Diabetes Neuropathy: Diabetic neuropathies are nerve-damaging disturbances linked to diabetes mellitus. It is a progressive disease, and manifestations worsen over a number of years. Diabetes is thought to damage nerves as a result of prolonged high levels of blood glucose. Diabetic neuropathy is the most frequent complication of diabetes.
Approximately 60 to 70 percent of people with diabetes have some form of neuropathy. People with diabetes can exhibit nerve problems at any time, but the risk increases with age and the longer duration of diabetes.
Causes of Diabetes Neuropathy
Prolonged exposure to high blood sugar can damage sensitive nerve fibers, causing diabetic neuropathy. The exact impact of glucose on the nervous system is still not known. High blood sugar interferes with the capacity of the nerves to transmit signals. It also weakens the walls of the small blood vessels that provide the nerves with oxygen and nutrients.
High levels of triglycerides are further associated with the increase of nerve damage.
A combination of Other factors includes:
- High blood pressure
- Being overweight.
- Alcohol use
- Genetic factors unrelated to diabetes make some people more susceptible to nerve damage.
- Having chronic liver or kidney disease
Lowering levels of vitamin B-12 can further lead to neuropathy. Metformin, a traditional medicine used to control the symptoms of diabetes, can lower levels of vitamin B-12.
Types of diabetic neuropathy
There are different types of diabetic neuropathy. Four main types of neuropathy are-
- Peripheral neuropathy is the most common form of diabetic neuropathy, which affects the feet and hands.
- Diabetic proximal neuropathy concerns nerves in the thighs, hips, or buttocks.
- Autonomic neuropathy, affecting the nerves that regulate the involuntary functions of the body. For instance, it can affect nerves of the gastrointestinal, genital, urinary, or vascular systems.
- Diabetic focal neuropathy concerns a specific nerve or region at any site in the body.
Symptoms of Diabetic Neuropathy
The symptoms and signs of diabetic neuropathy depend upon the type of neuropathy that is present, and which nerves are being affected.
Common symptoms of neuropathy include:
- Loss of sensation in the feet or lower legs
- Pain or burning sensations
Symptoms of diabetic proximal neuropathy include:
- Weakness of the legs
- Pain, usually on one side, in the hips, buttocks, or thighs
Symptoms of diabetic autonomic neuropathy can include:
- Indigestion, nausea, and vomiting
- Urinary problems
- Impotence(Erectile dysfunction in men)
- Vaginal dryness
- Incontinence of urine
- Profuse sweating, when eating or at night
- Difficulty swallowing
Diabetic Neuropathy Diagnosis
Your physician will ask about your symptoms and medical history. You’ll further have a physical examination, Your physician may test the sensitivity in your feet. During this test, your physician will use a nylon fiber to check your limbs for any sensation loss. A tuning fork may be used to test your vibration threshold, and may also test your ankle reflexes. Your physician additionally checks your heart rate, blood pressure, and muscle tone.
Treatment for Diabetic Neuropathy
Diabetic neuropathy has no known cure. Diabetic neuropathy worsens over time. The first step for neuropathy is to get blood sugars under control and to manage high blood pressure and cholesterol levels.
If diabetes is well controlled, and glucose levels are kept within a healthy range throughout the day, the risks of diabetic neuropathy can be minimized.
Physical therapy, and Some drugs as well as other treatments, can help to control the pain caused by diabetic neuropathy.
- Tricyclic antidepressants, such as amitriptyline, imipramine, and desipramine.
- Other antidepressants, such as venlafaxine, duloxetine, bupropion, paroxetine, and citalopram.
- Anticonvulsants, such as pregabalin, gabapentin, carbamazepine, and lamotrigine.
- Opioids and opioid-like drugs, such as controlled-release oxycodone, an opioid; and tramadol, an opioid that also acts as an antidepressant.
Duloxetine and pregabalin are also for treating painful diabetic peripheral neuropathy(approved by the U.S. Food and Drug Administration specifically).
Physical therapy, used in combination with medications. Some physical therapies can alleviate pain, burning, and tingling sensations. Physical therapy may help patients with muscle cramps, muscle weakness, and sexual dysfunction.
Electrical nerve stimulation is painless, and it helps to reduce feelings of stiffness and improve the healing of foot ulcers.
Gait training involves relearning how to walk. It helps to prevent and stabilize foot complications, such as ulcers.
Therapeutic ultrasound uses very high-frequency sound waves, can help some patients to regain sensitivity in their feet.
Taking a warm bath or foot warmer can soothe and can also ease pain symptoms from neuropathy. Warm water raises blood circulation throughout the body, decreasing pain symptoms from numbness.
Complications of Diabetic Neuropathy
Possible complications include-
- Loss of a limb-A lack of sensation in the feet, risk of not feeling cuts or sores, which can infect, leading to a risk of amputation
- Bladder and kidney infections
- Charcot joint-This occurs when a joint, usually in the foot, deteriorates because of nerve damage.
- Urinary tract infections and urinary incontinence.
- Muscle damage or loss of muscle mass
- Digestive problems.
- Sexual dysfunction
To limit the developments of diabetic peripheral neuropathy, healthy foot care is needed.