What is diabetic neuropathy?
Diabetic neuropathy is a type of nerve damage that can accompany diabetes. High blood sugar (glucose) levels can damage nerves throughout your body. Diabetic neuropathy most often damages the nerves in your legs and feet.
Depending on which nerves are affected, symptoms of diabetic neuropathy can range from pain and numbness in your legs and feet to problems with your respiratory system, urinary tract, blood vessels and heart. Some people have mild symptoms. But for others, diabetic neuropathy can be excruciatingly painful and disabling.
There are four main types of diabetic neuropathy. The symptoms you feel will depend on the type and which nerves are affected. Symptoms usually develop gradually, and you may not notice that something is wrong until significant nerve damage has occurred.
This is the most common type of diabetic neuropathy. It affects the feet and legs first, followed by the arms and hands. Symptoms and signs of superficial diabetic neuropathy usually worsen at night and may include:
- Numbness or decreased ability to feel pain or temperature changes.
- Numbness or burning sensation.
- Sharp pain or cramps.
- Increased sensitivity to touch – for some, even the weight of a bed sheet can be painful.
- Severe foot problems such as ulcers, infection, joint and bone pain.
The autonomic nervous system controls the heart, bladder, stomach, intestine, reproductive organs, and eyes. Diabetes can affect the nerves in any of these areas, which may cause:
- Loss of consciousness due to low blood sugar levels (hypoglycemic coma).
- Bladder or bowel problems.
- Slow stomach emptying (gastroparesis); This leads to nausea, vomiting and loss of appetite.
- Changes in the way your eyes accustom to transition from light to dark.
- Decreased sexual response.
Proximal neuropathy (diabetic polyradiculopathy)
This type of neuropathy – called diabetic muscular dystrophy – often affects the nerves in the thighs, hips, buttocks or legs. It may also affect the abdomen and chest area. Symptoms are usually on one side of the body but may spread to the other side. You may experience:
- Severe pain in one of the hips, thighs, or buttocks.
- Weakness and contraction of the thigh muscles.
- Difficulty getting up from a sitting position.
- Severe stomach pain.
Mononeuropathy (focal neuropathy)
There are two types of mononeuropathy – cranial and peripheral. Mononeuropathy refers to damage to a specific nerve. Mononeuropathy may lead to:
- Difficulty concentrating or double vision.
- Feeling pain behind one eye.
- Paralysis of one side of the face (Bell’s palsy).
- Numbness or tingling in the hands or fingers, except for the little finger.
- Feeling of weakness in the hands that may cause objects to be dropped.
The exact cause of each type of neuropathy is unknown. Researchers believe that over time, uncontrolled high blood sugar damages nerves and impairs their ability to transmit nerve signals, leading to diabetic neuropathy. High blood sugar also causes the walls of small blood vessels (capillaries) that supply nerves to be weakened with oxygen and nutrients.
The following risk factors may make you more likely to develop neuropathy:
- Poor blood sugar control. Poor blood sugar control puts you at risk of all diabetes complications, including diabetic neuropathy.
- History of diabetes. Your risk of developing diabetic neuropathy increases with the time you have diabetes, especially if your blood sugar level is poorly controlled.
- Kidney disease. Diabetes may damage your kidneys. The affected kidneys excrete toxins into the blood. Which may lead to nerve damage.
- Obesity. The risk of developing diabetic neuropathy increases if your body mass index (BMI) is 25 or greater.
- Smoking. Smoking causes arteries to narrow and harden. This reduces blood flow to your legs and feet and damages the peripheral nerves.
- Amputation of a toe, foot, or leg. Nerve damage can cause you to lose sensation in your foot, so even the simplest wounds may turn into sores without realizing they are present. In severe cases, the infection can spread to the bone or lead to tissue death. The toe, foot, or even the lower leg may need to be amputated.
- Urinary tract infection and urinary incontinence. If the nerves that control your bladder are damaged, you may not be able to empty your bladder completely. The bacteria can build up in the bladder and kidneys. This leads to urinary tract infection. Nerve damage can also affect your ability to feel the urge to urinate or to control the muscles that produce urine which leads to leakage (enuresis).
- A sharp drop in blood pressure. Damage to nerves that control blood flow can affect your body’s ability to control blood pressure. This can lead to a severe drop in pressure when you stand up after sitting, which can lead to dizziness and fainting.
- Digestion problems. If your digestive tract suffers nerve damage, you may experience constipation, diarrhea, or both. Nerve damage related to diabetes can lead to gastroparesis, a condition in which the stomach empties slowly, or it may not empty at all; What leads to bloating and indigestion.
- Impaired sexual function. Autonomic neuropathy usually damages the nerves that affect the sexual organs. Men may develop erectile dysfunction. Women may have difficulty lubrication and sexual arousal.
Our neurologist can diagnose diabetic neuropathy by performing a physical examination and carefully reviewing your symptoms and medical history.
During the physical exam, our neurologist will examine your muscle strength and tension, tendon reflexes, and sensitivity to touch and vibration.
In addition to the physical examination, our neurologist may perform or order specific tests; To help diagnose diabetic neuropathy, such as:
- Filament test. Your doctor will apply soft nylon fibers (bristles) over areas of your skin to test for sensitivity to touch.
- Sensation test. This non-invasive test is used to see how your nerves respond to vibrations and changes in temperature.
- Nerve conduction examination. This test measures how quickly nerves in the arms and legs conduct electrical signals. It is often used to diagnose carpal tunnel syndrome.
- Muscle response test (electromyogram). This test is often done with nerve conduction studies. It measures the electrical charges in your muscles.
- Autonomic nervous system test. Special tests may be done to determine how your blood pressure changes while you are in different positions, and whether you are sweating normally.
How is diabetic neuropathy treated?
Diabetic neuropathy has no known cure. Treatment mainly aims to slow disease progression, reduce pain and manage complications and restore functions.
Slowing disease progression
Regularly keeping your blood sugar level within a target range is the key to preventing or delaying neurological damage. Good blood sugar regulation can improve some of your current symptoms. Your doctor derives your best target rate based on many factors, such as age, length of diabetes and general health.
There are many prescription medications available for nerve pain associated with diabetes, but they don’t work for everyone. When considering any medication, talk to your doctor about the benefits and potential side effects to see what might work best for you.
Managing complications and restoring functions
To manage complications, you may need care from different specialists who can help prevent or treat complications.
The treatment you’ll need will depend on your neuropathy complications:
- Low blood pressure upon standing (orthostatic hypotension). Treatment begins with simple lifestyle steps, such as avoiding alcohol, drinking lots of water, and slowly changing positions or standing up. Several drugs may be used, either alone or together, to treat orthostatic hypotension.
- Digestion problems. To relieve signs and mild symptoms of gastroparesis – indigestion, belching, nausea or vomiting – doctors suggest eating smaller, more frequent meals. Diet changes and medications may help relieve gastroparesis, diarrhea, constipation and nausea.
- Urinary problems. Some drugs affect bladder function, so your doctor may recommend stopping or changing the medications. A strict urination schedule or urination every few hours (timed urination) with light pressure on the bladder area (lower abdomen) can help with some bladder problems.
Sexual dysfunction. Medicines taken orally or injected may help improve sexual performance in some men. Mechanical pumps devices may help increase blood flow to the penis. Women may feel relief when using vaginal lubricants.