Diabetic neuropathy

Diabetic neuropathy is a complication of diabetes that causes  damage to the nervous system. It is a progressive disease, and symptoms get worse as time  goes  on .It occurs only in prolonged cases of diabetes and mostly damages the nerves of legs and feet.

Neuropathy happens when high levels of fats or sugar in the blood cause damage to  the nerves in the body. It can affect virtually any nerve in the body, and there is  wide range of symptoms. So once diabetes is diagnosed it  should be strictly  kept under  control by  either  oral hypoglycemics  or  by  insulin  as  suggested  by  physician (MD General Medicine doctor)

Nerves are essential to the  normal  working  of the human  body . They enable movement of  people ,control  senses  ,control automatic functions, as breathing and diabetic neuopathy affects it.

Affection  of  nerves  in  diabetes is  of several types. Some involve the peripheral nerves, while others damage the nerves that supply the internal organs, such as the heart, the bladder ,e.t.c. In this way, it can affect several  body functions.

Between one-third and a half  of people with diabetes have neuropathy.

In this article, we describe the different types, effects, and risks of diabetic neuropathy.

Peripheral neuropathy can lead to a loss of sensation in the feet and  hands.

Four main types of neuropathy can have  impact on the nervous system, including:

Peripheral symmetric neuropathy: This affects the feet and hands. It is the most commonly  encountered  form of diabetic neuropathy.

Autonomic neuropathy: This occurs in the nerves that control involuntary functions of the body, such as digestion, urination, or heart rate.

Thoracic and lumbar root, or proximal, neuropathy: This causes damage to the  nerves along a specific distribution in the body, such as the chest wall or legs.

Mononeuropathies: These affect any individual nerve.

The symptoms of neuropathy depend on the type and the nerves involved.

The signs and symptoms of diabetic neuropathy are  not  immediate, but  usually take several years to appear. Signs and symptoms (Clinical features) depend on which type of neuropathy and nerves it affects.

For  symptoms and  signs  of  diabetes  pl click on the link given below

Peripheral neuropathy

The symptoms of peripheral neuropathy are  as  follows –

numbness, pain, tingling, and burning sensations starting in the toes and fingers then continuing up the legs or arms

loss of muscle tone in the hands and feet

not being able to get the  sensation of  heat, cold, or physical injury

loss of balance

Charcot’s joint, in which a joint breaks down because of nerve issues, often in the feet

Peripheral neuropathy that causes  affection of the feet can make it difficult for a person to stand and walk. It can increase the risk of the  individual falling-all these things are seen in diabetic neuropathy.

When a person cannot feel heat, cold or injury, this can lead to new problems.This can  cause  injuries  or  aggravate previous  injuries.

For example, a blister on the foot can become ulcerated because the person did not get the  sensation of pain in the early stages. As the infection progresses, gangrene can result in which  may  even  require  amputation of  a  portion of the  inferior  extremity .

Autonomic neuropathy

Following are the  effects of autonomic neuropathy :

heartburn and bloating

nausea, constipation or diarrhea ,                                                                                                                                                                                               for  further  details of  effects  of  diabetes on  the gastrointestinal system pl click on the link given below 

hypoglycemic unawareness, in which a person does not feel the effects of low sugar levels,as routinely  an  individual feels  when  he  has  not  taken  breakfast ,lunch, till  late

difficulties speaking or swallowing

feeling full after eating small amounts of food

vomiting several hours after eating

orthostatic hypotension, or feeling light-headed and giddiness  when standing up-this  is  more  common  in uncontrolled  diabetes.

a  heart rate  higher than normal range

excessive sweating, even in cool temperatures or while at rest not  doing  any  exertion

bladder problems, for example, difficulty emptying the bladder completely ,this  can  lead to  incontinence

sexual dysfunction in  both men and women

dysesthesia, or a distorted sense of touch,due to  involvement  of  sensory  nerves

significant drooping of the face and eyelids in  severe  cases

muscle weakness

There are many types of neuropathy.

Proximal neuropathy can lead to pain in the lower body, which is frequently  on one side, and weakness in the legs.

Symptoms of focal neuropathy can vary widely, depending on the nerve affected as  each  spinal  nerve has  specific  areas of  distribution. Focal neuropathy and cranial neuropathy can both lead to visual disturbances, such as double vision.

People with diabetic neuropathy often do not realize they have it until the symptoms are more advanced.These are  never  observed  in  early  stages of  diabetes.

 All of the symptoms of peripheral neuropathy are  not visible, but people should  have  knowledge  of any wounds on their feet.

A physician (MD General Medicine ) or  Neurologist  will carry out a  generalised physical examination ,take thorough medical  history  ,foot examination  ,check blood pressure,pulse rate, fasting and postprandial blood sugar.

He will test  the  following  things –

ankle reflexes

loss of sensation

changes in skin texture

changes in skin color.

If the Physician suspects diabetic neuropathy, they may suggest some  diagnostic tests,  as:

an electromyogram (EMG), which is the  recording of electrical activity in the muscles

a nerve conduction velocity test (NCV) which records the speed at which induced signals are  traveling through the nerves

Most types of diabetic neuropathy gets worse  as time passes by .

 Blood sugars should  be  brought into  a target range agreed with a physician  (MD General Medicine) doctors and management of  high blood pressure and to  bring  cholesterol and  entire  lipid  profile within  normal levels.

The  physician  usually  advises  oral  hypoglycemics or  insulin  injections.

For  details  regarding  insulin  pl  click  on the link given below

Maintaining the blood glucose levels within the  target  range will minimize the risk of diabetic neuropathy. Treatment  objectives are on reducing pain and managing some of the symptoms.

 Physiotherapy  can be  given  to  some  patients to help to control the pain of diabetic neuropathy, alongside other treatments. However,  the nerves cannot  be  repaired.

So  previously  it was  said that  once  an  individual  becomes  above  40 yrs old he  should  undergo  fasting  ,postprandial  blood sugar, lipid profile, SGOT, SGPT, Sr Creatinine ,CBC, ECG.

But  nowadays  it  is  advisable  that  an  individual  of  20 yrs  age  should  also  undergo  these  investigations.

Afterall prevention  is  better  than  cure.

People  often  avoid  health  check ups.

They  say  they are totally normal and  so  why  to  do  check ups.

But instead of  waiting  for  the  day to  come  when  problem  occurs, it  is  much  wise  do  do  health  check ups and  SOS  early  treatment  than  too  late  treatment.

The  individual  should also  stop smoking ,alcohol and  other  bad  habits .

Drugs that can help to manage pain include-

Diclofenac  sodium  ,

Ibuprofen or  as  suggestions  by  the  treating  physician.

Topical lotions, compound creams, and some ,ALA or topical capsaicin, may also provide relief to  the  individual.

Medications like capsaicin cream may  not  be  available  in  your  local  medical  stores, but  they  are  available at trusted and  reputed online sites.

Physical therapy, combined with medications, may help relieve pain and decrease need  for opioids.

It may also help to  decrease the  following  things –

burning and tingling sensations in the inferior extremities

muscle cramps

muscular weakness

sexual dysfunction

Electrical nerve stimulation is a physical therapy that is  painless and  may help to decrease  feelings of stiffness and improve the healing of  ulcers of  foot

Gait training includes  training about  how to walk.It should be done  by  physiotherapist.  It helps to prevent and stabilize  complications of foot  as ulcers ,injury,gangrene,and This type is crucial for people using prosthesis after losing limbs if  amputation is required in  case  of  gangrene  due to severe  diabetic  neuropathy.

A good physical therapist/physiotherapist will take  care  that exercises for people with diabetic neuropathy do not cause  injury  to the feet, which can be sensitive.

Other therapies include devices that the  individual  can utilise to prevent painful or sensitive extremities from touching the bed or chair.

A chiropractor, massage therapist, or osteopath can carry out regular massages or manual therapy to  cause stretching of  the muscles. Massage can inhibit muscle contractions, spasms, and atrophy  as  the  blood  supply  has  become  poor .

Some  exercises  that  are  advised are swimming or aerobics, to maintain muscle strength and  decrease the loss of muscle mass.

Therapeutic ultrasound is a type of physical therapy that uses very high-frequency sound waves to stimulate the tissue beneath the skin which can help some people to regain sensitivity in their feet.

Changing  the  way  you  eat  can  have a significant  effect  on maintenance of  the  target range  levels  of blood  glucose. For  that  pl click on the links given below.

Some types of diabetic neuropathy can affect a person’s vision.

For  effects of diabetes on  vision  pl click on the link given below

Diabetic neuropathy can result in a number of high-risk complications .

Possible complications include loss of  sensation in the feet.

This can lead to an inability to feel injuries or sores, and infection might occur as a result. Untreated infection in a limb can result in need for amputation.

Severe infections of  kidney  and  bladder may also occur, causing health problems and may  make  it  necessary for the  patient  to  get  admitted to hospital.

To prevent the complications of diabetic peripheral neuropathy, it is  necessary to do  regular  examination  of the  foot and  maintain normal  target  levels  of  blood  sugar.

People with the condition should do regular  inspection of their feet  on  daily  basis for injuries or sores.

In  individuals  doing  smoking there  is higher  chance  of  occurrence of  foot problems of  diabetes   with certain types of diabetic neuropathy. Consultation  with  a podiatrist should be done.

Diabetic neuropathy is a type of nerve damage .It occurs in individuals  who have diabetes.

There are four types: autonomic, peripheral, proximal, and focal neuropathy.

Each affects a different set of nerves and has a different range of effects. Autonomic neuropathy affects  automatic processes in the body, such as digestion. Peripheral neuropathy causes  damage to the nerves in the toes, fingers, hands, and feet.

Diagnosis is  done  by physican with the help of  scans, and tests for ankle reflexes, sensation, and skin texture and tone.

Treatment involves several types of physical therapy/physiotherapy and medicines to control pain and nerve conduction.

As people with diabetic neuropathy tend not to feel injuries on the feet, regular examination  of the feet is essential  to avoid undetected infection and the possible loss of limbs.

Q:

If an  individual is having  type 2 diabetes then  what  should be done to prevent diabetic neuropathy?

A:

This can be done by maintainence of  blood sugar  in  target range and taking  regular care of  foot.  If  Metformin is  taken  for a  prolonged  duration for type 2 diabetes, then  it  can  cause  lowering of  the serum Vitamin B12 level and  so Serum Vitamin  B12  assessment should  be  done  at  regular  intervals as  low  levels of  serum B12 can cause neuropathy.

 All this above  content is strictly informational and should not be considered medical advice or  treatment.

For  medical  advice and treatment  you  may  contact  your physican (MD General Medicine) or Neurologist.

Then  why  to  read  this  article ?

This  article  should be  read  as -Knowledge  is  Power. You  should have  thorough knowledge  of  the  disease  or  disorder  which  you  are  having and  for  proper  coordination  to  treatment.

The phrase “diabetic neuropathy” describes the nerve injury brought on by diabetes, which often affects the lower extremities but has the potential to affect other body regions as well. It can present as discomfort, numbness, tingling, or muscular weakness, and in extreme cases, it can cause significant problems such foot ulcers and infections.

Important features of diabetic neuropathy:

Reason:
Over time, excessive blood sugar damages blood vessels and nerves.

Kinds:

• Peripheral neuropathy: Can impact the arms and hands, but frequently affects the legs and feet.
• Autonomous neuropathy: Affects the nerves that govern the bladder, heart, digestive system, and sexual organs.
• Localized neuropathy: Impacts specific nerves, frequently in the head, trunk, hand, or leg.
• A less prevalent kind of neuropathy that affects the hip, thigh, or buttock is known as proximal neuropathy.

Symptoms:

• Pain: Burning, stabbing, or shooting pain, frequently more severe at night.
• Tingling and numbness: particularly in the feet and toes.
• Muscle weakness: In the afflicted limbs.
• Issues with the digestive system, such as nausea, diarrhea, and constipation.
• Sexual and bladder dysfunction: problems urinating or having an erection.
• Problems with the cardiovascular system: Dizziness, particularly when getting up.

Risk Factors:
The risk can be increased by obesity, high blood sugar, persistent diabetes, and specific hereditary variables.

Administration:

• Blood sugar management: The most important aspect of care is maintaining blood sugar levels under tight control through diet, exercise, and medication.
• Regular foot assessments: appropriate footwear, and quick care of any foot injuries are all necessary for good foot care and the avoidance of problems.
• Drugs: Pain can be managed with analgesics, antidepressants, and anticonvulsants.
• Physical therapy: May enhance mobility and help with muscular weakness.
• Adjustments to one’s lifestyle: such as maintaining a healthy weight, stopping smoking, and controlling blood pressure, may also be helpful.

What are the various forms of diabetic neuropathy?

Different kinds of nerve injury are referred to as neuropathy. There are four primary forms of neuropathy in persons with diabetes.

1. Neuropathy of the periphery

Peripheral neuropathy is the most prevalent kind of neuropathy. The feet and legs are often affected by peripheral neuropathy, but the hands and arms can also be affected. The symptoms range from moderate to severe. They include muscle weakness as well as tingling, burning, or numbness.

It’s possible that you won’t experience any discomfort or pain on your foot if you have peripheral neuropathy. Poor blood circulation, which is common in diabetics, makes it harder for wounds to heal. The likelihood of infection is increased by this combination. Amputation may result from infection in rare circumstances.

2. Neuropathy of the autonomic nervous system

Autonomic neuropathy is the second most prevalent kind of neuropathy among those who have diabetes.

Other bodily systems over which you have no conscious control, such as the digestive and cardiovascular systems, as well as organs like the bladder and sex organs, are regulated by the autonomic nervous system.

difficulties with digestion

Digestive system nerve damage may result in:

• constipation
• diarrhea
• Difficulty swallowing
• gastroparesis, which slows the stomach’s emptying into the small intestine

Delayed digestion brought on by gastroparesis can get worse over time, resulting in recurrent nausea and vomiting. People with gastroparesis often experience fullness too soon and are unable to complete a meal.

An extended digestion period frequently causes blood glucose levels to be more difficult to manage, as evidenced by repeated alternating high and low readings.

Furthermore, in those with autonomic neuropathy, the symptoms of hypoglycemia, such as sweating and heart palpitations, may not be recognized. This may result in you failing to recognize low blood sugar, which raises the possibility of a hypoglycemic crisis.

Issues with bladder and sex

Sexual issues such as erectile dysfunction, vaginal dryness, or trouble experiencing orgasm can also be caused by autonomic neuropathy. Incontinence or trouble emptying your bladder completely might result from bladder neuropathy.

Issues with the heart and vascular system

Nerve injury that affects blood pressure and heart rate may cause a slower reaction. When you stand up after sitting or lying down or when you overexert yourself, you may experience a drop in blood pressure and feel light-headed or dizzy. An abnormally rapid heartbeat can also be caused by autonomic neuropathy.

Some of the signs of a heart attack might be hard to spot due to autonomic neuropathy. When your heart is not receiving enough oxygen, you might not experience any chest discomfort. You should be aware of the other signs of a heart attack if you have autonomic neuropathy, such as:

• excessive perspiration
• discomfort in the stomach, jaw, neck, back, or arm
• a lack of breath
• feeling nauseous
• dizziness

3. Proximal neuropathy

Diabetic amyotrophy, sometimes known as proximal neuropathy, is uncommon. Adults over 50 with type 2 diabetes are more likely to have this kind of neuropathy, and males are more likely to be diagnosed with it.

Frequently, it strikes the thighs, hips, or buttocks. The discomfort may be unexpected and occasionally unbearable. You may have trouble standing up without help due to muscle weakness in your legs. Usually, just one side of the body is impacted by diabetic amyotrophy.

They usually experience a worsening of their symptoms following the onset of the illness, but they eventually start to get better. Even without therapy, the majority of individuals recover in a few years.

4. Neuropathy of the focal point

When a single nerve or cluster of nerves is injured, resulting in weakness in the afflicted region, the condition is known as focal neuropathy or mononeuropathy. Your hand, head, torso, or leg are the most common places for this to happen. It manifests out of nowhere and is often quite painful.

The majority of focal neuropathies, similar to proximal neuropathy, disappear after a few weeks or months without causing long-term harm. Carpal tunnel syndrome is the most prevalent kind.

Despite the fact that the majority of people do not experience the symptoms of carpal tunnel syndrome, around 25% of diabetics have some level of nerve compression at the wrist.

The following are signs of focal neuropathy:

• discomfort, tingling, and numbness in the fingers
• a lack of focus
• twofold vision
• painful in the back of the eyes
• Bell’s paralysis
• discomfort in specific locations like the front of the thigh, lower back, pelvic area, chest, belly, inside the foot, outside the lower leg, or weakness in the big toe

If I have diabetes-related neuropathy, when should I visit my doctor?

If you have neuropathy related to diabetes, you should visit your doctor frequently. This is to allow them to keep an eye on your symptoms and determine whether they are improving or worsening. Additionally, you’ll need to visit your diabetes doctor (such an endocrinologist) on a frequent basis to make changes to your diabetes treatment regimen.