Diabetic neuropathy

Diabetic neuropathy is one of the common complications of diabetes. The majority of diabetes patients suffer from this neuropathy. This results because high blood sugar levels damage nerves in the body. At the highest risk are nerves in the lower extremity. The exact mechanism of nerve damage is still not discovered but the scientists think that multiple factors play a role in nerve damage. The most important are metabolic factors, damage of blood vessels which supply the nerves, autoimmune inflammation of nerves, lifestyle, mechanical injuries. You are at higher risk of nerve damage if you have high levels of blood sugar, if you have diabetes for a longer period of time, if you are excessive alcohol drinker, if you have arterial hypertension, your age, smoking, dyslipidemia.

The number of patients with diabetes is constantly increasing. Diabetes has a big impact on their life. It is important for them to diagnose diabetes early and to treat it right. In case it stays untreated then complications will occur. They can endanger their health and life.

Symptoms of Diabetic Neuropathy

Diabetes can cause damage to every nerve in the human body. Therefore this neuropathy can be divided into autonomic, motor and sensory neuropathy.

In sensory neuropathy, sensory nerves are damaged. Their role is to transmit messages for different body parts about the position of these body parts, temperature, sense of touch, pain. When sensory nerves are damaged due to diabetes the body loses this information. You will probably feel tingling in feet or hands or they will go numb. You can feel a burning sensation. You will not be able to feel temperature changes properly as well as pain in these body parts. It is dangerous because the lack of pain can lead foot injuries. Something as simple as uncomfortable shoes can lead to wound, infection, and amputation. In more severe cases you will not be able to sense the position of your body parts which can present a big problem while moving. Because of that loss, you will not be able to walk safely and most often you will suffer an ankle injury. If this happens often you will have chronic ankle pain.

In the case of motor neuropathy, motor nerves are damaged. Their main function is a movement of different body parts. In motor neuropathy, after these nerves are damaged the muscles which are served by these nerves will loose its function, you will feel muscle weakness. Your muscle mass will deteriorate because of lack of action. Also, you can feel muscle cramps. Severe motor neuropathy can lead to hammertoes or other foot deformities. 

In autonomic neuropathy, the autonomous nervous system is damaged by high blood sugar levels. It is responsible for proper organ functioning. In the case of autonomic neuropathy, those organs will fail in their function. You might feel stomach symptoms, such as bloating, constipation because of slower bowel movement, incontinence because of loss of bladder function, impotence, sweating problems, irregular heartbeats, vaginal dryness.

There are cases where only one nerve is involved and it is called diabetic mono-neuropathy. Signs and symptoms depend on the involved nerve.

Diagnosis of Diabetic Neuropathy

For diagnosis of diabetic neuropathy, signs and symptoms are important as well as tests which should be conducted. The most commonly used test is 10g monofilament test. The monofilament test determines the ability to feel the touch of monofilament on different parts of the sole of the foot. This test is positive if the patient does not feel the touch of monofilament.

Standard 128 Hz tuning fork is another testing tool for diabetic neuropathy. This test is positive if the patient does not feel the vibration of a tuning fork.

Nerve conduction studies are diagnostic methods which are used to detect changes in the conduction of nerve signal through the nerves. Electromyography (EMG) is used to detect how muscles react to messages from nerves to act.

Deep tendon reflexes are in most cases decreased or absent. There are signs of muscle atrophy.

Treatment of Diabetic Neuropathy

At the moment there is no definite cure for nerves damaged by diabetes. It can not be reversed totally. The best thing you can do is controlling your blood glucose levels and prevent occurrence in the first place. However, you can use other medicines to help you cope with symptoms.

You can use painkillers to relieve your pain. NSAIDs such as ibuprofen can sometimes be used, but you should use them with precaution because regular use can lead to other health issues (gastric ulcer). Other drugs such as anti-seizure medicines (gabapentin, pregabalin, carbamazepine) and antidepressants (amitriptyline, desipramine, imipramine) can be used for the treatment of neuropathy.

 If you feel muscle weakness you can always use crutches to help you moving. Or you can use physical therapy to gain muscle strength again.

As you can see there are many diabetic neuropathy treatment methods which can help you relieve your symptoms.

Prevention of Diabetic Neuropathy

It is important to educate patients whose nerves have been affected by diabetes.. They should know as much as possible about their disease. They should know that the most important for them is to keep their blood sugar levels in normal range. They should follow diet plans but their diet should not lead to big variations in blood glucose levels. Stop with bad habits like smoking and alcohol drinking.

You should not be restrained from walking and other activities. Only you should avoid them in extreme weather conditions, like low temperatures at winter.

It is important to teach the proper way of nail trimming. On that way, wounds will be prevented and further complications. Keep your feet well moisturized to avoid skin cracks. Wash them daily in warm water, after that dry them carefully. Wear proper shoes which are not tight. In case blisters occur, apply antibiotic cream and cover them with a sterile bandage. Check your feet every day for wounds and changes.

 

Patients which suffer from diabetic neuropathy have a higher risk of other diabetes complications. They have extremely high risk of ulcers and amputations so is you suffer from diabetes you should control it to prevent diabetic neuropathy. 

References

Diabetes UK, "Nerves (neuropathy)“, retrieved from https://www.diabetes.org.uk/Guide-to-diabetes/Complications/Nerves_Neuropathy/

Dianna Quan, "Diabetic Neuropathy Workup“, 2016, retrieved from http://emedicine.medscape.com/article/1170337-workup

Mayo Clinic Staff, "Diabetic neuropathy“, 2015, retrieved from http://www.mayoclinic.org/diseases-conditions/diabetic-neuropathy/basics/symptoms/con-20033336

The National Institute of Diabetes and Digestive and Kidney Diseases, "Nerve Damage (Diabetic Neuropathies)“, 2015, retrieved from https://www.niddk.nih.gov/health-information/diabetes/preventing-diabetes-problems/nerve-damage-diabetic-neuropathies


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