Diabetic Neuropathy

1 What is Diabetic Neuropathy?

Diabetic neuropathy is a condition in which high levels of blood sugar injure the nerves of the body.

It can occur as a complication of diabetes, especially if diabetes is left untreated. Although all nerves can be injured, the nerves of the legs and feet are at a higher risk of being injured.

Symptoms vary on the nerves affected and can range from pain to numbness. Other symptoms include problems with the digestive system, urinary tract, blood vessels and heart. Some people may experience mild symptoms while others may have severe, potentially fatal symptoms.

This disease can be prevented or its progression slowed down by monitoring blood sugar levels and living a healthy life.

2 Symptoms

Signs and symptoms of diabetic neuropathy vary depending on its type.

There are four main types of diabetic neuropathy.

Patients may experience just one type or symptoms of several types. Most develop gradually, and patients may not notice problems until considerable damage has occurred.

The signs and symptoms of diabetic neuropathy vary, depending on the type of neuropathy and which nerves are affected.

Peripheral neuropathy

Peripheral neuropathy is the most common form of diabetic neuropathy. The feet and legs are often affected first, followed by the hands and arms.

Signs and symptoms of peripheral neuropathy are often worse at night, and may include:

  • Numbness or reduced ability to feel pain or temperature changes: If you are unable to feel temperature changes or even heat or pain in your arms and legs, chances are that you are suffering from peripheral neuropathy. You need to consult a doctor as soon as possible.
  • A tingling or burning sensation: If you experience a persistent burning or tingling sensation in your arms and legs, you may want to consult a doctor right away, as this is symptomatic of peripheral neuropathy.
  • Sharp pains or cramps: Frequent pain or cramps in the legs and arms can occur for several reasons, but it is indicative of peripheral neuropathy. If these symptoms continue to persist, you need to consult your physician at the earliest.
  • Increased sensitivity to touch: Damage to the nerves in the periphery can either make them overly sensitive to the slightest pressure or totally numb them. As a result, patients suffering from peripheral neuropathy are known to experience agonizing pains when draped with a bed sheet or coverlet.
  • Muscle weakness: If left untreated, peripheral neuropathy is also known to cause muscle weakness and even impair the functioning of muscles in the extremities. So if you are experiencing muscle weakness, which can occur on account of several underlying causes, you need to consult a doctor for speedy diagnosis and treatment.
  • Loss of reflexes, especially in the ankle: If you are unable to turn or pivot using your ankles and feel a slowdown in your reflexes, especially in your arms and legs, it could be on account of peripheral neuropathy. This is indicative of your nerves being damaged by the high blood sugar levels in your body. You will need to seek medical consultation for diagnosis and effective treatment to help combat this.
  • Loss of balance and coordination: Peripheral neuropathy can also lead to a loss of balance and coordination. If you find yourself experiencing this over prolonged periods for no reason at all, consult your physician right away.
  • Serious foot problems such as ulcers, infections, deformities, and bone and joint pain: This particular condition is known to cause ulcers, infections, and numbness in the arms and legs, along with joint pain and deformities. These can be treated with medication after consulting your doctor.

Autonomic neuropathy

The autonomic nervous system controls the heart, bladder, lungs, stomach, intestines, sex organs and eyes.

Diabetes can affect the nerves in any of these areas, possibly causing:

  • A lack of awareness that blood sugar levels are low (hypoglycemia unawareness): It is always a good idea to get your blood tested once a month or on a periodic basis. Unfortunately, many continue to remain unaware of the dangers and health impacts of diabetes. Moreover, autonomic neuropathy is known to cause patients to remain unaware of their low blood sugar levels since this particular condition can suppress the normal symptoms of it, such as sweating, heart palpitations, etc. As a result, a patient may remain unaware of their low blood sugar level until a full blown attack takes place.
  • Bladder problems, including urinary tract infections, or urinary retention or incontinence: Autonomic neuropathy can cause you to develop sudden urinary infections and even bouts of incontinence, which can lead to further health complications.
  • Constipation, uncontrolled diarrhea, or a combination of the two: This particular condition is also known to cause patients to experience constipation, along with frequent bouts of diarrhea. This can lead to further health complications and even severe dehydration.
  • Slow stomach emptying (gastroparesis), leading to nausea, vomiting, bloating, and loss of appetite: Autonomic neuropathy can literally cause your appetite to disappear and can even cause you to experience bloating and nausea. If you continue to suffer from these symptoms, you need to consult your doctor right away.
  • Difficulty swallowing: Patients whose nerves have been damaged by high blood sugar levels can also experience trouble swallowing. If you are finding it difficult to swallow your own saliva, chances are you are experiencing one of the many symptoms of autonomic neuropathy.
  • Erectile dysfunction in men: Autonomic neuropathy is also known to cause erectile dysfunction in certain patients. If you happen to suffer from this, you need to consult your physician, get your blood tested for blood sugar levels, and receive appropriate treatment.
  • Vaginal dryness and other sexual difficulties in women: This condition can cause women to experience a sudden onset of dryness in their vagina, which can impede sexual relations. Moreover, dry vagina can lead to other health complications if left untreated. So kindly consult your gynecologist at the earliest and get your condition diagnosed for effective treatment.
  • Increased or decreased sweating: If you find yourself experiencing excess sweating or lack of sweating altogether, you need to consult your doctor right away. Abnormally functioning sweat glands can be indicative of several serious health issues, of which autonomic neuropathy is one. So consult your doctor and seek treatment right away.
  • Inability for the body to adjust blood pressure and heart rate, leading to sharp drops in blood pressure after sitting or standing that may cause a patient to faint or feel lightheaded: If you happen to suffer from bouts of lightheadedness, this could be due to low blood pressure, so you should have your blood tested.
  • Problems regulating body temperature: Patients with autonomic neuropathy often find it extremely difficult to regulate their body temperatures. This particular condition can impair the sweat glands, leading to either excess sweating or none at all. If these sound familiar, you may want to consult your physician right away, as an inability to regulate body temperature can lead to other health complications.
  • Changes in the way the eyes adjust from light to dark: If you find your ability to distinguish between colors, or even the way your eyes adjust from light to dark, has changed, chances are high that you are suffering from autonomic neuropathy.
  • Increased heart rate at rest: If you are experiencing increased heart rate even when at complete rest, you need to consult your physician or even a specialist since this particular condition can lead to tachycardia and other health complications. 

Radiculoplexus neuropathy (diabetic amyotrophy)

Radiculoplexus neuropathy affects nerves in the thighs, hips, buttocks or legs. Also called diabetic amyotrophy, femoral neuropathy or proximal neuropathy, this condition is more common in people with type 2 diabetes and older adults.

Symptoms are usually on one side of the body, though in some cases symptoms may spread to the other side. Most people improve at least partially over time, though symptoms may worsen before they get better.

This condition is often marked by:

  • Sudden, severe pain in the hip and thigh or buttocks: If you experience sudden sharp pain in the hip area and around the lower back and buttocks, you could be suffering from diabetic amyotrophy.
  • Eventual weak and atrophied thigh muscles: Untreated diabetes can lead to muscle atrophy in your thighs and legs.
  • Difficulty rising from a sitting position: Patients suffering from diabetic amyotrophy can find it extremely hard to get up from a sitting position. If you are experiencing something similar, it may be time to consult a physician or even a specialist.
  • Abdominal swelling, if the abdomen is affected.
  • Weight loss

Mononeuropathy

Mononeuropathy involves damage to a specific nerve. The nerve may be in the face, torso or leg.

Mononeuropathy, also called focal neuropathy, often comes on suddenly. It's most common in older adults. Although mononeuropathy can cause severe pain, it usually doesn't cause any long-term problems. Symptoms usually diminish and disappear on their own over a few weeks or months.

Signs and symptoms depend on which nerve is involved and may include:

  • Difficulty focusing the eyes, double vision or aching behind one eye.
  • Paralysis on one side of the face (Bell's palsy).
  • Pain in the shin or foot
  • Pain in lower back or pelvis
  • Pain in the front of thigh
  • Pain in chest or abdomen

Sometimes mononeuropathy occurs when a nerve is compressed. Carpal tunnel syndrome is a common type of compression neuropathy in people with diabetes.

Signs and symptoms of carpal tunnel syndrome include:

  • Numbness or tingling in the fingers or hand, especially in the thumb, index finger, middle finger and ring finger.
  • A sense of weakness in the hand and a tendency to drop things.

3 Causes

Diabetic neuropathy is caused by long-term exposure to high blood sugar.

Researchers believe that a combination of factors may play a role in the development of diabetic neuropathy although the exact reason why this happens is unknown.

Complex interaction with between nerves and blood vessels may be one of the factors. High blood sugar affects the ability of nerves to transmit signals and also weakens the walls of the small blood vessels (capillaries) that supply the nerves with oxygen and nutrients.

Other factors that can cause diabetic neuropathy include:

  • Inflammation of the nerves caused by autoimmune responses.
  • Genetic factors which predispose some individuals to developing diabetic neuropathy.
  • Smoking and Alcohol abuse as these two factors may increase the risk of infections.

4 Making a diagnoosis

Diabetic neuropathy is diagnosed based on the symptoms of a patient, a medical history and physical examination.

A physical exam to check the function of nerves is required. This can be achieved by checking muscle strength and tone, tendon reflexes and sensitivity to touch, temperature and vibration.

Other tests that can be used include:

  • Filament test - in which a soft nylon fiber called a monofilament is used to check for sensitivity to touch. 
  • Nerve Conduction Studies
  • Electromyography - to measure the electrical activities of the muscles.
  • Quantitative sensory testing to assess the response of the nerves to vibration and changes in temperature.
  • Autonomic testing to check for symptoms of autonomic neuropathy, such as changes in blood pressure.

Feet should be frequently checked for cracks, sores, calluses, blisters and bone or joint abnormalities since changes can indicate diabetic neuropathy.

5 Treatment

Treatment for diabetic neuropathy is aimed at slowing the progression of the disease, relieving pain and managing the complications and restoring function.

Methods include:

  • Keeping the blood sugar levels within the target range can slow down the progression of diabetic neuropathy and other complications associated with diabetes.
  • Avoiding smoking and alcohol, eating a healthy diet and exercising regularly can also be beneficial.
  • Medications, such as anti-seizure drugs and antidepressants can be given for relieving pain.

There are specific treatments for the complications of diabetic neuropathy. For example, urinary tract problems can be treated by administering antispasmodics, which can help with the loss of bladder control.

6 Prevention

Diabetic neuropathy can be prevented by constant monitoring of the blood sugar level.

Foot problems, such as sores that don't heal, ulcers, and amputations, are a major complication of diabetic neuropathy. Therefore, the feet should be properly taken care of by keeping them clean and dry, trimming toenails carefully, wearing clean, dry socks, and wearing cushioned shoes that fit well.

7 Alternative and homeopathic remedies

A few alternative remedies exist to help relieve the pain associated with diabetic neuropathy.

These include:

  • Capsaicin cream
  • Alpha-lipoic acid, an antioxidant that can be found in some foods.
  • Transcutaneous electrical nerve stimulation (TENS), in which tiny electrical impulses generated by small electrodes are applied through the skin to specific nerve pathways preventing pain signals from reaching the brain.
  • Acupuncture

8 Lifestyle and coping

Lifestyle modifications are necessary in order to cope with diabetic neuropathy.

Living with diabetic neuropathy can be difficult and frustrating. It is for this reason why some patients may require a counselor or therapist.

Joining a support group can also help patients not to feel alone.

9 Risks and complications

There are several risks and complications associated with diabetic neuropathy.

Factors that may increase the risk of developing diabetic neuropathy include:

  • Poor control of blood sugar levels
  • Long duration of diabetes
  • Kidney diseases
  • Being overweight with a body mass index greater than 24
  • Smoking

Complications of diabetic neuropathy include:

  • Loss of a limb
  • A charcot joint - a joint marked by loss of sensation
  • Urinary tract infections and problems voiding urine from the urinary bladder
  • Hypoglycemia unawareness
  • Low blood pressure
  • Gastrointestinal disorders, such as diarrhea or constipation
  • Sexual dysfunction
  • Disorders in the body's ability to regulate temperature
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