nutrition, and can also avoid post-meal blood sugar peaks.

　　3. Carbohydrate foods should be eaten according to regulations; neither too little nor too much should be eaten, and they should be eaten evenly (carbohydrates refer to sugars in grains, vegetables, milk, fruits, soy products, and hard nut foods).

　　4. There is no difference between eating sweet snacks and salty snacks; both can cause blood sugar levels to rise.

　　5. The amount of 'diabetes food' should be equal to the amount of ordinary food. 'Diabetes food' refers to food made from high-fiber grains, such as: buckwheat, oatmeal. Although these foods take longer to digest and absorb, they will eventually become glucose.

　　6. So-called 'sugar-free foods' are essentially foods that have not added sucrose. Some foods use sweeteners instead of sucrose, but they still cannot be eaten carelessly.

　　7. Vegetables mainly composed of starch should be counted as part of the staple food intake. These vegetables include potatoes, sweet potatoes, lotus root, yam, water chestnuts, taro, lily, water caltrop, and lotus root tuber, etc.

　　8. Besides soybeans, other beans such as red beans, mung beans, broad beans, kidney beans, and green beans, their main component is also starch, so they should also be counted as part of the staple food.

　　Second, eat side dishes in moderation

　　1. Do not use hard foods such as peanuts, melons, walnuts, almonds, and pine nuts to satisfy hunger.

　　2. Eat more foods rich in dietary fiber.

　　3. Eat less salt.

　　4. Eat less food containing cholesterol.

　　Third, issues related to eating fruit

　　1. Patients with good blood sugar control can eat fruits with low sugar content, such as apples, pears, oranges, tangerines, strawberries, etc., but the amount should not be too much. The time to eat fruits should be when blood sugar is low between meals. If you eat fruit after a meal, it is equivalent to a snack, and blood sugar will rise immediately. In addition, watermelons are absorbed quickly after eating, so try not to eat them. Bananas have a high starch content and should be counted as part of the staple food.

　　2. Sweeteners do not convert to glucose and do not affect blood sugar levels, and cannot be used as self-help food for hypoglycemia.

　　3. Diabetics should never restrict drinking water.

　　What are the treatment methods for diabetic myelopathy caused by diabetes? Briefly described as follows:

　　First, to treat diabetic myelopathy, it is necessary to control diabetes.

　　1. Control diet.

　　2. Participate in sports appropriately.

　　3. Take oral hypoglycemic agents or insulin.

　　In addition, it is generally recommended to take vitamin B1, vitamin B12, vitamin B6, and drugs to promote neural cell metabolism, and physical therapy and acupuncture should be applied simultaneously.

　　Second, symptomatic treatment of complications

　　Diabetic myelopathy is one of the serious complications of diabetes. Patients with peripheral neuropathy and autonomic neuropathy have a high risk of disability and mortality. A prospective follow-up study showed that the mortality rate of patients with autonomic neuropathy symptoms and abnormal autonomic function tests was 44% after 2.5 years and 56% after 5 years, half of whom died of renal failure, half died of sudden respiratory and circulatory arrest and hypoglycemia, and secondary urinary tract infections due to atonic bladder.