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Diabetic Neuropathy, A Dangerous Complication

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Diabetic Neuropathy

Diabetic neuropathy is defined as a nerve damage that is often seen in diabetes. Over time, hyperglycemia can affect nerves throughout the body. There are several types of diabetic neuropathy.

Peripheral neuropathy it is a result of  the damage of the peripheral nervous system. This leads to decreased pain sensitivity, tactile, thermal and vibration sensitivity in certain parts of the body and can sometimes interfere with the ability to exercise and muscle strength. The most commonly are affected the feet (foot and calf) and this can lead  to serious complications  such as ulcers, infections or bone and joint deformities.  Peripheral neuropathy represents  the most common form of diabetic neuropathy.

Diabetic Neuropathy

Diabetic Neuropathy

Peripheral neuropathy (autonomic) results from damage to the autonomic nervous system. These nerves are involved in the control of the  involuntary body functions like  heartbeat, blood pressure, digestion, perspiration, sexual and kidney function. This is a common form of diabetic neuropathy too.

Focal neuropathy affects a single nerve, most commonly in the wrist, thigh or foot. It may also affect the nerves in the back and chest  and the nerves that control eye muscles. Often occurs in compression or stress conditions of the nerves such as carpal tunnel syndrome (a consequence of compression of the median nerve at the wrist). Carpal tunnel syndrome often occurs in people with diabetes but is not length to neuropathy. Focal neuropathy usually appear suddenly and is the most rare form of diabetic neuropathy.

Focal Neuropathy

Focal Neuropathy

Symptoms

Diabetic neuropathy, especially  peripheral neuropathy, is initially asymptomatic. Patients with diabetes should undergo regular medical checks to timely diagnose and treat this problem before they develop serious complications.

If the nerves are affected, the doctors are making efforts to establish the level of glucose to a target value (hemoglobin A1c <7% for a period of 2 to 3 months). The initial symptoms will increase during the decrease of blood glucose . However, the symptoms will improve when the level of blood sugar will stabilize at a lower value .
In diabetic neuropathy symptoms can vary, depending on which type of neuropathy will appear.

Peripheral neuropathy tends to develop slowly over time, in months or years. In general symptoms are:

  • Numbness, tingling, burning, pain with a sting character in the legs, hands, or in other parts of the body, bone and joint deformities that occur especially in the foot (such as diabetic foot or Charcot arthropathy);
  • Loss of feeling or numbness are more common in the foot and is required every day self-examination for skin lesions (cracks, sores or excessive dryness) or minor injuries (blisters or  friction areas). The evolution of diabetes for 10 years or more, with a poor glycemic control, vascular, kidney or eye complications, all can increase the risk of leg injuries and possible evolution to a leg amputation;
  • Major reduction of the  sensitivity to light touch;
  • Reduction or loss of balance and coordination disorders can represent symptoms of peripheral neuropathy.

Autonomous neuropathy affect digestion, the ability of control the body temperature, kidney function, sexual function and the activity of the heart and blood vessels, including blood pressure. In general symptoms are represented by:

  • Frequent belching, bloating and constipation, burning chest, nausea and vomiting, diarrhea or abdominal pain. These symptoms may indicate gastroparesis, a condition in which the stomach empties more slowly than normal;
  • Profuse sweating on the trunk, face and neck at night or during the ingestion of certain foods;
  • Loss of sensation of fullness bladder or the difficulty emptying the  bladder when is completely full;
  • Sexual dysfunction, for example disorders of erection in men and vaginal dryness in women;
  • Dizziness, weakness, or syncope (loss of consciousness) appeared when the patient suddenly rising from a lying position (orthostatic hypotension);

Symptoms in focal neuropathy can occur suddenly. These may include:

  • Pain, weakness and motor problems in one region of the body such as the wrist, thigh or leg, where the mechanism is represented by the nerve compression (for example carpal tunnel syndrome), pain or suffering of the median nerve will gradually develop over a period of weeks or months;
  • Intraocular and periocular pain, difficulty moving the eyes and double vision because focal neuropathy may sometimes affect the nerves that control muscles responsible for eye movments;
Symptoms in Focal Neuropathy

Symptoms in Focal Neuropathy

Investigations

The diagnosis of peripheral neuropathy is based on symptoms, medical history and physical examination. Electromyogram and nerve conduction studies can be done to confirm the diagnosis of diabetic neuropathy . These tests measure how fast and how well electrical pulse is driven through nerves and muscles. If  exists nerve problems, then the nerve conduction velocity is slowed.

Various laboratory tests like CBC, blood sugar level, hemoglobin A1C and others are required for screening of diabetes and other causes that produce the same type of symptoms. These reviews will be made according to medical history and symptoms.

Early Diagnosis

There is no recommended protocol for the screening of diabetic neuropathy, but during regular health checks are watched all these aspects. The patients should declare any pain, weakness or motor disorder, changes in digestion, sex or renal function, sweating or dizziness.

Peripheral neuropathy screening helps to prevent the ulcers or amputations of the foot.  American Diabetes Association (ADA) recommends that people with diabetes should be consulted by a doctor who will examine the foot for cracking or flaking of the skin, excessive or reduced sweating, blisters, ulcers or signs of infection, bone deformities or joint changes, gait and balance during each checkup. ADA recommends that this review should be made at least once a year. During these checks can be detected loss of sensation in the foot which can lead to the appearance of more severe complications.

Treatment

There is no cure for diabetic neuropathy. Once installed, the treatment focuses on secondary prevention which consists in maintaining a blood glucose level to a target value. A tight control of blood glucose is to maintain an average hemoglobin A1c < 7% for a period of 2 to 3 months.

Treatment of diabetic neuropathy depend on the nature and type of neuropathy symptoms. In general, treatment is going to reduce symptoms and prevent complications by maintaining glucose levels as close to the target values. This values can be achieved by treatment with insulin or oral hypoglycemic agents as prescribed by the physician, periodic checks of blood glucose, diabetes diet, regular exercise and regular checkups.

If the diabetic neuropathy alredy exist, the patient should do a careful self-examination because at the level of the legs can exist unnoticed wounds or other severe injuries which can go unnoticed  due to the loss of sensation. Without careful tracking these problems, in time, can lead to severe complications such as infections or amputations. It is also important to maintain a healthy lifestyle such as regular exercise, controlling blood pressure, diet, quitting  smoking and limiting alcohol consumption.