Common Complications of Diabetes: What is Diabetic Neuropathy?

by Cindy

Diabetic Neuropathy

Diabetes mellitus is a condition that is characterized by a disruption in the way the body processes sugars, resulting in high blood sugar levels called hyperglycemia. Over time, hyperglycemia can cause significant damage to different body systems, such as the eyes, kidneys and nerves. Diabetic neuropathy is the most common complication of diabetes, affecting half of all diabetics. This condition is characterized by the slow loss of nerve function due to damage from elevated glucose levels in the bloodstream. All patients with diabetes are at risk for developing neuropathy. In fact, many patients with type 2 diabetes will have some nerve damage existing at the time of diagnosis due to years of undetected high blood sugars.

How does diabetes cause neuropathy?

At this time, it is unknown why high sugar levels damage the nervous system. There are many scientific theories in existence but none have been proven to explain why this happens.

What we do know is that, over time, high blood sugar levels damage nerve fibers, starting with the smallest nerve fibers first. These smaller nerves are sensory fibers that detect changes in temperature and sharp pain. If there is continued exposure to high glucose levels the larger sensory nerves that are responsible for vibration and pressure sensations begin to suffer from damage.

What are the types of neuropathy?

There are many different types of nerves in the body and all can be affected by uncontrolled sugars.

  • Sensory Nerves: The sensory nerves are most commonly affected by uncontrolled hyperglycemia. When diabetes damages the sensory nerves it is called diabetic peripheral neuropathy.  Over 50% of diabetic neuropathy cases affect the sensory nerves. Typically, the patient will experience numbness in the extremities, starting in the fingers and toes. Some patients describe a decrease in sensation where it feels as if they are wearing thin glove or stocking. Patients with neuropathy may experience other symptoms such as burning, shock-like sensations, aching or hypersensitivity.
  • Motor Nerves: Diabetes affects the motor neurons less frequently than the sensory nerves. When hyperglycemia affects motor nerves patients may experience difficulty with fine motor coordination and weakness in the toes. Patients may complain of difficulty opening jars or performing fine motor tasks. They may trip more frequently due to weakness in the feet.
  • Autonomic Nerves: Autonomic nerve pathways regulate bodily functions such as blood pressure, digestion, balance and heart rate. When diabetic patients have damage to these types of nerves, it is called diabetic autonomic neuropathy.  Patients with damage to these nerves experience autonomic dysfunction which can present with a variety of symptoms. When nerve damage affects the autonomic nerves that are responsible for regulating the heart, patients can experience abnormal heart rates, fainting and difficulty regulating blood pressure. If the regulation of digestion is affected, patients may have difficulty swallowing, slow digestion, constipation or diarrhea. Other complaints include difficulty urinating, erectile dysfunction and abnormal sweating.

How will my doctor check for neuropathy?

Your doctor should perform a detailed neurological exam every year to screen for signs of nerve damage starting at the time of diagnosis of type 2 diabetes. Remember, many diabetic patients will already have nerve damage when diabetes is diagnosed. Your physician should take a detailed history, focusing on questions that my suggest problems with the regulatory systems of the body. The physical exam should include a detailed neurological assessment that includes, but is not limited to, checking vibration and sensitivity to light touch, reflex testing and balance tests.

If your physician suspects that you have nerve damage additional testing and blood work may be required because not all neuropathy is caused by diabetes. There are many different disorders that can damage the nervous system such as vitamin B12 deficiency, alcoholism, syphilis and spinal disease. The doctor will decide on additional testing will depend based on your individual’s symptoms.

Is there a cure for diabetic neuropathy?

For patients wondering, can diabetic neuropathy be reversed? Unfortunately once the damage is done to the nervous system, it is not reversible. It is important to get blood sugars as close to normal as possible to prevent further damage to the nerves. This can be done with dietary changes, exercise and weight loss. In many instances, the patient will need to start medications to improve blood glucose levels.

What are the treatments for diabetic neuropathy?

  • The number one priority is to prevent further damage by controlling blood sugar levels and keeping hemoglobin a1c levels low. Careful monitoring of sugars using a glucose machine and the a1c blood test, and adherence to the prescribed treatment will help slow the progression of nerve damage.
  • Prevention of complications that are associated with neuropathy is also important. Patients with diabetic foot neuropathy are at very high risk for foot infections and amputation due to loss of sensation in the foot. Patients with diabetes need to check their feet every day, looking for any signs of injury or infection. Wearing proper orthopedic shoes for diabetics and keeping feet clean and dry will help prevent skin breakdown and foot infections.
  • Patients with diabetic neuropathy may need medication to help manage the symptoms. The type of medications used will depend on the type of nerve damage that the patient has. For pain associated with nerve damage, patients may be advised to take over the counter pain relievers. Anti-seizure medications and anti-depressants can also help decrease nerve pain associated with diabetic neuropathy in feet and other regions. If the patient has damage to the regulatory nerves, different medications that treat those specific symptoms may be necessary to correct these abnormalities.

Living with diabetes is not easy. It is difficult to improve your blood glucose levels and many patients lack motivation for doing so. Hopefully, understanding the different complications of diabetes and how good glucose control can prevent these complications will provide the motivation that patients need to stick to the diabetic diet, exercise plan and medications that are prescribed.

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