All You Need To Know About Diabetic Neuropathy

 

What Is Diabetic Neuropathy?

 

Diabetic neuropathy is a cluster term for several nerve disorders that are a result of diabetes. Studies show that people with diabetes tend to develop nerve damage with the passage of time1. Some people show no symptoms at all, while others show symptoms like numbness, tingling, loss of feeling in the extremities of the body like hands and feet. In addition to this, nerve problems start to occur in every organ of the body that includes the heart, sexual organs, as well as the digestive tract.

 

Per the National Institute of Diabetes and Digestive and Kidney Diseases, around 60 to 70% of the people that have diabetes also have some form of neuropathy. Such people can develop neuropathy any time but the risk gets higher with age or if the person had diabetes from a very young age. It is also found in people who have problems with blood pressure or blood sugar.

 

Learning about the Causes of Diabetic Neuropathies

 

There are different causes for different types of neuropathy. However, it has been observed that people who have had high pressure or blood glucose may have nerve damage. Some of the causes of neuropathy are:

  • Autoimmune issues that can cause inflammation in the nerves
  • Hereditary issues
  • Injury to the nerves like the carpal tunnel syndrome
  • Metabolic factors that can include high blood fat levels, high blood glucose, low levels of insulin, extended duration of diabetes
  • Neurovascular issues that can lead to damage to the blood vessels that are responsible for leading nutrients as well as oxygen to the nerves
  • Use of alcohol

 

Learning about the Symptoms of Diabetic Neuropathies

 

The symptoms highly depend on the kind of neuropathy that the person has3. As mentioned earlier, some people may not show any symptoms at all, whereas others start feeling numbness and a tingling sensation in their hands and feet. In the beginning, the symptoms are always very minor, but if the situation goes unnoticed, then severe damage may occur. Symptoms may involve motor, sensory, autonomic, as well as nervous systems. However, in some people the symptoms may be severe and sudden in nature.

 

Some of the symptoms of nerve damage include:

 

  • Erectile dysfunction
  • Feeling dizzy because of a sudden drop in the blood pressure
  • Tingling and numbness sensation in hands and feet
  • Urinary issues
  • Vaginal dryness
  • Vomiting or indigestion
  • Wasting of the muscles in the extremities of the body
  • Weakness

 

Learning About the Types of Diabetic Neuropathy

 

Diabetic neuropathy can be broken down into different categories. To understand the symptoms that you are experiencing, it is important you learn about the different types of diabetic neuropathy4.

 

Peripheral Neuropathy

 

Peripheral neuropathy is also known as distal polyneuropathy and diabetic nerve pain. It is one of the most common types of neuropathy that is found in diabetic patients and tends to affect the limbs. Most of the time, the nerves that go to the feet are severely damaged. The reason is that these nerves have to travel a long distance as they are branched off in the spinal cord and then make their way to the lower back (the lumbar region) and then to the feet. This often leads to foot related problems, amputations, infections, and even ulcers. Some of the symptoms include:

  • Cramps
  • Insensitivity to temperature
  • Loss of balance
  • Loss of coordination
  • Numbness
  • Sharp pains
  • Tingling and burning sensation

 

People often report that these symptoms worsen at night and they feel pain in the feet, arms, legs, and toes. Since the muscles in the limbs are affected, there are chances that it might affect the way these people walk. A lot of times, patients develop foot deformities or their mid foot collapses. They also report that sores and blisters appear on their body and sometimes they suffer from infections. It is important to treat the issues on time or else it can lead to amputation.

 

Proximal Neuropathy

 

Proximal Neuropathy is also referred to as diabetic amyotrophy. Since the word ‘myo’ refers to muscle, this is a form of neuropathy that deals with muscle weakness and muscles in hips, legs, as well as the buttocks5. Sometimes, people with proximal neuropathy also experience nerve pain, especially the kind that shoots down from spine towards the leg. This is the kind of pain that is commonly referred to as sciatica, described as a shooting pain, and is also known as polyradiculopathy-diabetic amyotrophy. This is the second most common type of neuropathy and generally affects elderly people that have diabetes. However, it can be treated with the help of medicines. It is seen that proximal neuropathy is very common in people that have type 2 diabetes. The recovery process highly depends on the type of nerve damage that a person has experienced.

 

Autonomic Neuropathy

 

Our autonomic nerves help the body run smoothly. If you think about it, there are many functions happening in the body without you doing anything about it, like your heart beating, breathing, your digestive track is functioning6. The nerves that look after your system are the ones that make up the autonomic nervous system. These are the muscles that are responsible for your body’s balance and if these muscles are affected, the body will experience problems in retaining its balance, also known as its homeostasis.

 

Hypoglycemia Unawareness

 

The symptoms include palpitations, shakiness, as well as sweating because the blood sugar level drops. There are people that suffer that show no symptoms at all and for them it might be difficult to detect hypoglycemia, hence the term hypoglycemia unawareness.

 

Heart and Blood Vessels

 

The heart and the blood vessels are a part of the cardiovascular system which regulates the blood in the body. When there is damage in this area, the body loses its ability to regulate the heart beat and the blood pressure. What happens then is that the blood pressure drops suddenly and the person starts feeling lightheaded and may even faint. In addition to this, the nerves that regulate the heart rate are damaged, leading to a high heart rate that can affect the level of physical activity and the body functions as well.

 

Digestive System

 

Damage to the digestive system means that the person may experience constipation or develop a problem known as gastroparesis in which the stomach empties slowly. Gastroparesis can lead to issues like bloating, vomiting, nausea, as well as loss of appetite. It can also cause the blood sugar level to fluctuate a lot but that is due to abnormal food digestion. If there is nerve damage in the esophagus, the person will have difficulty swallowing. Damage in the digestive track can lead to weight loss as well as constipation or diarrhea at night time.

 

Urinary Tract and Sex Organs

 

Autonomic neuropathy has a direct effect on organs such as the urinary tract and the sex organs. This can cause the bladder to empty completely, leading to bacterial growth, urinary tract infections as well as kidney infections. Due to the damage, sometimes the people are not able to tell when their bladder is full and have no control over their muscles that control urine in the body.

 

Sex organs are also affected and there may be a gradual increase in the response in both men and women, however there is no recorded change in the sex drive. Women may experience issues getting an orgasm or being aroused, whereas men may not be able to get an erection or may have difficulty in ejaculation.

 

Sweat Glands

 

The glands that affect sweat in the body are also affected by autonomic neuropathy. When the nerves that regulate the sweat are affected, the body loses its ability to regulate the temperature or may even result in profuse sweating.

 

Eyes

 

Neuropathy can also affect the pupils in the eye, which means that they will be less responsive to the changes in light. This means that the person will not be able to look at things properly and may have difficulty with their vision during night. It is advised that such people avoid driving during the night.

 

Focal Neuropathy

 

All the above-mentioned neuropathies are example of polyneuropathy, which means that there are several nerves affected. Focal neuropathy means that only one nerve is affected and is also known as mononeuropathy7. Most of the time, the muscles in the head are affected, especially the ones that go to the eyes. Proximal neuropathy causes shooting pain and muscle weakness, whereas in focal neuropathy, the pain is in very specific locations on the body.

 

Some of the problems that are caused by focal neuropathy are:

Abdominal pain that may be mistaken for appendix or heart attack

  • May experience pain in the eye
  • May have double vision
  • May suffer from Bell’s palsy that is paralysis on one side of the face
  • Pain in foot or in the shin area
  • Pain in front on the thigh
  • Pain in the pelvic area
  • Pain in the stomach or in the chest
  • The eye may lose the ability to focus

 

Focal neuropathy can cause a lot of pain and is often found in the elderly having diabetes. It gets better with treatment or on its own and does not cause any long-term damage.

 

Neuropathy Affects Nerves throughout the Body

 

Peripheral Neuropathy Affects

  • Arms
  • Feet
  • Hands
  • Legs
  • Toes

 

Autonomic Neuropathy Affects

  • Digestive System
  • Eyes
  • Heart and Blood Vessels
  • Lungs
  • Sex Organs
  • Sweat Glands
  • Urinary Tract

 

Proximal Neuropathy Affects

  • Buttocks
  • Hips
  • Legs
  • Thighs

 

Focal Neuropathy Affects

  • Abdomen
  • Chest
  • Ears
  • Eyes
  • Facial Muscles
  • Feet
  • Legs
  • Pelvis and Lower Back
  • Thighs

 

In addition to this, people that have diabetes can also have entrapment syndromes, which lead to nerve compressions. One of the most common results of this is carpel tunnel syndrome9 10.

 

Can Diabetic Neuropathy Be Prevented?

 

One of the ways in which diabetic neuropathy can be prevented is keeping your blood glucose levels normal as it will protect the nerves in the body from damage8.

 

How Is Diabetic Neuropathy Diagnosed?

 

Most of the times doctors diagnose it through a physical exam, based on the symptoms and checks the following things during the exam:

  • Blood pressure
  • Heart rate
  • Muscle strength
  • Reflexes
  • Sensitivity to position changes, temperature, and touch

 

Foot Exams

 

A lot of experts resort to foot exams and encourage the people to go for a yearly examination so that they can get their peripheral neuropathy checked. The doctor does a comprehensive foot exam and looks at the sensation of the foot, muscles, bones, condition of the skin, and the circulation of blood. In addition to this, they assess the protective sensation as well by touching the feet with a nylon monofilament that is just like a bristle but has a pin attached to it. People that can’t feel any pressure when the nylon monofilament is applied are at a risk of developing foot sores. The doctors also assess the temperature sensitivity of the feet by applying a tuning fork.

 

Other Tests

 

Some of the other tests that doctors perform are:

  • Using electromyography so that the extent as well as the type of nerve damage can be determined11. With the help of this, doctors try to see how the muscles react to the electrical signals that are transmitted by the nerves as this helps in diagnosing the onset of neuropathy.
  • An ultrasound is done by sending sound waves to get an image of the internal organs. The urinary tract as well as the bladder is assessed to see whether the bladder is completely emptying itself after urination.
  • The heart rate is checked and it is seen how it reacts when the posture or the blood pressure is changed. Patients are also asked to breathe deeply, so that the changes in the heart can be determined.

 

How Diabetic Neuropathy Are to Be Treated?

 

The first step is to make sure that the blood glucose levels come to the normal range. This can be done by monitoring the levels, taking medicines, getting insulin, planning meals, and with the help of light exercise12. By controlling the blood glucose level, you would be stopping the onset of other symptoms as well.

 

Pain Relief

 

Some of the medicines that help with nerve pain are:

  • Anticonvulsants
  • Opioids and opioidlike drugs
  • Other types of antidepressants
  • Tricyclic antidepressant
  • Duloxetine
  • Pregabalin

 

Things You Did Not Know About Diabetic Neuropathy

 

There are more than 20 million people that suffer from peripheral neuropathy but not all of them have diabetes. Here are a few things that you might not have known before:

  • A lot of times, to help patients in coping up with the loss of feeling, doctors ask them to do exercises where they grasp things or use Velcro on things so that it increases the sensation of the grip.
  • Burning sensations in the feet can be treated with topical creams or by soaking feet in ice cold water for 15 minutes before going to bed.
  • Diabetic nerve pain can be controlled if you pair up with your doctor to find out the treatment plan that works for you.
  • Diabetic neuropathy can affect the sensory motor nervous system as well as autonomic nervous system. It can also affect organs including kidney, lungs, stomach, and the heart.
  • Good nutrition is extremely important especially vitamin supplements as they help in overcoming the symptoms.
  • If you want to seek help or want to learn more about the symptoms, you should get in touch with a neuromuscular neurologist.
  • To maintain the flexibility and the strength of the muscle exercise is important. However, intense exercises are not recommended as they may increase the pain in the muscles.
  • It is seen that serotonin helps in reducing main so some of the things that can be tried include biofeedback and massages.
  • Neuropathic pain is a result of affected nerves that send faulty signals to the brain. This type of pain is generally controlled in the patients with the help of anticonvulsants and anti-depressants. In some of the severe cases, a combination of both may also be used.
  • There are special shoes and socks that are made for diabetic patients, which help in alleviating the symptoms as it allows the blood to flow freely.
  • Neuropathy is basically a nerve disorder that is caused by abnormalities that are similar to diabetes like high blood glucose.
  • The treatment involves bringing the blood glucose level to normal that may alleviate the symptoms for the time being but will lessen them in the long run
  • Foot care is important to people who have diabetic neuropathy need to examine their foot on a daily basis.

 

End Notes

  1. Kawamura N, Dyck PJ, Schmeichel AM, Engelstad JK, Low PA, Dyck PJ. Inflammatory mediators in diabetic and non-diabetic lumbosacral radiculoplexus neuropathy. Acta Neuropathol 2008;115(2):231-239
  2. Dyck PJ, Giannini C. Pathologic alterations in diabetic neuropathies of humans: a review. J Neuropathol Exp Neurol 1996;55:1181-1193.
  3. Garland H. Diabetic amyotrophy. Br Med J 1955;2:1287-1296.
  4. Hahn AF, Hartung HP, Dyck PJ. Chronic inflammatory demyelinating polyradiculoneuropathy. In: Peripheral neuropathy, 4th ed. Vol. 2. PJ Dyck, PK Thomas, eds. Philadelphia: Elsevier Saunders; 2005.
  5. Kelkar PM, Masood M, Parry GJ. Distinctive pathologic findings in proximal diabetic neuropathy (diabetic amyotrophy). Neurology 2000;
  6. Figueroa JJ, Dyck PJ, Laughlin RS, Mercado JA, Massie R, Sandroni P, Low PA. Autonomic dysfunction in chronic inflammatory demyelinating polyradiculoneuropathy. Neurology 2012;78:702-708
  7. Said G, Lacroix C, Lozeron P, Ropert A, Plante V, Adams D. Inflammatory vasculopathy in multifocal diabetic neuropathy. Brain 2003
  8. Zochodne DW, Isaac D, Jones C. Failure of immunotherapy to prevent, arrest or reverse diabetic lumbosacral plexopathy. Acta Neurol Scand 2003;107:299-301.
  9. Chaudhuri KR, Davidson AR, Morris IM. Limited joint mobility and carpal tunnel syndrome in insulin-dependent diabetes. Br J Rheumatol 1989;28:191-194.
  10. Nordstrom DL, DeStefano F, Vierkant RA, et al. Incidence of diagnosed carpal tunnel syndrome in a general population. Epidemiology 1998;9:342-345.
  11. Mulder DW, Lambert EH, Bastron JA, et al. The neuropathies associated with diabetes mellitus. A clinical and electromyographic study of 103 unselected diabetic patients. Neurology 1961;11:275-284.
  12. Dyck PJB, O’Brien P, Bosch EP, Grant I, Burns T, Windebank A, Klein C, Haubenschild J, Peterson D, Norell J, Capelle S, Lodermeier K, Dyck PJ. The multi-center, double-blind controlled trial of IV methylprednisolone in diabetic lumbosacral radiculoplexus neuropathy. Neurology 2006;66:(5 Suppl 2):A191.

©