Written Assignment 2- Science Length 1500 words Weight: 30% of final mark Task description Choose ONE macrovascular OR ONE microvascular complication of Diabetes and address the following questions...

Running head: Diabetic Neuropathy
Diabetic Neuropathy 5
    Assignment 2
    Diabetic Neuropathy
Student Name:………….
Submitted to:……………
    School of Health, UNE
Introduction
Diabetic Neuropathy is a micro vascular complication characterized by dysfunction and damage of peripheral nerves due to diabetes (National Institute of Diabetes and Digestive and Kidney Disease, 2018).Generally the condition initially affects the nerves of feet and legs and later on the arms and hands (Vinik, 2017). The problem may target distal or proximal nerve fibers and sometimes may influence the autonomic and somatic nervous system (Inzucchi, Rosenstock & Umpierrez, 2016). The diabetes results into progressive reduction in the number of nerve fibers beneath the epidermis (Razmaria, 2015). The high levels of blood sugar and high level of fats for prolonged duration of time due to diabetes may stimulate the nervous dysfunction (Tavakoli, 2017). The patient often reports tingling, burning sensation with stabbing pain in feet that worsens during the night time (Hobson-Webb, 2016). The patient may also perceive numbness, weakness and sensory loss (Razmaria, 2015).
Neuropathy is the most common cause of mortality and morbidity in diabetic patients in the world (Inzucchi et al 2016). The report analyses the Pathophysiology, assessment and diagnosis, treatment and management of Diabetic neuropathy.
Pathophysiology
The impaired metabolism of glucose results into high blood sugar levels in diabetic patients which lead to development of neuropathy (Tavakoli, 2017). A study conducted on diabetic adolescents by Chawla et al (2016) postulated that genetic polymorphism in AKR1B1 genes are primarily involved in dysfunction of nerves. The mitochondria of hyperglycemic sensory neurons produce oxygen which impairs the membranes and DNA of these neurons (Chawla et al, 2016). Impaired regulation of many proteins which play an important role in fission and fusion reactions and control the number and shape of mitochondria is also reported to cause degeneration and impair the normal function of cells (Bril, et al. 2018).
High blood sugar produces advanced glycation end products which are reported to adversely affect the matrix metalloproteinases, which potentially damage the nerve fibers (Tavakoli, 2017). Research by American Diabetes Association (2018) found the evident relationship between oxidative stress and diabetic neuropathy. Oxidative stress refers to an imbalance between antioxidants and free radicals in the body (Farhat & Yezback, 2016). The study proceeded with a number of clinical trials where the antioxidants like alpha lipoic acid use the superoxide, hydroxyl and peroxyl radicals to remake Glutathione. In these clinical trials, the administration of alpha lipoic acid elevated the velocity of nerve potential and reduced the neuropathic indications as well (American Diabetes Association, 2018).
Diabetic neuropathy is a resultant of both the ischemic and metabolic mechanisms (Razmaria, 2015).
Classification
The diabetic Neuropathy can be classified as Peripheral, Autonomic, Focal or Proximal Neuropathy (Bril et al, 2018). The symptoms depend on the type and severity of disease. 1. The neuropathy affecting the feet and legs primarily and later on spreading to hands and arms is known as Peripheral Neuropathy (American College of foot and ankles, 2018). The patients may have sharp pain, with elevated sensitivity to touch (Iodice & Sandroni, 2014). They may experience muscle weakness, impairment of reflex, loss of coordination and balance in body posture, and critical skin problems like ulcers, acne, scars, joint pain and bone pain (US National Library of Medicine, 2018). The wounds heal very slowly due to low immunity (Bril et al, 2016). 2. The autonomic neuropathy affects the nerves mainly controlling the internal organs of the body like heart, digestive system, respiratory system, reproductive system etc (Verrotti, et al. 2014). The patient may have problems in controlling the urine, uncontrolled diarrhea, constipation, issues in swallowing, issues in maintaining the body temperature, loss of appetite, bloating and bladder infections (Iodice &...