Diabetic Neuropathy

Diabetes is a chronic condition that affects millions of people worldwide. While managing blood sugar levels is a primary focus, the long-term effects of uncontrolled diabetes can lead to various complications, one of the most significant being diabetic neuropathy. This condition affects the nerves, leading to a range of symptoms from numbness and pain to problems with digestion and heart function. In this detailed guide, we will shed light on the causes, symptoms, diagnosis, treatment, and how to live well with diabetic neuropathy. 

Diabetic neuropathy is a type of nerve damage that can occur if you have diabetes. Over time, high blood sugar (glucose) can injure nerves throughout your body. This damage can affect nerves that send messages to and from the brain, spinal cord, and other parts of the body. There are various forms of diabetic neuropathy, each affecting different nerves and presenting with unique symptoms. It’s a common and serious complication of both type 1 and type 2 diabetes. The good news is that with careful diabetes management, you can often prevent or slow the progression of diabetic neuropathy. Managing diabetes effectively is key to preventing further nerve damage and addressing existing diabetic nerve pain.

Diabetic neuropathy is a very common complication of diabetes. It’s estimated that between 60% and 70% of people with diabetes will eventually develop some form of neuropathy. The risk increases with the duration of diabetes and with poorer blood sugar control. Early diagnosis and management of blood glucose are essential in reducing the risk and severity of this condition.

Diabetic neuropathy can manifest in several ways, depending on which nerves are affected. The main types include:

• Peripheral Neuropathy: This is the most common type, primarily affecting the nerves in the legs and feet, but it can also affect the arms and hands. Symptoms often include pain, tingling, numbness, and weakness. This type of neuropathy is a common cause of diabetic foot problems.
• Autonomic Neuropathy: This type affects the nerves that control involuntary bodily functions, such as digestion, heart rate, blood pressure, bladder control, and sexual function. Symptoms can range from digestive issues like gastroparesis to problems with blood pressure regulation and erectile dysfunction.
• Proximal Neuropathy (Diabetic Amyotrophy): This rare and disabling type of neuropathy affects nerves in the thighs, hips, buttocks, or legs. It usually affects one side of the body, causing pain and weakness in these areas, making it difficult to stand up from a sitting position without support.
• Focal Neuropathy (Mononeuropathy): This type affects a single nerve, most often in the leg, torso, or head. Symptoms appear suddenly and can include double vision, Bell's palsy, or pain in the thigh or chest wall. While often painful, focal neuropathies usually improve on their own over a few weeks or months.

The primary cause of diabetic neuropathy is prolonged exposure to high blood sugar levels. Over time, elevated glucose damages the delicate walls of the small blood vessels that supply the nerves with oxygen and nutrients. This damage impairs nerve function and can lead to nerve death. Other factors that contribute to the development of diabetic neuropathy include:

• Inflammation: Chronic inflammation associated with diabetes can contribute to nerve damage.
• Genetic Factors: Some people may be genetically more susceptible to nerve damage from diabetes.
• Lifestyle Factors: Smoking and alcohol abuse can worsen nerve damage and symptoms.
• Mechanical Injury: Compression of nerves, particularly in the feet, can also exacerbate symptoms.
• Metabolic Factors: High levels of triglycerides and other fats in the blood can also contribute to nerve damage.

The symptoms of diabetic neuropathy vary widely depending on the type of neuropathy and which nerves are affected. They often develop gradually, and in the early stages, you might not notice any symptoms.

Symptoms of peripheral neuropathy can include:

• Numbness or reduced ability to feel pain or temperature changes, especially in your feet and toes.
• Tingling or burning sensation.
• Sharp, shooting pains or cramps.
• Increased sensitivity to touch.
• Muscle weakness.
• Loss of reflexes.
• Loss of balance and coordination.
• Foot deformities, such as hammertoes.
• Diabetic foot ulcers and infections due to unnoticed injuries.

Symptoms of autonomic neuropathy can include:

• Nausea, vomiting, indigestion, or feelings of fullness after a few bites of food (gastroparesis).
• Difficulty swallowing.
• Diarrhoea or constipation.
• Dizziness or light-headedness upon standing (orthostatic hypotension).
• Bladder problems, such as incomplete emptying, leading to urinary tract infections.
• Erectile dysfunction in men and vaginal dryness or difficulty with arousal in women.
• Increased or decreased sweating.
• Difficulty regulating body temperature.
• Silent heart attacks, where chest pain is absent during a heart attack.

Diagnosing diabetic neuropathy involves a thorough medical history, a physical examination, and various tests to assess nerve function. Your doctor will ask about your symptoms, your diabetes history, and any other medical conditions.

During the physical examination, your doctor will check:

• Foot examination: Looking for signs of injury, infection, or structural changes.
• Sensory testing: Using a monofilament test to check for sensation in your feet, as well as tests for vibration and temperature sensation.
• Reflexes: Checking ankle and knee reflexes.
• Muscle strength: Assessing the strength of your leg and foot muscles.

Additional tests that may be performed include:

• Nerve conduction studies and electromyography (NCS/EMG): These tests measure the speed at which electrical signals travel through your nerves and the electrical activity of your muscles.
• Quantitative sensory testing: Measures your ability to feel vibration, cold, and heat.
• Autonomic testing: Includes tests to assess heart rate variability, blood pressure response to changes in position, and sweat gland function.
• Nerve biopsy: In rare cases, a small sample of nerve tissue may be taken for examination.

While there is no cure for diabetic neuropathy, treatment focuses on managing blood sugar levels, relieving symptoms, slowing progression, and preventing complications.

Blood Glucose Control: This is the cornerstone of managing diabetic neuropathy. Maintaining target blood sugar levels through diet, exercise, and medication can prevent further nerve damage and may even improve some symptoms.

Pain Management: Various medications can help alleviate nerve pain, including:

• Antidepressants (e.g., duloxetine, amitriptyline)
• Anti-seizure medications (e.g., gabapentin, pregabalin)
• Topical creams (e.g., capsaicin cream)

Medications for Autonomic Symptoms: Medications can address specific autonomic symptoms, such as:

• For gastroparesis: prokinetics to speed up stomach emptying.
• For orthostatic hypotension: fludrocortisone or midodrine.
• For erectile dysfunction: sildenafil or tadalafil.

Foot Care: Meticulous foot care is essential to prevent foot ulcers and infections. This includes daily foot inspections, wearing proper footwear, and regular visits to a podiatrist.

Lifestyle Modifications:

• Quitting smoking.
• Limiting alcohol intake.
• Maintaining a healthy weight.
• Engaging in regular physical activity
• Taking supplements (Brands: Neurobion Forte) to improve nerve function and reduce tingling, numbness, and pain.

• Poorly controlled blood sugar levels.
• Long duration of diabetes.
• Kidney disease.
• High blood pressure.
• High cholesterol.
• Smoking.
• Obesity.
• Alcohol abuse.

• Foot ulcers, infections, and potentially amputation due to unnoticed injuries and poor circulation.
• Charcot joint, a progressive degeneration of weight-bearing joints, typically in the feet.
• Urinary tract infections and kidney damage due to bladder problems.
• Sexual dysfunction.
• Hypoglycaemia unawareness, where the body no longer produces symptoms of low blood sugar.
• Gastrointestinal problems, leading to malnutrition and weight loss.
• Dizziness and falls due to blood pressure fluctuations.
• Increased risk of cardiovascular events, including silent heart attacks.

• Prioritise Blood Sugar Control: Consistently managing your blood glucose is paramount to preventing the progression of diabetic neuropathy and improving existing symptoms.
• Practice Meticulous Foot Care: Inspect your feet daily, wear appropriate footwear, and seek professional help for any foot concerns to prevent serious complications like ulcers and infections.
• Manage Pain Effectively: Work with your doctor to find the most suitable pain relief strategies, whether through medication, topical treatments, or alternative therapies.
• Stay Active Safely: Engage in regular, low-impact exercise to improve circulation and overall well-being, but choose activities that are gentle on your feet and avoid aggravating nerve pain.

"Diabetic neuropathy only affects the feet." 

While peripheral neuropathy in the feet is the most common form, diabetic neuropathy can affect nerves throughout the entire body, leading to issues with digestion, heart function, and more.

"Once you have diabetic neuropathy, there's nothing you can do." 

This is untrue. While there isn't a cure, effective blood sugar management, pain relief strategies, and lifestyle changes can significantly slow progression, manage symptoms, and improve quality of life.

"Numbness means the neuropathy isn't serious." 

Numbness is a significant symptom as it prevents you from feeling injuries, leading to serious complications like undetected wounds and infections, especially in the feet.

It's important to see your doctor regularly for diabetes management. You should specifically contact your doctor if you experience any of the following symptoms of diabetic neuropathy:

• Tingling, numbness, pain, or weakness in your hands or feet.
• Changes in digestion, urination, or sexual function.
• Dizziness or light-headedness.
• Any wound or sore on your foot that doesn't heal.
• Sudden weakness in a limb or changes in vision.

• What type of diabetic neuropathy do I have?
• What are my blood sugar targets, and how can I best achieve them?
• What pain relief options are available for my specific symptoms?
• Are there any lifestyle changes I should make to help manage my neuropathy?
• How often should I have my feet checked by a professional?
• What are the potential complications I should be aware of, and how can I prevent them?

Diabetic neuropathy is a common and sometimes tough problem caused by diabetes, but it can be managed. By knowing what causes it, spotting the symptoms early, and taking the right steps, people can feel better and live well. The key is to keep blood sugar levels under control, take good care of your feet, manage pain, and have support from family or healthcare providers. It might not always be easy, but with proper care and guidance, you can reduce the effects of diabetic neuropathy and enjoy a good quality of life. The more you know, the better choices you can make for your health.