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HEALTH CONDITIONS
Diabetic Neuropathy
Overview
Symptoms
Risk Factors
Commonly Prescribed Drugs
Treatment and Management
Doctors to Consult
Overview

Diabetic neuropathy results from the nerve damage due to the high blood sugar levels of diabetic patients. It affects the nerves throughout the body with the nerves of the legs and feet as the most common targets. Symptoms of this complication depend on the location of the affected nerves.

When the nerve fibers are constantly exposed to high blood sugar, damages occur causing neuropathy. This interferes with the transmission of signals between nerves. The walls of the capillaries are weakened causing problems in the supply of oxygen and nutrients to the nerves. Inflammation due to autoimmune attack can also cause nerve damage. Smoking and alcohol abuse also damage the nerves and blood vessels.

Types of Diabetic Neuropathy:

·  Peripheral neuropathy is the most common type of diabetic neuropathy. It often starts on the feet and legs followed by the hands and arms. Its symptoms typically worsen at night.

  • Autonomic neuropathy affects the nerves of the heart, bladder, lungs, stomach, intestines, sex organs or eyes.
  • Proximal neuropathy or diabetic amyotrophy affects the nerves of the thighs, hips, buttocks, and legs. This type commonly occurs in patients with Type 2 diabetes and older patients. Most of the symptoms occur on one side of the body.
  • Mononeuropathy or focal neuropathy occurs suddenly and affects a specific nerve. It causes severe pain but rarely leads to long-term problems. Its signs and symptoms resolve within a few weeks or months even without treatment. It can also occur when a nerve is compressed or constricted like in carpal tunnel syndrome.

Diagnosis of diabetic neuropathy is based on the patient’s symptoms, a physical exam and medical history especially the control of his/her blood sugar level. Sensitivity to touch can be assessed using a monofilament. Nerve conduction tests are used to measure the speed of the arms and legs in conducting electrical signals while electromyography measures the electrical discharges of the muscles.

Symptoms

Peripheral neuropathy

  • Numbness or reduced ability to feel pain or changes in temperature
  • Tingling or burning sensation
  • Sharp pain or cramps
  • Increased sensitivity to touch
  • Muscle weakness
  • Loss of reflexes
  • Loss of balance and coordination
  • Serious foot problems like infection or deformities

Autonomic neuropathy

  • Lack of symptoms signaling low blood sugar levels
  • Bladder problems
  • Constipation or uncontrolled diarrhea
  • Slow emptying of the stomach
  • Difficulty swallowing
  • Erectile dysfunction
  • Vaginal dryness
  • Sharp decrease in blood pressure when changing position
  • Problems regulating the body temperature
  • Changes in ability of eyes to adjust to light
  • Increased heart rate at rest

Proximal neuropathy

  • Sudden, severe pain in hip and thigh or buttock
  • Weak and atrophied thigh muscles
  • Difficulty standing
  • Abdominal swelling
  • Weight loss

Focal neuropathy

  • Eye problems like difficulty focusing, double vision or pain behind the eye
  • Facial paralysis or Bell’s palsy
  • Pain of the shin or foot
  • Lower back pain
  • Pain in front of thighs
  • Chest or abdominal pain
Risk Factors
  • Poor blood sugar control. Causes prolonged exposure of the nerves to high blood sugar
  • Length of time of having diabetes. Risk increases with patients who had diabetes for a longer period
  • Kidney disease. Toxins from the kidney damage contributes to nerve damage
  • Being overweight.
  • Smoking. Narrows and hardens arteries making it difficult for blood to flow into the limbs

 

Complications

  • Cuts and sores on the feet may not be noticed when peripheral neuropathy occurs. When the cuts and sores become infected, spread to the bone and cause tissue damage, amputation of the toe, foot or lower leg might be required.
  • Deterioration of the joint known as Charcot joint can occur. It leads to loss of sensation, swelling, instability, and deformity of the joint.
  • Nerve damage on the bladder may reduce the ability to completely empty the bladder leading to urinary tract infection. It can also affect the ability to feel the need to urinate or to control the muscles of the bladder.
  • Autonomic neuropathy can affect the ability of a person to notice the symptoms of low blood sugar such as shaking, sweating, and fast heartbeat.
  • If the nerves controlling blood circulation are affected, the blood pressure drops drastically when a person stands after sitting because of the inability to adjust the blood pressure.
  • Once the sweat glands are affected, the body might not be able to regulate the body temperature due to an increase or decrease in sweating.
Commonly Prescribed Drugs
  • Anti-seizure medications are given to manage nerve pain. Anti-seizures prescribed for diabetic neuropathy include gabapentin, pregabalin, and carbamazepine. Side effects: drowsiness, dizziness, swelling
  • Antidepressants manage the chemical processes in the brain to alleviate the pain. Examples of antidepressants for nerve pain include amitriptyline, desipramine, and imipramine. Side effects: dry mouth, sweating, weight gain, constipation, dizziness

 

Treatment and Management
  • There are no known cures for diabetic neuropathy. Treatment approaches are focused on slowing down its progression, pain relief, restoring function, and managing complications.
  • The best method in slowing down the progression of diabetic neuropathy is maintaining the blood sugar level within the target range. The target range varies and depends on the age and presence of other diseases of the patient. The blood pressure should be maintained within the normal range. A healthy lifestyle is also encouraged.
  • Loss of bladder control can be managed by scheduling urination throughout the day or use of devices like pessaries to prevent urine leakage.
  • Dietary changes can be done to relieve some of the symptoms when the digestive system is affected. Smaller and more frequent meals and reducing fiber and fat can help manage indigestion, belching, or vomiting.
  • For patients with peripheral neuropathy, daily checking of feet and legs for any cuts or sores can prevent infections and eventual amputation. Wear shoes that fit well all the time to prevent injuries.
Home Remedies
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