Diabetic Neuropathy

Jai Ganesh · Today 16:38:48

Diabetic Neuropathy

Gist

Diabetic neuropathy is a common, often disabling form of nerve damage caused by long-term high blood sugar and fat levels, affecting up to 50% of people with diabetes. It most frequently causes pain, burning, and numbness in the legs and feet, but can also impair digestion, bladder function, and cardiovascular systems. While it can lead to serious ulcers or amputations, it is often managed by tight glucose control, pain medications, and lifestyle changes.

What is the best cure for diabetic neuropathy?

While keeping blood glucose levels in goal range can prevent peripheral neuropathy and keep it from getting worse, there aren't any treatments that can reverse nerve disease once it's established. Once neuropathy is detected, the focus is on keeping the feet and legs healthy and on managing pain.

Summary

Diabetic neuropathy includes various types of nerve damage associated with diabetes mellitus. The most common form, diabetic peripheral neuropathy, affects 30% of all diabetic patients. Studies suggests that cutaneous nerve branches, such as the sural nerve, are involved in more than half of patients with diabetes 10 years after the diagnosis and can be detected with high-resolution magnetic resonance imaging. Symptoms depend on the site of nerve damage and can include motor changes such as weakness; sensory symptoms such as numbness, tingling, or pain; or autonomic changes such as urinary symptoms. These changes are thought to result from a microvascular injury involving small blood vessels that supply nerves (vasa nervorum). Relatively common conditions which may be associated with diabetic neuropathy include distal symmetric polyneuropathy; third, fourth, or sixth cranial nerve palsy; mononeuropathy; mononeuropathy multiplex; diabetic amyotrophy; and autonomic neuropathy.

Diabetic neuropathy is the most common complication of diabetes mellitus (DM), affecting as many as 50% of patients with type 1 and type 2 DM. Diabetic peripheral neuropathy involves the presence of symptoms or signs of peripheral nerve dysfunction in people with diabetes after other possible causes have been excluded. In some cases, patients are symptomatic long before routinely performed clinical examination reveals abnormalities. Of all treatments, tight and stable glycemic control is probably the most important for slowing the progression of neuropathy.

Signs and symptoms of diabetic neuropathy

In type 1 DM, distal polyneuropathy typically becomes symptomatic after many years of chronic prolonged hyperglycemia, whereas in type 2, it may be apparent after only a few years of known poor glycemic control or even at diagnosis. Symptoms include the following:

Sensory – Negative or positive, diffuse or focal; usually insidious in onset and showing a stocking-and-glove distribution in the distal extremities

Motor – Distal, proximal, or more focal weakness, sometimes occurring along with sensory neuropathy (sensorimotor neuropathy)

Autonomic – Neuropathy that may involve the cardiovascular, gastrointestinal, and genitourinary systems and the sweat glands.

Details:

Overview

Diabetic neuropathy is a type of nerve damage that can happen with diabetes. Blood sugar, also called glucose, becomes high because of diabetes. Over time, high blood sugar can injure nerves throughout the body. Diabetic neuropathy most often damages nerves in the legs and feet.

Depending on the affected nerves, diabetic neuropathy symptoms may include pain and numbness in the legs, feet and hands. It also can cause problems with the digestive system, urinary tract, blood vessels and heart. Some people have mild symptoms. But for others, diabetic neuropathy can be painful and disabling.

Diabetic neuropathy is a serious health concern. It may affect up to half of people who have diabetes. But diabetic neuropathy often can be prevented. And people who have it can take steps to keep it from getting worse. The key is to tightly manage blood sugar and lead a healthy lifestyle.

Symptoms

There are four main types of diabetic neuropathy. You can have one type or more than one type of neuropathy.

The symptoms depend on the type of diabetic neuropathy you have and which nerves are affected. Usually, symptoms appear slowly over time. You may not notice anything is wrong until a lot of nerve damage has happened.

Peripheral sensorimotor neuropathy

This type of neuropathy also may be called distal symmetric peripheral neuropathy. It's the most common type of diabetic neuropathy. It affects the feet and legs first, followed by the hands and arms. Symptoms often are worse at night. They may include:

* Loss of feeling, also called numbness, or less ability to feel pain or temperature changes.
* A tingling or burning feeling.
* Sharp pains or cramps.
* Muscle weakness.
* Being very sensitive to touch. For some people, even a bedsheet's weight can be painful.
* Serious foot problems, such as ulcers, infections, and bone and joint damage.

Autonomic neuropathy

The autonomic nervous system controls blood pressure, heart rate, sweating, pupils, bladder, digestive system and sex organs. Diabetes can affect nerves in any of these areas. That can cause symptoms including:

* A lack of the usual warning symptoms that let you know when blood sugar levels are low. This is called hypoglycemia unawareness.
* Drops in blood pressure when rising from sitting or lying down. This is called orthostatic hypotension. It can cause dizziness or fainting.
* A fast-beating heart while at rest.
* Bladder or bowel problems.
* Slow stomach emptying, also called gastroparesis. This can cause upset stomach, vomiting, a feeling of fullness and loss of appetite.
* Trouble swallowing.
* Changes in the way the eyes adjust from light to dark or far to near.
* More or less sweating than usual.
* Problems with sexual response. For instance, some people may have vaginal dryness or trouble feeling aroused. Others may have trouble getting or keeping an erection.

Proximal neuropathy

This type of neuropathy also is called diabetic polyradiculopathy. It often affects nerves in the thighs, hips, buttocks or legs. It can affect the stomach area and chest area. Symptoms often are on one side of the body. Rarely, they spread to the other side. Proximal neuropathy may include:

* Serious pain in the buttock, hip or thigh.
* Weak and shrinking thigh muscles.
* Trouble rising from a sitting position.
* Pain in the chest or the walls of the stomach area.

Mononeuropathy

This type of neuropathy also is called focal neuropathy. It damages a single, specific nerve. That nerve may be in the face, torso, arm or leg. It’s possible for mononeuropathy to affect single nerves in different parts of the body at the same time. Mononeuropathy may lead to:

* Trouble focusing or seeing two images of the same object, also called double vision.
* Not being able to move one side of the face. This is called paralysis.
* Numbness or tingling in the hand or fingers.
* Weakness in the hand that may result in dropping things.
* Pain in the shin or foot.
* Weakness that makes it hard to lift the front part of the foot. This condition is known as foot drop.
* Pain in the front of the thigh.

When to see a doctor

Call your healthcare professional for a checkup if you have:

* A cut or sore on your foot that is infected or won't heal.
* Burning, tingling, weakness or pain in your hands or feet that makes it hard to do daily activities or sleep.
* Changes in digestion, urination or sexual function.
* Dizziness and fainting.

Tests can check for diabetic neuropathy before a person has symptoms of it. These are called screening tests. Screening tests can find diseases early when they're easier to treat. The American Diabetes Association recommends that screening for diabetic neuropathy start:

* Right after you learn you have type 2 diabetes.
* Or five years after you're found to have type 1 diabetes.

After that, screening is recommended once a year.

Causes

The exact cause of each type of neuropathy is unknown. Researchers think that over time, uncontrolled high blood sugar damages nerves and interferes with their ability to send signals. This process may lead to diabetic neuropathy. High blood sugar also weakens the walls of the small blood vessels called capillaries that supply the nerves with oxygen and nutrients.

Risk factors

Anyone who has diabetes can get diabetic neuropathy. But these risk factors make nerve damage more likely:

* Poor blood sugar control. Uncontrolled high blood sugar raises the risk of every medical complication that can happen with diabetes, including nerve damage.
* Diabetes history. The risk of diabetic neuropathy rises the longer you have diabetes, especially if your blood sugar isn't well controlled.
* Kidney disease. Diabetes can damage the kidneys. Kidney damage sends toxins into the blood, which can lead to nerve damage.
* Being overweight. Having a body mass index (BMI) of 25 or more may raise the risk of diabetic neuropathy.
* Smoking. Smoking narrows and hardens the arteries, lowering blood flow to the legs and feet. This makes it harder for wounds to heal. It also damages the peripheral nerves.
* High blood pressure and high cholesterol. Both are linked with a higher risk of diabetic neuropathy.

Complications

Diabetic neuropathy can cause serious medical conditions, including:

* Hypoglycemia unawareness. Most often, blood sugar levels below 70 milligrams per deciliter (mg/dL) — 3.9 millimoles per liter (mmol/L) — cause shakiness, sweating and a fast heartbeat in people living with diabetes. But people who have autonomic neuropathy may not feel these warning signs.
* Loss of a toe, foot or leg. Nerve damage can cause a loss of feeling in the feet. That means even minor cuts can turn into sores or ulcers without being noticed. Sometimes, an infection can spread to the bone or lead to tissue death. Without fast treatment, a toe, foot or even part of the leg may need to be removed with surgery. This is called amputation.
* Urinary problems. If the nerves that control the bladder are damaged, the bladder may not empty fully when urinating. Bacteria can build up in the bladder and kidneys, causing urinary tract infections. Nerve damage also can affect the ability to feel the need to urinate or to control the muscles that release urine. This can lead to leakage, also called incontinence.
* Sharp drops in blood pressure. Damage to the nerves that control blood flow can affect the body's ability to adjust blood pressure. This can cause a sharp drop in pressure when standing after sitting or lying down. That may lead to lightheadedness and fainting.
* Digestive problems. If nerve damage happens in the digestive tract, you may get constipation or diarrhea, or both. Diabetes-related nerve damage can lead to a condition in which the stomach empties too slowly or not at all. This is called gastroparesis. It can cause bloating and an upset stomach.
* Sexual conditions. Diabetic neuropathy often damages the nerves that affect the sex organs. Symptoms may include vaginal dryness, having trouble becoming aroused, and difficulty getting or keeping an erection. This is called erectile dysfunction.
* More or less sweating than usual. Nerve damage can disrupt how the sweat glands work. That makes it hard for the body to control its temperature properly.

Prevention

You may be able to prevent or delay diabetic neuropathy and the medical problems that can happen with it. To do so, closely manage your blood sugar and take good care of your feet.

Blood sugar control

A blood test called the A1C test looks at your average blood sugar level for the past 2 to 3 months. The American Diabetes Association recommends that people with diabetes have an A1C test at least twice a year. You also might hear it called the glycosylated hemoglobin, hemoglobin A1C or HbA1c test.

A1C goals may need to be tailored to each person. But for most adults, the American Diabetes Association recommends an A1C of less than 7.0%. The goal may be higher for older adults or those with other medical conditions. If your blood sugar levels are higher than your goal, you may need to change how you manage your diabetes. Your healthcare professional might change your medicine or add medicine to your treatment plan. Or you might be told to change your diet or physical activity.

Foot care

Foot problems are common with diabetic neuropathy. Examples include sores that don't heal and ulcers. But you can prevent many of these problems. The key is to take good care of your feet at home. And have a thorough foot exam at least once a year. Also have your healthcare professional check your feet at each office visit.

Follow your healthcare professional's advice for good foot care. To protect the health of your feet:

* Check your feet every day. Look for blisters, cuts, bruises, cracked and peeling skin, redness, and swelling. Use a mirror to look at parts of your feet that are hard to see. Or ask a friend or family member to help check.
* Keep your feet clean and dry. Wash your feet every day with lukewarm water and mild soap. Don't soak your feet. Dry your feet and between your toes thoroughly.
* Moisturize your feet. This helps prevent cracking. But don't get lotion between your toes. It might make fungus more likely to grow.
* Trim your toenails carefully. Cut your toenails straight across. File the edges gently so they are smooth. If you can't do this yourself, see a specialist in foot problems, called a podiatrist, for help.
* Wear clean, dry socks. Look for socks made of cotton or moisture-wicking fibers. The socks should not have tight bands or thick seams.
* Wear cushioned shoes that fit well. Wear closed-toed shoes or slippers to protect your feet. Make sure your shoes fit properly, and give your toes space to move. A foot specialist can teach you how to buy properly fitted shoes. The specialist also can show you how to prevent problems such as corns and calluses. If you have Medicare, your plan may cover the cost of at least one pair of shoes each year.
* Protect your feet from the heat. Wear shoes if you walk on hot pavement or go to the beach. If you go barefoot outdoors, put sunscreen on the tops of your feet so they don't get sunburned.
* Boost blood flow to your feet. If you can, put your feet up while you sit. And throughout the day, wiggle your toes around for a few minutes. It also helps to move your ankles in and out as well as up and down.

Additional Information

Diabetes-related neuropathy is nerve damage that affects people with diabetes. The most common type is peripheral neuropathy, which often affects your feet. There’s no cure for diabetes-related neuropathy. But you can manage it with medication, therapies and tighter blood sugar management.

Overview:

What is diabetes-related neuropathy?

Diabetes-related neuropathy happens when you experience nerve damage due to high blood sugar (hyperglycemia) that lasts a long time. It can affect people with long-term diabetes, like Type 1 diabetes and Type 2 diabetes. But not everyone with diabetes develops it.

Neuropathy can develop from other causes, too, like pinched nerves, inflammation, nutrient deficiencies and injuries affecting your nerves. Healthcare providers diagnose neuropathy as diabetes-related if you have diabetes and they can’t find another cause for it.

Types of diabetes-related neuropathy

Diabetes-related neuropathy can damage different nerves throughout your body. Types of diabetes-related neuropathy include:

* Peripheral neuropathy: This is the most common type of neuropathy. “Peripheral” refers to any of the nerves outside of your spinal cord. It often affects your feet and legs and sometimes your hands.
* Autonomic neuropathy: This type of neuropathy happens when you have damage to autonomic nerves, which control your involuntary body processes. They control things like your bladder, intestinal tract, blood pressure, heart and sex organs. Another name for autonomic neuropathy is dysautonomia.
* Proximal neuropathy: This is a rare type of neuropathy that affects nerves in your hip, thigh or buttock. It typically only affects one side of your body.

How common is diabetes-related neuropathy?

Overall, diabetes-related neuropathy is fairly common. Studies show that up to 50% of people with diabetes have peripheral neuropathy. More than 30% of people with diabetes have autonomic neuropathy.

Symptoms and Causes:

What are the symptoms of diabetes-related neuropathy?

Your symptoms will depend on which type of diabetes-related neuropathy you have.

Symptoms of diabetes-related peripheral neuropathy

Diabetes-related peripheral neuropathy commonly affects your feet. Symptoms include:

* Numbness, tingling and/or pins and needles sensations (paresthesia).
* Pain, which may be burning, stabbing or shooting.
* Unusual touch-based sensations (dysesthesia).
* Muscle weakness.
* Slow-healing leg or foot sores (ulcers).
* Total loss of sensation in your feet, like not feeling pain from foot injuries.
* Nerve damage that causes peripheral neuropathy typically develops over many years. You may not notice symptoms of mild nerve damage for a long time.

Symptoms of diabetes-related autonomic neuropathy

Autonomic neuropathy can have many different symptoms because it can affect several body systems. Examples include:

* Digestive system: Indigestion, heartburn, nausea and vomiting, gas, diarrhea and constipation. Gastroparesis is a type of digestive system neuropathy.
* Urinary system: Urinary incontinence, urinary retention and frequent UTIs.
* sex organs: Sexual dysfunction, erectile dysfunction, retrograde ejaculation, vaginal dryness and anorgasmia.
* Cardiovascular system: Low blood pressure, irregular heart rate, dizziness and fainting.
* Sweat glands: Excessive sweating or a lack of sweat.
* Eyes: Difficult for your pupils to adjust to changes in light.

Autonomic neuropathy can also cause hypoglycemia unawareness. This means you don’t experience the typical warning signs of low blood sugar, like shakiness, confusion and intense hunger.

Symptoms of diabetes-related proximal neuropathy

Symptoms of proximal neuropathy include:

* Sudden and severe pain in your hip, buttock or thigh.
* Weakness in your leg that makes it difficult to stand up.
* Loss of reflexes, like the knee-jerk reflex.
* Loss of muscle tissue (atrophy) in the affected area.
* Unexplained weight loss.

What causes diabetes-related neuropathy?

Perpetually high blood sugar levels can damage small blood vessels that provide oxygen and nutrients to your nerves. Without enough oxygen and nutrients, nerve cells can die, affecting the function of your nerve. This causes neuropathy.

Each person is different, so it’s almost impossible to predict how high blood sugar levels have to be — and for how long — to cause neuropathy. One study of people with Type 2 diabetes shows that having an A1C over 7% for at least three years increases your risk of diabetes-related neuropathy. An A1C of 7% means your blood sugar is 154 mg/dL on average.

What are the risk factors for diabetes-related neuropathy?

If you have diabetes, your chance of developing diabetes-related neuropathy increases the older you get and the longer you’ve had diabetes.

Studies show that peripheral neuropathy affects at least 20% of people with Type 1 diabetes who’ve had diabetes for at least 20 years. It affects 15% to 50% of people with Type 2 diabetes who’ve had diabetes for at least 10 years.

You’re also more likely to develop neuropathy if you have diabetes along with:

* High blood pressure (hypertension).
* High body mass index (BMI).
* High cholesterol.
* Kidney disease.
* Alcohol use disorder.
* Smoking.

Studies show that genetics may also increase your risk of diabetes-related neuropathy.

Diagnosis and Tests:

How is diabetes-related neuropathy diagnosed?

To start, a healthcare provider will ask detailed questions about your medical history and diabetes management. They’ll ask about your symptoms and do a physical exam. Tests that help confirm a diabetes-related neuropathy diagnosis include:

* Diabetes foot exam: Your provider will visually assess your feet for any injuries or issues. They’ll then touch your toes and feet with various tools to check if you have numbness. This exam helps diagnose peripheral neuropathy.
* NCS (nerve conduction studies): This test checks how fast electrical signals move through your peripheral nerves in different parts of your body. It helps diagnose peripheral and proximal neuropathies.
* EMG (electromyography): This test evaluates the health and function of your skeletal muscles and the nerves that control them. It helps diagnose peripheral and proximal neuropathies.

Tests to diagnose autonomic neuropathy vary depending on which body system is affected. For example, an ultrasound can show how well your bladder empties when you pee. Tests like gastric emptying scintigraphy (GES) can help diagnose digestive system issues.

It may take more time to get an autonomic neuropathy diagnosis, as many other conditions can cause the same symptoms.

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Diabetic Neuropathy

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