Diabetic Neuropathy: Causes, Symptoms, Prevention & Treatment
What is Diabetic Neuropathy?
Diabetic neuropathy (DN) refers to nerve damage in diabetes patients caused due to high blood sugar levels.
The most common type of diabetic neuropathy is peripheral neuropathy. The nerves present in the feet and legs of diabetic patients are affected and lead to symptoms such as pain, burning sensations, tingling sensations, or numbness in legs.
Diabetic Neuropathy Causes
Blood vessels in our body supply nutrients, blood, and oxygen to the nerves. Essentially, it helps them in functioning and pass signals.
Due to high blood sugar, these blood vessels get weak. Consequently, it results in the diminished supply of nutrients to nerves and eventually damages them.
However, with proper diabetic care and management, it can be reversed if detected in the early phase.
Diabetic Neuropathy Types
More than 8% of the population is affected by diabetes in India. With the increase in population and poor control of blood sugar in patients with diabetes in India, diabetic neuropathy has become a common problem. Diabetic neuropathy is of four types majorly and depends on which nerve is getting affected.
Peripheral neuropathy
In peripheral neuropathy, nerves present in our legs and, sometimes, hands, gets damaged.
Symptoms depend on the severity of the neuropathy. A person suffering from peripheral neuropathy may feel one or more of these symptoms in their hands and legs:
- Numbness
- Needle and pricking sensations
- Burning sensations
- Pain
- Weakness of muscle
- Loss of reflex
- Reduced balance or coordination
Autonomic Neuropathy
The autonomic nervous system controls our organs like the digestive system, urinary system, eyes, heart, sweat glands, and sexual organs.
Any kind of damage to nerves of this system leads to loss of control over these organs and can cause:
- Urinary issues like difficulty to control urine, urine leakage, urine infection and disturbance in urine flow
- Changes in the adjustment of iris (a part of the eye) in response to dark and light
- Erectile dysfunction (in men)
- Vaginal dryness (in women)
- Increased heart rate
- Excess sweating
- Gastric issues like loose stools, constipation, indigestion, bloating, nausea, and vomiting
Femoral Neuropathy
In this type of neuropathy, nerves of thighs, hips, and legs get affected. Symptoms may include:
- Pain in thighs, hips, or legs
- Muscle weakness
- Shrinkage of muscles
Focal Neuropathy
In this type of neuropathy, the specific nerves of legs, face or middle of the body get affected and you may experience pain in:
- Feet
- Lower back
- Thighs
- Chest or abdomen
Diagnosis of Diabetic Neuropathy
Diabetic neuropathy can be diagnosed by a doctor after:
- Reviewing symptoms
- Physical examinations by checking signs such as feet injury, boils, and blisters
However, diabetic neuropathy cannot always be ascertained after reviewing symptoms only
Your doctor may ask you to get one or more of these tests done:
- Filament test: In this test, sensitivity to touch and vibration will be checked by brushing a soft nylon fiber over your skin.
- Quantitative sensory testing: In this test, maximum levels of tolerability for any stimuli (such as a low voltage current, pressure, or touch) is determined.
- Nerve conduction test: This test helps in the diagnosis of peripheral diabetic neuropathy and other nerve disorder. In this test, the ability of nerves to send signals is recorded and how quickly a signal travels through the nerve is measured.
- Electromyography (EMG): It measures electrical discharge in your muscle (Like ECG is assessed for the heart, EMG is assessed for muscles).
- Autonomic testing: If you have symptoms of autonomic neuropathy, then special tests are done to determine how your BP changes with changing your position
Diabetic Neuropathy Risk Factors
- Uncontrolled blood sugar levels: High blood sugar directly weakens small blood vessels and affects supplies of nutrients and oxygen to the nerve and damages them.
- Kidney disease: Kidney disease leads to affected filtration of blood and toxin remains in the body which damages nerves.
- Overweight: If your BMI is equal to or more than 25, then your at greater risk to develop diabetes mellitus which ultimately leads to diabetic neuropathy.
Complications related to Diabetic Neuropathy
Diabetic neuropathy complications include:
- Amputation: Amputation refers to removal of body parts by surgery. With continuous high blood sugar, a simple cut in the foot can cause infection and lead to ulcers and dead tissues, and removal of toe or limb becomes necessary
- Joint damage: Nerve damage may lead to swelling, loss of sensation and other deformities in joints also
- Urinary complication: If your autonomic nerves get damaged, it leads to urinary complications like inability to control urination, urine leakage, weak urine stream, and incomplete voiding of urine
- Undetected episodes of low blood sugar: In low blood sugar episodes, we may experience shaking, increased heart rate and sweating but in case of autonomic neuropathy, these episodes aren’t observed since nerves are unable to send signals and hence, these episodes may go unnoticed.
- Change in BP: If nerves which control blood flow get damaged, the ability of our body to control blood pressure also gets affected and sudden drop in BP occurs while changing position like when you stand up after sitting
- Altered Sweating: Damage to the nerves which control the working of sweat glands may affect the ability of our body to adjust according to environmental temperature and we may experience increased sweating while eating or sleeping or maybe a chance of decreased or no sweating
- Sexual dysfunction: Autonomic nervous system also controls our sex organ and any damage to nerves may lead to sexual dysfunction like erectile dysfunction in male and women may experiences difficulty in lubrication while performing sexual activity
Diabetic Neuropathy Treatments
The aim of the treatment is to slow the progression of the disease, relieve pain which may occur due to deficiency of vitamin B12 as well, and restore functioning which is lost due to nerve damage.
Slow the progression of diabetic neuropathy:
This includes managing blood sugar levels and keeping them in the normal range. Download Zyla app to help us control your blood sugar levels. These targets can be met with regular exercise, controlling body weight and dietary modifications. Specified blood sugar level can be easily achieved with the help of Zyla which provides you personalized health plan by analyzing the root cause of your disease and helps in controlling blood sugar levels. Control over blood sugar level slow down the progression of damage to the nerves
Relief of pain:
It can be done by taking prescribed medicine like anticonvulsant, antidepressant, topical agents and painkillers. Anticonvulsant medicines include pregabalin and gabapentin. Antidepressant medicine consists of amitriptyline, nortriptyline, and desipramine. For taking antidepressant medicine to relieve neuropathic pain, it’s not necessary that we have depression. We can also take painkillers like tramadol, ibuprofen, and aspirin to get relief from pain or using topical ointments like lidocaine or capsaicin. The doctor may also ask for supplements in case of a deficiency of vitamin B12 level. By using these medicines we can get relief from pain with fewer side effects like nausea, vomiting, drowsiness, etc.
Restoring functions:
In diabetic neuropathy, our various body organ functions get altered like urinary, digestive and sexual organ function.
Urine leakage can be reduced by scheduled urination or may take the help of catheterization and medicines.
For erectile dysfunction, oral medicines are prescribed which have side effects.
For vaginal dryness in women, lubricants are prescribed.
For our digestive issues like nausea vomiting, indigestion, doctor may advise for smaller and frequent intake of food and some medications can also be advised to get relief from acidity, diarrhea, and constipation.
Diabetic Neuropathy Prevention
Like most of the ailments and complications arising out of diabetes, diabetic neuropathy can be kept at bay by proper management and care.
1. Keep BP under control
People with diabetes are more likely to have high BP as compared to non-diabetic patients. High BP causes damage to blood vessels and reduces the blood flow which further leads to nerve damage.
2. Take a healthy diet
A healthy diet helps in reducing the progression of the disease and keeps us away from associated complications.
For controlling blood sugar levels, download the Zyla app.
3. Regular Exercise
Daily physical activity helps you to stay active and away from disease. The main cause of diabetic neuropathy is high blood sugar level and reduced blood supply to the nerve and these factors can be controlled by regular exercise
4. Quit addictions
Addictions may involve smoking, intake of alcohol or tobacco. Try to avoid these addictions as these are injurious to heart and blood vessels and may lead to blockage in blood vessels and result in poor supplies to your limbs and feet.
Manage diabetes at home and prevent its complications. Download Zyla app to get continuous and personalised care.
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References
Relationship of Polyunsaturated Fatty Acid Intake to Peripheral Neuropathy Among Adults With Diabetes in the National Health and Nutrition Examination Survey (NHANES) 1999 –2004: https://care.diabetesjournals.org/content/diacare/31/1/93.full.pdf
