Thus, small blood vessel dysfunction occurs early in diabetes, parallels the progression of neural dysfunction, and may be sufficient to support the severity of structural, functional, and clinical changes observed in diabetic neuropathy. Advanced glycated end products
Elevated levels of glucose within cells cause a non-enzymatic covalent bonding with proteins, which alters their structure and inhibits their function. Some of these glycated proteins have been implicated in the pathology of diabetic neuropathy and other long-term complications of diabetes. Polyol pathway
Also called the sorbitol/aldose reductase pathway, the polyol pathway appears to be implicated in diabetic complications, especially in microvascular damage to the retina, kidney, and nerves. Diagnosis
Diabetic peripheral neuropathy can be diagnosed with a history and physical examination. The diagnosis is considered in people who develop pain or numbness in a leg or foot with a history of diabetes. Muscle weakness, pain, balance loss, and lower limb dysfunction are the most common clinical manifestations. Physical exam findings may include changes in appearance of the feet, presence of ulceration, and diminished ankle reflexes. The most useful physical examination finding for large fiber neuropathy is an abnormally decreased vibration perception to a 128-Hz tuning fork (likelihood ratio (LR) range, 16–35) or pressure sensation with a 5.07 Semmes-Weinstein monofilament (LR range, 11–16). Normal results on vibration testing (LR range, 0.33–0.51) or monofilament (LR range, 0.09–0.54) make large fiber peripheral neuropathy from diabetes less likely.
A carbuncle is a cluster of boils caused by bacterial infection, most commonly with Staphylococcus aureus or Streptococcus pyogenes. The presence of a carbuncle is a sign that the immune system is active and fighting the infection. The infection is contagious and may spread to other areas of the body, or other people; those living in the same residence may develop carbuncles at the same time. In the early 21st century, infection involving methicillin-resistant Staphylococcus aureus (MRSA) has become more common. Signs and symptoms
A carbuncle is a cluster of several boils, which is typically filled with purulent exudate (dead neutrophils, phagocytized bacteria, and other cellular components). Fluid may drain freely from the carbuncle, or intervention involving an incision and drainage procedure may be needed. Carbuncles may develop anywhere, but they are most common on the back and the nape of the neck.A carbuncle is palpable and can range in size to be as small as a pea or as large as a golf ball. The surrounding area is indurated. Later, skin on the centre of the carbuncle softens and peripheral satellite vesicles appear, which rupture discharging pus and give rise to cribriform appearance. As the impending infection develops, itching may occur. There may be localized erythema, skin irritation, and the area may be painful when touched. Sometimes more severe symptoms may occur, such as fatigue, fever, chills, and general malaise as the body fights the infection. Cause
The initial cause of a carbuncle can often not be determined.