Avoiding Diabetic Neuropathy

You are diabetic. On occasion, you feel pain, numbness, tingling and muscle weakness. You could be suffering from diabetic neuropathy.

Diabetic neuropathy is a family of nerve disorders that are caused by diabetes. People with diabetes can over time, have damage to nerves throughout the body. Neuropathies lead to numbness and sometimes pain and weakness in the hands, arms, feet and legs. Problems may also occur in every organ system, including the digestive tract, heart and sex organs. People with diabetes can develop nerve problems at any time, but the longer a person has diabetes, the greater the risk.

An estimated 50 percent of those with diabetes experience some form of neuropathy, but not all with neuropathy have symptoms. The highest rates of neuropathy are among people who have had the disease for 25 years.

Diabetic neuropathy also appears to be more common in people who have had problems controlling their blood glucose levels, in those with high levels of blood fat and blood pressure, in overweight people and in people over the age of 40. The most common type is peripheral neuropathy, also called distal symmetric neuropathy, which affects the arms and legs.

The causes are probably different for various types of diabetic neuropathy. Researchers are studying the effect of glucose on nerves to find out exactly how prolonged exposure to high glucose causes neuropathy. Nerve damage happens due to a combination of factors:

·       Metabolic factors, such as high blood glucose, long duration of diabetes, possibly low levels of insulin, and abnormal blood fat levels.

·       Neurovascular factors, leading to damage to the blood vessels that carry oxygen and nutrients to the nerves.

·       Autoimmune factors that cause inflammation in nerves.

·       Mechanical injury to nerves, such as carpal tunnel syndrome.

·       Inherited traits that increase susceptibility to nerve disease.

·       Lifestyle factors such as smoking or alcohol use.

Symptoms depend on the type of neuropathy and which nerves are affected. Some people have no symptoms at all. For others, numbness, tingling or pain in the feet is often the first sign. A person can experience both pain and numbness. Often, the symptoms are minor at first and since most nerve damage occurs over several years, mild cases may go unnoticed for a long time. Symptoms may involve the sensory or motor nervous system, as well as the involuntary (autonomic) nervous system. In some people, mainly those with focal neuropathy, the onset of pain may be sudden and severe. Symptoms may include:

·       Numbness, tingling or pain in the toes, feet, legs, hands, arms, and fingers.

·       Wasting of the muscles of the feet or hands.

·       Indigestion, nausea or vomiting.

·       Diarrhea or constipation.

·       Dizziness or faintness due to a drop in postural blood pressure.

·       Problems with urination.

·       Erectile dysfunction (impotence) or vaginal dryness.

·       Weakness.

In addition, the following symptoms are not due to neuropathy but nevertheless often accompany it:

·       Weight loss.

·       Depression.

Diabetic neuropathies can be classified as peripheral, autonomic, proximal and focal. Each affects different parts of the body in different ways.

Peripheral neuropathy causes either pain or loss of feeling in the toes, feet, legs, hands and arms.

Autonomic neuropathy causes changes in digestion, bowel and bladder function, sexual response and perspiration. It can also affect the nerves that serve the heart and control blood pressure. Autonomic neuropathy can also cause hypoglycemia (low blood sugar) unawareness, a condition in which people no longer experience the warning signs of hypoglycemia.

Proximal neuropathy causes pain in the thighs, hips and buttocks and leads to weakness in the legs.

Focal neuropathy is the sudden weakness of one nerve, or a group of nerves, causing muscle weakness or pain. Any nerve in the body may be affected.

Peripheral neuropathy may also cause muscle weakness and loss of reflexes, especially at the ankle, leading to  changes in gait (walking). Foot deformities, such as hammertoes and the collapse of the midfoot, may occur. Blisters and sores may appear on numb areas of the foot because pressure or injury goes unnoticed. If foot injuries are not treated promptly, the infection may spread to the bone, and the foot may then have to be amputated. Some experts estimate that half of such amputations are preventable if minor problems are caught and treated in time.

Autonomic neuropathy affects the nerves that control the heart, regulate blood pressure, and control blood glucose levels. It also affects other internal organs, causing problems with digestion, respiratory function, urination, sexual response and vision. In addition, the system that restores blood glucose levels to normal after a hypoglycemic episode may be affected, resulting in loss of the warning signs of hypoglycemia such as sweating and palpitations.

Proximal neuropathy, sometimes called lumbosacral plexus neuropathy, femoral neuropathy, or diabetic amyotrophy, starts with pain in either the thighs, hips, buttocks, or legs, usually on one side of the body. This type of neuropathy is more common in those with type 2 diabetes and in older people. It causes weakness in the legs, manifested by an inability to go from a sitting to a standing position without help. Treatment for weakness or pain is usually needed. The length of the recovery period varies, depending on the type of nerve damage.

Occasionally, diabetic neuropathy appears suddenly and affects specific nerves, most often in the head, torso, or leg. Focal neuropathy may cause:

·       Inability to focus the eye.

·       Double vision.

·       Aching behind one eye.

·       Paralysis on one side of the face (Bell’s palsy).

·       Severe pain in the lower back or pelvis.

·       Pain in the front of the thigh.

·       Pain in the chest, stomach or flank.

·       Pain on the outside of the shin or inside the foot.

·       Chest or abdominal pain that is sometimes mistaken for heart disease, heart attack, or appendicitis.

Focal neuropathy is painful and unpredictable and occurs most often in older people. However, it tends to improve by itself over weeks or months and does not cause long-term damage.

According to the Cleveland Clinic, neuropathy is diagnosed based on symptoms and a physical exam. During the exam, the doctor may check blood pressure and heart rate, muscle strength, reflexes, and sensitivity to position, vibration, temperature, or a light touch.

To check for nerve damage, your provider will use an electromyogram (EMG). The test measures electrical activity or nerve response. During an EMG:

·       Electrodes are connected to your body.

·       You move or contract certain muscles, such as lifting your leg or wiggling your toes.

·       Your nerve activity will display on the oscilloscope (monitor that shows electrical signals as a wave).

Treating diabetic neuropathy means carefully managing your blood sugar levels. You can do this by:

·       Eating a healthy diet.

·       Exercising as much as possible.

·       Taking all diabetes medications as prescribed.

·       Taking pain medicines, including topical creams or patches.

·       Using other medications that can reduce pain.

You can also learn to manage your mental outlook by joining a support group, seeing a therapist, and taking antidepressants.