Diabetic Neuropathy

Posted in Diabetic Complications

Diabetic neuropathy is a type of nerve damage that can occur in people with type 1 or type 2 diabetes. Moreover, long-term high blood sugar levels puts you more at risk for this problem. Also, it mostly affects nerves in the legs and feet. As a result, diabetics should always wear diabetics socks to care for their feet. Socks for diabetics provide comfort and protection for at risk feet.

Why is this a problem? Firstly, this can be painful. For example, problems can range from pain and numbness in the legs and feet to damage found in the digestive system, urinary tract, blood vessels, and heart. In addition, depending on the amount of damage, symptoms can be mild to severe. 

Diabetic neuropathy is a health condition affecting up to 50% of people with diabetes. Nonetheless, you can prevent this disease by working with your doctor to manage and maintain your blood sugar levels. 

There are several types of diabetes-related neuropathy. These include peripheral, autonomic, proximal, and focal. 

  • Peripheral: legs and feet
  • Autonomic: digestive system, blood vessels, urinary tract, and sex organs 
  • Proximal: thighs, hips, and buttocks (usually isolated to one side of the body) 
  • Mononeuropathy: head, torso, leg 

Peripheral Neuropathy 

This problem affects the nerves in the legs and feet. Also, it can sometimes affect nerves in the arms, stomach, and back. It is the most common type of neuropathy.

In addition, signs can include tingling, numbness, burning, and pain. However, if you treat this problem early enough through medication and diet, symptoms should get better without causing major damage. On the other hand, the loss in feeling can be lasting if the damage is left untreated.

Autonomic Neuropathy 

This type of nerve damage mainly affects the digestive system. However, it can affect blood vessels and urinary tract. In addition, signs of the condition depend on the location of the nerves. 

Problems to your digestive system include:

  • Diarrhea
  • Constipation
  • Bloating 
  • Heartburn
  • Nausea
  • Vomiting
  • Feeling full after eating a small amount of food 

Issues affecting the blood vessels:

  • Fast heartbeat
  • Low blood pressure
  • Dizziness
  • Dazed after standing up quickly

Urinary tract problems:

  • Need to urinate a lot 
  • Hard to empty bladder
  • Loss of bladder control

Proximal neuropathy 

This issue affects nerves in the thighs, buttocks, and hips. However, it sometimes affects the stomach and chest area. It is usually on one side of the body, but it can spread to the other side. Also, you may require physical therapy alongside medication to manage the weakness and pain. 

What does it feel like?

  • Extreme stomach pain
  • Pain on the thighs or hips
  • Weakness in thigh muscles
  • Hard to stand up from sitting position 

Mononeuropathy

As the name implies, this disease relates to damage to a single nerve. Furthermore, the signs can appear suddenly. The damage can affect specific nerves in the head, torso, or legs. 

Problems include:

  • Double vision
  • Eye pain
  • Weakness in the hand
  • Numb feeling in the hands  
  • Loss of feeling on one side of the face
  • Pain related to one area of the body such as the lower back or leg 
  • Chest or stomach pain that could be mistaken for a heart attack

What if I Already Have Diabetic Neuropathy? 

If you have diabetic neuropathy, you can stop it from getting worse by managing your blood glucose, cholesterol, and blood pressure levels and by following the above preventative measures. You should also monitor your weight because obesity can worsen nerve damage. 

It’s important for anyone with diabetes to take good care of their feet but it’s especially important for people with diabetic neuropathy. Proper foot care can help prevent complications related to the condition like severe infection or amputation. 

Foot Care

Foot problems like sores, ulcers, or amputations are common issues related to nerve damage. You can prevent these complications by having an annual foot exam, or by following these suggestions: 

Choose Proper Footwear

Wear special socks for diabetics: Socks can be a breeding ground for bacteria. Therefore, it is important to wear clean and dry ones every day. Diabetic socks can help with that. These socks are made from cotton and other fabrics that keep your feet from sweating. Diabetes socks are never tight. Also, they have loose sock tops that improve circulation in the legs. In addition, the extra padding on the bottom help to protect the feet from injuries and add comfort.

Wear proper fitting and cushioned shoes: Always wear shoes to protect your feet. Shoes should fit properly (not too tight or too loose) and your toes should have room to move. If you don't know how to pick shoes that fit properly, you can ask a doctor. A pair of shoes that fit well will help you avoid issues with your feet.

Take Care of your Feet

Keep feet clean and dry: You can keep your feet clean by washing them every day with warm water and a mild soap. However, it is recommended that you avoid soaking your feet. After that, dry them well with a clean towel including between your toes.

Prevent dry feet: Moisturize your feet to prevent cracks on the skin. You should avoid getting lotion between the toes because the added moisture can promote fungus growth.

Keep your toenails short: To avoid infection, you should cut your toenails straight across. If you have any sharp edges on your toenails, you can file them down with a nail file. 

Causes of Nerve Damage

While the exact cause is not known, doctors believe that it is linked to high blood sugar levels. High blood sugar weakens the walls of small blood vessels. As a result, this can cause damage to nerves over time. Therefore, this problem impacts the amount of oxygen and nutrients sent to nerves throughout the body. When nerves become damaged, they are unable to send signals to the rest of the body.

What are the Risk Factors?

Type 1 or type 2 diabetes can lead nerve damage. However, there are other factors that make you more at risk for this condition.

Blood sugar that is not controlled: High blood sugar levels create problems for small blood vessels. Moreover, this limits the amount of oxygen and nutrients sent to nerves, leading to damage over time. 

Kidney disease: Diabetes can impair kidneys if not treated properly with medication and a good diet. Consequently, damaged kidneys can lead to more toxins in the blood. 

Fat: A body mass index of 25 or more puts you more at risk for developing nerve damage because extra weight puts more stress on the body. 

Smoking narrows and hardens blood vessels making it difficult for blood to circulate through the body. Also, it can make symptoms worse and increase the risk of developing heart disease. 

What are the Complications?

Diabetic nerve damage can cause many serious problems including: 

Loss of legs, toes, and feet: Nerve damage can lead to loss of feeling in the affected areas. In fact, you may not even feel a minor cut, but it can lead to something more deadly. For instance, a small wound can turn into infected sores. However, in some cases, the infection can travel to the bone or tissue. You may need to have the infection removed, resulting in the amputation of
the body part.

Hypoglycemia: Signs such as shaking, sweating, and fast heart rate means that your blood sugar is very low.

Urinary tract infections and a loss of bladder control: If the nerves are damaged, you may find it harder to empty your bladder. This becomes a problem because bacteria can build up in the bladder and kidneys leading to an infection. Also, nerve damage can make it tough for you to feel the
need to go to the bathroom or control your bladder muscles. As a result, you may urinate without meaning to. This is referred to as incontinence.

A drop in blood pressure: Damage to the nerves that control blood pressure makes it difficult for your body to maintain a consistent blood pressure level. This could cause you to have a severe drop in blood pressure when you stand up after sitting. You might experience symptoms like dizziness and blacking out. 

Digestive issues: If nerve damage is located in your digestive tract, you could experience symptoms like constipation or diarrhea. Over time, it can cause your stomach to empty slowly or not at all, resulting in bloating and indigestion.

Increased/decreased sweat production: Nerve damage can impact how sweat glands work making it difficult for your body to regulate body temperature effectively. 

How To Prevent Diabetic Neuropathy

The most effective way to prevent or delay the onset of diabetic neuropathy is by managing your blood glucose, cholesterol, and blood pressure levels. Other preventative measures include:

  • Being physically active
  • Following a diabetic-friendly diet 
  • Quitting smoking 
  • Limit alcoholic drinks
  • Take diabetic medication as prescribed by a doctor 

The American Diabetes Association recommends that diabetics have an A1C at least two times each year. An A1C test measures your average blood glucose level over a two to three month period. 

For the average diabetic, the recommended A1C level is less than 7%. If your A1C level is higher than this, you may need to modify your diet, medication, or lifestyle choices. 

Diagnosing Diabetic Neuropathy

To help determine if you have a form of nerve damage, your doctor will need to perform an exam. They will ask about your pain symptoms and do tests on your body. The doctor will also review your medical history to see if your problems could be caused by other diseases.

Some factors your doctor will check are:

  • Muscle strength and tone
  • Tendon reflexes 
  • Sensitivity to touch and vibration 
  • Blood pressure
  • Heart rate
  • Ability to move 

In addition to the exam, your doctor may order the following tests:

  • Autonomic: This test determines how your blood pressure changes when you switch positions.
  • Nerve conduction: This test measures how fast the nerves in your arms and legs produce signals. 
  • Muscle response: This test measures the waste produced from your muscles, It is often done along with the nerve conduction test.
  • Sensory: This examines how your nerves responds to vibration and temperature. 
  • Filament:  This test includes brushing a cloth over your skin to determine your sensitivity to touch. 

Treatment for Diabetic Neuropathy

There is not a cure for this disease, but there are treatments available to make it easier to live with. 

Treatment has three goals: 

  • Slow down the progression
  • Manage pain
  • Treat complications

Slowing Down the Progression

The best way to prevent or delay nerve damage is to manage your blood glucose level. You can attain this by eating a low sugar diet and taking medication. Managing your blood glucose can also improve symptoms if you already have some nerve damage. Your doctor will help you determine your ideal blood glucose level. It is usually based on age, how long you have had diabetes, and your overall health. 

The American Diabetes Association (ADA) suggests the following blood glucose targets for people with diabetes:

  • Between 80 and 130 mg/dL or 4.4 and 7.2 millimoles per liter (mmol/L) before meals
  • Less than 180 mg/dL (10 mmol/L) two hours following a meal 

These numbers may change depending on your needs and health, so it is important to check with your doctor before making changes to your diet.

Manage Pain

Pain and discomfort are common symptoms associated with this disease. Luckily, there are medications available to treat the symptoms. If you
have concerns about the side effects, your doctor can go over them with you
and help you make an informed choice.

Pain medication includes: 

Anti-depressants can be used to treat nerve pain even if you do not have depression. They can help with mild to moderate nerve pain. Possible side effects include drowsiness and dry mouth. 

Anti-seizure drugs: According to the ADA, some of these drugs can be prescribed to manage nerve pain. They usually recommend starting with pregabalin (Lyrica) or Gabapentin (Gralise, Neurontin). Possible side effects include drowsiness and swelling. 

Treating Complications from Nerve Damage

To help treat complications, it will depend on the symptoms you are experiencing. You might require care from a urologist or cardiologist. 

Urinary Tract: Some medications are known to worsen bladder complications so your doctor may change or stop your medication. If incontinence is an issue, you might have to start a strict urination schedule to avoid leakage. Applying gentle pressure to your bladder can help you urinate. In extreme cases, you may need to start self-catheterization to remove urine from your bladder. 

Digestive: To relieve symptoms of gastroparesis like nausea or indigestion, your doctor may recommend eating frequent small meals throughout the day. Diet changes and medication can also help alleviate symptoms.

Low blood pressure: To avoid issues associated with low blood pressure, simple lifestyle changes will be recommended. This includes eliminating alcohol consumption,  drinking plenty of water throughout the day, and being mindful of how you change positions (like moving from sitting to standing). Your doctor might suggest compression support for your abdomen and/or medication to manage your blood pressure. 

Other Diabetic Complications

Diabetes can cause a lot of health problems. Moreover, these issues can and often do extend to other parts of the body.

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