Diabetic neuropathy
Diabetic neuropathy is a significant and common complication arising from diabetes mellitus, characterized by nerve damage primarily due to prolonged high blood sugar levels. This condition can affect nerves throughout the body, leading to symptoms that range from discomfort in the feet and legs to severe pain and loss of sensation. The various forms of diabetic neuropathy include peripheral, autonomic, proximal, and focal neuropathies, each affecting different parts of the body and causing a diverse range of symptoms, such as tingling, burning sensations, and difficulties with bodily functions like digestion and blood pressure regulation.
Factors contributing to diabetic neuropathy can include genetics, autoimmune disorders, and lifestyle choices like smoking and alcohol use. Diagnosis typically involves assessing symptoms through physical examinations and various diagnostic tests. Treatment focuses on controlling blood glucose levels to prevent further nerve damage, along with medications for managing pain and other symptoms associated with the condition. Lifestyle modifications, such as exercise and diet, play a vital role in managing and potentially alleviating symptoms. Understanding diabetic neuropathy is crucial for those affected, as it emphasizes the importance of comprehensive diabetes management and self-care practices.
Subject Terms
Diabetic neuropathy
Diabetic neuropathy is a common and serious complication of the disease diabetes mellitus. This form of nerve damage is caused by high blood sugar that can affect nerves serving the heart, blood vessels, digestive system, urinary tract, and the extremities. The condition is most commonly experienced as uncomfortable or even painful sensations in the feet and legs. Its severity can range from mild to debilitating, and it can prove fatal in extreme cases.
Causes, Forms, and Symptoms
Diabetes is a disease in which the body's ability to produce the hormone insulin—which regulates the amount of glucose, or sugar, in the blood and urine—is impaired. In some diabetic patients, prolonged exposure to high levels of sugar in the blood can cause damage to nerve fibers, though researchers have not yet determined why it happens to some people and not others. It is known that high blood sugar levels damage the capillaries (small blood vessels) that provide oxygen and other nutrients to nerves and disrupt the way nerves transmit signals to and from the brain.
Other factors that cause damage to nerves or make people more susceptible to nerve damage include genetics, autoimmune disorders (in which the immune system responds as though part of the body is foreign), smoking, and alcohol abuse. These may be contributing factors in diabetic neuropathies. Direct nerve or blood vessel damage from injury may also play a role in developing this condition.
Diabetic neuropathies are divided into different forms depending on the part of the body that is affected. The main types are peripheral, autonomic, proximal, and focal neuropathies.
Peripheral neuropathy is the most common form of neuropathy. It frequently affects the toes, feet, and legs but can also involve the arms and hands. This type of neuropathy is experienced as loss of feeling or as painful sensations in the affected body parts. Patients with peripheral neuropathy describe the sensations as tingling, burning, or picking, and some say it feels like something is crawling over their limbs or jabbing them with a pin. The pain can be mild or severe. Some patients experience peripheral neuropathy at the opposite extreme of sensation and are unable to sense pain or temperature changes. This form of neuropathy makes foot care critical for diabetics, who may sustain a significant injury or infection to the foot without realizing it due to a lack of pain sensation. Patients with peripheral neuropathy are at increased risk of requiring amputation because of poor healing and infections, particularly to the foot and lower extremities. Some patients might also experience cramping, have extreme sensitivity to touch, or suffer loss of coordination and balance because of the nerve damage.
Autonomic neuropathy can affect the heart and blood vessels, the lungs, the digestive system, the urinary tract, the sex organs, the sweat glands, and the eyes. It can result in changes to blood pressure, or affect lung function and vision. This form of neuropathy can also cause changes to digestion, leading to difficulty swallowing, constipation, diarrhea, or gastroparesis, the latter of which can cause persistent nausea and vomiting. Bladder function can be impaired and lead to retained urine, which can cause urinary tract infections. If the nerves that alert a person to a full bladder are affected, the patient may become incontinent. The condition can also cause decreased sexual responsiveness. When the sweat glands are affected, the patient may sweat profusely or be unable to sweat, which impairs the body's ability to regulate its own temperature. Some diabetics will also experience a condition known as hypoglycemic unawareness, in which they become unable to detect the warning signs of low blood sugar levels, such as irregular heartbeat, shakiness, weakness, and blurred vision. This can result in seizures and even death.
Proximal neuropathy affects the upper portions of the legs, including the thighs, hips, and buttocks. It causes weakness and pain in the legs and makes it difficult for people to move from sitting to standing and vice versa without assistance. Proximal neuropathy may also be known as diabetic amyotrophy, lumbosacral plexus neuropathy, or femoral neuropathy.
Focal neuropathy afflicts nerves in a specific area, usually in the head, torso, or legs. It can cause vision problems, such as double vision or difficulty focusing. When the nerves on one side of the face are affected, it can cause a paralytic condition known as Bell's palsy. Focal neuropathy can also cause severe pain in the chest, stomach, side, lower back or pelvis, thigh, shin, or inside edge of the foot.
While not a specific neuropathy, some patients can develop a related condition called nerve compression, or entrapment syndrome. An example of this is carpal tunnel syndrome, in which the nerves of the hands experience numbness, tingling, weakness, and/or pain.
Diagnosis and Treatments
Diabetic neuropathies are diagnosed by a patient's symptoms and a physical exam, during which the physician checks such factors as blood pressure and heart rate, reflexes and muscle strength, and the patient's reaction to vibration, temperature, touch, and position changes. In some cases, other diagnostic tests may be ordered. These can include tests to measure heart rate changes, electromyography or nerve conduction studies that test the transmission of electrical currents through the nerves, and ultrasounds of internal organs that assess function and possible damage.
The first step in treatment is to minimize the impact of diabetic neuropathies by ensuring blood sugar levels are under control. This may require medication changes or adjustments, exercise, and/or weight loss. Adequate diabetic control will minimize the amount of blood glucose and reduce the chances of it causing nerve damage.
In cases in which the neuropathy has become painful, analgesics or pain medications, anti-seizure medications, and antidepressants have been shown to be helpful. Antispasmodic drugs can be used to treat urinary tract problems, and erectile dysfunction medications can be prescribed for sexual response issues. Both prescription and over-the-counter medications can be used to control autonomic neuropathy symptoms such as nausea, vomiting, diarrhea, and constipation.
Other treatments may include lifestyle changes, such as scheduled bathroom breaks to help with urinary tract issues, eating smaller and more frequent meals to help with gastroparesis symptoms, and avoiding alcohol and tobacco. A healthy diet, regular physical activity, and adequate blood pressure control can also help prevent and mitigate neuropathies.
Some patients also experience relief from acupuncture or transcutaneous electrical nerve stimulation (TENS) therapy, and the topical application of creams containing capsaicin sometimes helps reduce the painful or tingling sensations of peripheral neuropathy.
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