What is Diabetic Neuropathy?
What is diabetic neuropathy?
Diabetic neuropathy is a group of nerve disorders common among people with diabetes. Diabetic patients have abnormally high levels of blood sugar, which can damage blood vessels and nerves. Diabetic neuropathy affects the peripheral nerves, or the nerves outside the brain and spinal column. More men than women suffer from the condition, and the patients most at risk are those who have trouble controlling their blood sugar, and those who have had diabetes for at least 25 years.
What are the symptoms of diabetic neuropathy?
Diabetic neuropathy most commonly occurs in the feet and hands. The condition often starts with numbness or tingling in the limbs, and as it progresses can interfere with sleep and cause pain throughout the body. In severe cases it can cause ulcerations in the feet, and if they do not heal, amputation is often considered necessary. It is sometimes estimated that half of amputations could be prevented if symptoms are identified and treated early.
What are the types of diabetic neuropathy?
The condition can affect every organ system in the body, including the heart, sex organs and digestive system. There are four types of diabetic neuropathy, and symptoms of the condition vary according to type.
The most common type, peripheral neuropathy, affects the limbs, and can cause numbness, tingling and pain. It can also cause cramps, loss of coordination and extreme sensitivity to touch. Muscle weakness, foot deformities, and blisters and sores can also occur. If wounds are not treated properly, the infection can spread to the bone and lead to amputation.
Autonomic neuropathy affects several bodily systems, the most common being the urinary tract and sex organs. By damaging the heart and circulatory system, it can cause a drop in blood pressure and make the patient feel dizzy after sitting or standing. By damaging the nerves that control heart rate, it can interfere with the natural rise and fall of heart rate. It can also damage the digestive systems, most commonly causing constipation. It sometimes leads to a condition called gastro paresis, in which the stomach empties too slowly, leading to nausea, vomiting, bloating and loss of appetite. The esophagus can be damaged, leading to difficulty swallowing, and the bowels may also be affected. It can also affect the sweat glands, leading to excessive sweating, and sometimes affects the eyes, making them less responsive to changes in light.
Proximal neuropathy causes pain in the thighs, buttocks or legs, and is usually limited to one side of the body. It can also cause weakness and make it difficult for a person to change positions. It primarily strikes older people and those with type 2 diabetes.
Focal neuropathy often occurs suddenly and affects nerves in the head, torso or legs. It can cause severe pain, vision problems and even paralysis on one side of the face. It most commonly occurs in older people, and can be painful and erratic. However, it usually clears up on its own, and is not known to cause long-term damage.
How is diabetic neuropathy diagnosed?
To diagnose neuropathy, doctors look at symptoms and perform a physical exam, where they may check blood pressure, heart rate, muscle strength, reflexes and sensitivity to touch. They may also perform various tests, including ultrasound; biopsy of the skin or nerves; quantitative sensory testing, which measures how the patients responds to various stimuli; heart rate variability test, which measures how the body responds to physical changes; electromyography, or EMG, which measures how muscles respond to electrical signals transmitted by nerves; nerve conduction studies to measure how electrical currents are conducted through nerves; and a foot exam.
How is diabetic neuropathy treated?
If diabetic neuropathy is suspected, the best course of action is to consult a doctor as soon as possible. There are several treatments available for the various types of neuropathy, but if medical attention is not sought, it could lead to long-term damage. Doctors start by restoring a patient’s blood glucose levels back to normal; this can be done through diet, exercise, medication or insulin injections. Symptoms sometimes worsen when blood glucose levels are initially brought back to normal, but over time, maintaining normal glucose levels can reduce symptoms and prevent or delay progression of the disorder.
Patients with neuropathy also need to pay special attention to their feet, which are the most frequently affected parts of the body. Sores and ulcerations are common in the feet of diabetic patients, and because neuropathy causes numbness, the sores may not be noticed and treated. The sores can become infected, and this infection can spread to the bone, leading to amputation.
Patients with neuropathy may also need medication for the pain, numbness, burning and tingling associated with the condition. Over-the-counter drugs like aspirin, ibuprofen or acetaminophen can be used, as can topical medications, antidepressants or anticonvulsant medications.
For the gastrointestinal problems sometimes associated with diabetic neuropathy, it is commonly recommended that patients eat frequent, small meals, and reduce fat and fiber in their diets. Patients may also need medication to regulate digestion, reduce secretion of stomach acid or treat nausea. They may also need antibiotics to treat bowel problems.
For dizziness, weakness or loss of coordination, patients with diabetic neuropathy may need physical therapy or high blood pressure medication, or may need to increase the salt in their diets and in their bodies.
What’s the prognosis for patients with diabetic neuropathy?
Diabetic neuropathy can cause severe and permanent damage, but patients have a better prognosis if they catch symptoms early. Also key is managing the underlying condition, diabetes. Bringing the diabetes under control can reduce symptoms of diabetic neuropathy and even stop the disorder from progressing. However, recovery can be slow, and patients need to be vigilant in managing their diabetes and watching for symptoms. But with the proper treatment, patients with diabetic neuropathy can maximize their chances for recovery.
