What Is Diabetic Neuropathy?

Date: May-11-2012Diabetic Neuropathy?

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Main Category: Neurology / Neuroscience

Also Included In: Diabetes;  Pain / Anesthetics

Article Date: 11 May 2012 - 0:00 PDT

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Diabetic neuropathy is damage that affects the peripheral nerves of the body. The damage is specifically to the nerves of the ganglia, outside of the skull, the spinal cord, and some other nerves that aid the body in assisting fundamental organs, such as the heart, bladder, intestines, and stomach.

Diabetic neuropathy refers only to individuals who have diabetes.

Different nerves are affected in varying ways. Relatively familiar conditions which may be associated with diabetic neuropathy include:
Third Nerve Palsy: When the individual cannot move his eye normally due to damage of a cranial nerve.

Mononeuropathy: When only a single nerve is affected - the nerve is physically compressed,  resulting in a lack of blood supply.

Amythrophy: Muscle pain due to progressive waste and weakening of muscle tissues.

Mononeuropathy multiplex: Profound aching soreness regularly felt in the lower back, hips or legs, resulting in sharp loss of sensory function of the nerves. This can slowly develop over a number of years.

Polyneuropathy: Most commonly, this disorder results in weaker hands and feet, as well as some loss of sensation in the affected areas. Some patients complain of a burning needles-like pain. This disorder occurs when many nerves throughout the body simultaneously malfunction. The patient might step on something that should hurt, but feel nothing. It can appear either without warning or steadily over a long period.

Autonomic neuropathy: The visceral nerve is affected, which may impact on the heart rate, digestion, respiration, salivation, perspiration, blood vessels, and sexual arousal. This occurs when there is a failure from the heart arteries to adjust heart rate and vascular tone to keep blood flowing continually to the brain. Dizziness or fainting when standing up rapidly is common.

Sensory motor neuropathy: When sensory nerve loss affects the face; in some cases it may spread to the upper arms.

According to recent studies, approximately half of all diabetes patients develop diabetic neuropathy. However, the signs and symptoms may nor start to show for one or two decades have diagnosis of diabetes.
The majority of individuals with diabetic neuropathy symptoms do not realize they are affected until the complications are severe or permanent.

According to Medilexicon's medical dictionary, Diabetic Neuropathy is:

"A generic term for any diabetes mellitus (DM)-related disorder of the peripheral nervous system, autonomic nervous system, and some cranial nerves."
What are the signs and symptoms of diabetic neuropathy?
What is the difference between a sign and a symptom? - A sign is something everyone, including the doctor or nurse, can detect, such as a rash or swelling, while a symptoms is something the patients can feel and has to describe for others to know, such as a headache, tingling or dizziness.

There are several signs and symptoms associated with diabetic neuropathy - they depend on which nerves are affected, and usually take several years to become noticeable.

Below are some of the signs and symptoms associated with diabetic neuropathy:

Numbness, electric pain, tingling and (or) burning sensations starting in the extremities and continuing up the legs or arms

Heartburn and bloating

Nausea, constipation or diarrhea

Problems swallowing

Feeling full when eating small amounts of food

Throwing up after a few hours of having eaten

Orthostatic Hypotension (feeling light-headed and dizzy when standing up)

Faster heart rate than normal

Chest pains, which sometimes can be a warning of an impending heart attack

Sweating excessively even when temperature is cool or the individual is at rest

Bladder problems - difficulty in emptying the bladder completely when going to the toilet, leading to incontinence

Sexual dysfunction in men

Sexual problems in women with vaginal dryness and lack of orgasms

Dysesthesia - the patient's sense of touch is distorted

Significant facial and eyelid drooping

Eyesight may be affected

Muscle weakness

Speech impairment

Muscle contractions

Diagnosing diabetic neuropathy
If some of the above-mentioned signs and symptoms are present, the doctor may recommend some diagnostic tests before making a diagnosis.

The doctor may order an electromyogram (EMG), which records the electrical activity in the muscles. He/she may also request a Nerve Conduction Velocity test (NCV), which records the speed on which induced signals pass through the nerves.

During the physical exam, the doctor will check for:

Ankle reflexes
Any loss of sensation in the patient's feet
Changes in skin texture
Changes in skin color
A sudden drop in blood pressure when the patient stands up from lying down

a Median Nerve Conduction Velocity test
What are the treatment options for diabetic neuropathy?
Although the metabolic causes of diabetic neuropathy are perfectly well understood and documented, treatments for this disorder are still limited. Most of the treatments described below only help in reducing pain and controlling some of the symptoms. Unfortunately, diabetic neuropathy, typically, is progressive - the symptoms get progressively worse over time.

Doctors say the best treatment for diabetic neuropathy is to have the diabetes well controlled, this means maintaining blood glucose levels within a healthy range throughout the day.

Diabetic neuropathy can be avoided by learning the simple steps on how to manage diabetes.

There are a few drug-related options as well as physical therapy for controlling pain caused by diabetic neuropathy.

Drug Options
Antiepileptic Drugs: these are becoming a common drug for painful diabetic neuropathy. It has important side effects like sedation and weight gain.

Classic Analgesics: for those with a debilitating chronic pain condition, these drugs can offer immediate relief.

Trycilic Antidepressants: Very effective in decreasing pain but since the doses must be high for them to be effective the individual can become addicted t the dosage. Cardiac arrests are common when ingesting this drugs.

Serotonin-Norepinephrine Inhibitors: these are commonly used to target painful symptoms of diabetic neuropathy. They may also help depressive patients.

Physical Therapy

Physical therapy, alongside medications, can help relieve pain, as well as reducing the risk of drug dependency. Certain physical therapies can help alleviate pain, burning, and tingling sensations in legs, feet. Physical therapy may also help patients with muscle cramps, muscle weakness, and even sexual dysfunction.

Electrical nerve stimulation, which is painless, may help those suffering from stiffness. Electrical nerve stimulation may also help foot ulcers heal up.

Gait training, which is re-learning how to walk, helps prevent and stabilize foot complications, such as ulcers. Gait training on individuals who have lost limbs due to diabetic neuropathy and are wearing prosthesis is crucial for their development.

Regular massages or manual therapy involving stretching of the muscles performed by qualified chiropractors, massage therapists, or osteopaths will inhibit muscle contractures, spasms, and atrophy due to poor blood supply. Muscle strengthening with specific exercises, such as swimming or even some aerobic exercises will help maintain muscle strength and reduce muscle mass reduction.

A good physical therapist will make sure that exercises for patients with diabetic neuropathy do not hurt their feet, which are usually sensitive.

Therapeutic ultrasound is a method of stimulating the tissue beneath the skin's surface using very high frequency sound waves, can help some patients regain sensitivity in their feet.
Complications linked to diabetic neuropathy
Several side effects or complications can occur when treating diabetic neuropathy. Patients should be aware of the following potential complications:

A lack of sensation in the feet means there is a much higher risk of infection, which can grow uncontrollably. In some cases, patients have needed amputations.

Bladder and kidney infections.

Muscle damage or decrease in mass.

Frequent nausea and vomiting will result in a poor blood sugar control.

Written by Christian Nordqvist

Copyright: Medical News Today

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