Diabetes can be harmful for nerves and may cause nerve damage. This condition is known as peripheral neuropathy or diabetic neuropathy. Nerves, on the other hand, are specialized form of tissues in brain that conduct messages from brain to other parts of body. Nerves play vital role in nervous coordination which eventually controls and regulate body functions.
In diabetes, the blood sugar level is abnormal that is either too high or too low. This condition leads to peripheral neuropathy.
This is estimated that up to one third patients of diabetes have peripheral neuropathy and more than 30% of diabetics have autonomic neuropathy. Similarly, most common type of focal neuropathy is carpel tunnel syndrome. The patient has a compressed nerve in wrist and these cases are almost 25% of all diabetics.
Depending on the type and severity of condition, peripheral neuopathy may cause loss of sensation in limbs, numbness or burning sensation and shooting pain in legs. The condition is painful and may result in severe complications.
Types of diabetic neuropathy
Just like diabetes, neuropathy also has further types that may vary from person to person. These are:
1. Peripheral neuropathy
This type mainly affects lower limbs and rarely affects arms and back or person. Its symptoms are ticklish feet, numbness and burning sensation.
2. Autonomic neuropathy
In this type, the person’s digestive system is affected and mainly his stomach. If it gets severe, this may affect the blood vessel, urinary system and even the reproductive system. The symptoms are those related to digestive system such as diarrhea, bloating, vomiting, nausea and constipation. If this affects the blood vessels, the symptoms are of low blood pressure and faster heart beat. Similarly, in case of affected urinary system, this causes the bloating and frequent urges to go to washroom at night.
3. Proximal neuropathy
This type of neuropathy is characterized by sudden pain, usually in one side of thighs, and buttock. The patient’s legs become weak and he experience problems in walking.
4. Focal neuropathy
This neuropathy affects specific type of nerves. These are mostly in head and lower limbs. The symptoms include blurry vision, eye pain, and paralysis on one side of face and sometimes chest pain which can be mistaken as heart attack or angina.
What cause diabetic neuropathy?
High blood glucose level is damaging to nerves. This high blood glucose level along with accumulation of fats and triglyceride not only damage the nerves but also triggers the diabetic neuropathy. The reason is that both the glucose and fats block and interrupt the normal supply of oxygen and nutrient to these vessels ad eventually these vessels get damaged or show poor functioning.
On the other hand, researchers also have identified a few genes and their genetic polymorphism that may contribute to onset of diabetic neuropathy. These include ACE, AKR1B1, NOS3 TNF-α gene and few more. These genes have vital role in molecular pathways of cellular functioning. So there are chances and possibilities that their polymorphism and variations contribute to onset of neuropathy.
Neuropathy is often associated with high blood sugar level or diabetes. Therefore, managing a normal blood glucose level is essential to prevent neuropathy. Some other conditions along with diabetes increase the risk factors of neuropathy in diabetic patient such as:
- High blood cholesterol level
- High blood pressure
- Drug addiction and alcohol consumption
- Having kidney disorder such as kidney stones
- Genetic susceptibility
Complications of symptoms
Neuropathy can lead to serious health issue and symptoms may get complicated. These complications include:
- Foot complications: Peripheral neuropathy that affects lower limbs leads to serious infections, sores and ulcers in feet. This occurs due to numbness of feet that you may not notice if your shoes or some hard object cause an injury and sore in feet. The high blood sugar level in diabetics makes it difficult to heal the wound. In most complicated situation, the infection may spread to whole feet and bone- a condition known a septicemia. Therefore, to prevent further spread of infection, doctors remove the infected area or even the whole foot is removed by surgery.
- Carpel tunnel syndrome: The patient experiences numbness of feet and hand due to muscular weakness.
- Joint problem: The damaged nerves lead to joint problems as the joint deteriorate- a condition named as Charcot joint. The joints become swollen, painful and deformed.
- Urinary tract infections: When the nerves of urinary system get weak, the patient is unable to completely empty the bladder. The opportunistic microbes such as pathogenic bacteria accumulate here and cause urinary tract infection. The other issues include incontinence-that is frequent urges to urinate.
- Digestive issues
- Increased heart beat and blood pressure
- Sexual dysfunction
The doctors diagnose diabetic neuropathy by performing these tests:
1. Complete examination
This is mainly to check the sensitivity and reflexes of muscles in limbs.
2. Filament test
In this test, doctors use a microfilament composed of nylon filament and brush it over your skin. This is basically to check the sensibility of touch.
3. Nerve conduction test
The brain performs coordination via nerve impulses that pass through the nerves. This test is performed to check how quickly the impulses pass through the parts of body and specially limbs.
4. Quantitative sensory testing
This is to check the nerve’s response to certain stimuli such as vibrations and temperature fluctuations.
5. Autonomic testing
In case of autonomic neuropathy, the doctors test person’s blood pressure changes in different positions.
This is similar to nerve conduction test as the doctor check electrical discharge of muscles in patient’s body.
The purpose of treatment is to relive pain and suffering of patient, slow down the progression and to revive the normal nerve functions.
1. Pain relief medicines
Doctors prescribe certain medicines which relive the pain associated with diabetic neuropathy. These are:
Antidepressants: Neuropathy may lead to anxiety and depression. These drugs relieve the associated symptoms. These drugs include those from class Tricyclics (such as norpramin) and the other class is serotonin and nor epinephrine inhibitors, as well as pregabalin and carbamazepine drugs. All of these reduce the pain and suffering of patient. However, these may have some side effects as well such as dizziness and vomiting.
Pain relief: Similarly, depending on the symptoms and the type of neuropathy, there are different drugs and medications. For instance, some medicines are for urinary tract problems while other aim to restore the functioning of digestive system and relive symptoms of abdominal pain diarrhea and constipation.
2. Ointments and lotions
Ointments also relive pain. For instance, Capsaicin cream is applied on skin and it relives the pain and burning sensation in limbs.
3. Transcutaneous electric nerve stimulation (TENS)
This therapy involves application of electrical impulses by placing electrode on skin. This stimulates the nerves and may revive their function. However, this therapy is not applicable for all type of neuropathies or every patient.
A part from treatment and medication, a person can prevent the diabetic neuropathy by considering these points:
1. Controlling blood sugar level
The main reason of neuropathy is high and abnormal blood glucose level. Take proper diet and step such as exercise and medications to maintain the blood sugar level. It is even better to have a glucometer at home to check the blood sugar level regularly.
According to American Diabetic Association, the normal range of blood sugar level is as follow;
- Before meal: 80-130 mg/dL
- After meal: less than 180mg/dL
2. Foot care
Diabetic patients are at great risks of developing infections and scars. Therefore, the best option is to protect the feet. to protect your feet, do these things regularly:
- Check your feet daily for any scar or blister and something like that
- Keep personal hygiene
- Use protective shoes but not too tight fitting to ventilate
- Trim toenails
- Keep skin moisturized and clean
- Perform some exercise as recommended by the physiotherapist
Diabetic neuropathy is a disorder which causes nerve damage and interrupts the nervous coordination. A few medication therapies are available. However, the best option is prevention which is possible by maintaining blood sugar level. A healthy life style such as balanced diet and regular exercise helps a lot to prevent the neuropathy and related complications.