Diabetic neuropathy is a type of nerve damage, which may occur in those suffering from diabetes. High blood sugar can damage nerves throughout the body, but diabetic neuropathy most often damages the nerves of legs and feet.
Depending on the affected nerves, symptoms of diabetic neuropathy can range from pain and numbness in the limbs to digestive problems, the urinary tract problems , blood vessels and heart. In some people, these symptoms are mild; other diabetic neuropathy can be painful and sometimes fatal.
Diabetic neuropathy is a common serious complication of diabetes. Nevertheless, it is often possible to prevent or slow its progress by means of strict control of blood sugar levels and maintaining a healthy lifestyle.
There are four main types of diabetic neuropathy, symptoms can vary depending on which nerves are affected.
Peripheral neuropathy is the most common form of diabetic neuropathy. Initially damaged feet and legs, and then hands. Possible signs and symptoms of peripheral neuropathy include numbness or decreased ability to feel pain or temperature changes, especially in the legs and fingers, tingling or burning sensation, pain is worse at night, pain when walking, enhanced sensitivity to light touch – for some people , even the weight of a sheet of paper can be painful, muscle weakness and difficulty walking, severe foot problems such as ulcers, infections, bone deformities and pain in the joints.
The autonomic nervous system controls the heart, bladder, lung, stomach, intestines, genitals and eyes. Diabetes can affect the nerves in any of these organs and lead to a lack of awareness of what your blood sugar is low (hypoglycemia unconscious), bladder problems, including frequent urinary tract infections or incontinence, constipation, diarrhea, uncontrollable, or combinations thereof, to slow gastric emptying (gastroparesis), resulting in nausea, vomiting and loss of appetite, difficulty swallowing, male erectile dysfunction, vaginal dryness and other sexual problems in women, increase or reduction of perspiration, body inability regulation of blood pressure and heart rate, which leads to a sharp drop in blood pressure when picked up from sitting or lying position (orthostatic hypotension), which can cause dizziness or even fainting, problems regulating body temperature, changes in eye adaptation from light to dark, an increase in heart rate at rest.
Unlike damage nerve endings as peripheral neuropathy, diabetic amyotrophy affects the nerves in the hips, buttocks and legs. Diabetic amyotrophy also called femoral neuropathy or neuropathy proksimalnooy. This condition is more common in people with type 2 diabetes and the elderly. Symptoms usually on one side of the body, although in some cases the symptoms can spread to the other side too. For most people, at least partially the symptoms disappear over time, though before symptoms occur improvement may also deteriorate.
This condition is often characterized by sudden severe pain in the lower leg and thigh or buttock, possible weak or atrophy of the thigh muscles, abdominal distention, if affected nerves abdomen, loss of weight.
Mononeuropathy is a specific nerve damage. Nerve can be in the face, torso or legs. Mononeuropathy, also called focal neuropathy often occurs suddenly. This condition most common in the elderly. Although mononeuropathy can cause severe pain, it usually causes no long term problems. Symptoms usually diminish and disappear by themselves within a few weeks or months. Signs and symptoms depend on what kind of nerve damage, and may include: difficulty focusing the eyes, double vision or pain in one eye, paralysis of one side of the face (Bell’s palsy), pain in the lower leg or foot pain in the front of the thighs, chest or abdomen.
Sometimes mononeuropathy occurs when nerve compression. Carpal tunnel syndrome is a common type of compression neuropathy in people with diabetes.
Signs and symptoms of carpal tunnel syndrome include:
Numbness or tingling in the fingers or hand, especially in the index finger, middle or ring, a feeling of weakness in the hand and a tendency to drop things
Ask for help from our experts, if you notice:
Cut or wound on the leg that does not heal, infection and infected its condition worsens when you feel burning, tingling, weakness or pain in the hands or feet that interferes with your daily life or sleeping, dizziness, changes in digestion, urination and sexual function.
These symptoms do not always indicate nerve damage, but they may indicate other problems that require medical attention. In any case, early diagnosis and treatment suggest a better outcome by controlling symptoms and preventing more-serious problems.
Even minor wounds on the feet that do not heal can turn into ulcers. In the most severe cases, untreated foot ulcers can turn into gangrene – a condition in which tissue dies – and this needs surgery or even amputation. Early treatment with our specialists will help prevent it.
Causes of diabetic neuropathy
Damage nerves and blood vessels
Continued exposure to high blood sugar (glucose) can damage the delicate nerve fibers, causing diabetic neuropathy. Why this happens is not fully understood, but in this case plays a major role complex interaction of nerves and blood vessels. High blood glucose levels interfere with the ability of the nerves to transmit signals. It also weakens the walls of small blood vessels (capillaries) that supply the nerves with oxygen and nutrients.
Inflammation of the nerves caused by an autoimmune reaction. It occurs when the immune system mistakenly attacks part of the body, as if it were a foreign body.
Genetic factors not related to diabetes, that make some people more susceptible to nerve damage.
Smoking and alcohol abuse, which harm the nerves and blood vessels, and significantly increase the risk of infections.
Neuropathy can develop in any person suffering from diabetes, but following factors make a person more susceptible to nerve damage:
Poor control of blood sugar. This is the biggest risk factor, including nerve damage. Blood sugar control is the best way to protect the health of nerves and blood vessels.
Duration of diabetes. Risk of diabetic neuropathy increases the longer a person has diabetes, especially if blood sugar is not controlled. Peripheral neuropathy is the most common in people who have diabetes for at least 25 years.
Kidney disease. Diabetes can lead to kidney damage, which leads to an increase in the blood of toxins and promotes nerve damage.
Smoking. Smoking constricts the arteries and makes hard, reducing blood flow to the legs and feet, making it difficult to heal wounds and restore the integrity of the peripheral nerves.
Diabetic neuropathy can cause a number of serious complications, including:
Loss of a limb. Because nerve damage can cause a lack of sensation in the feet, cuts and sores mogutostatsya unnoticed and, eventually, come to be heavily infected or ulcerated condition in which the damaged skin and soft tissue. The risk of infection is high, because diabetes reduces blood flow to the legs.
Infections that spread to the bone and cause death of tissue (gangrene), which may be incurable and require amputation of feet, legs or even the shin.
Charcot foot. This occurs when the condition worsens joint, usually in the leg due to nerve damage. Charcot joint is characterized by a loss of sensitivity as well as edema, instability, and sometimes in the deformation connection.
Urinary tract infections and incontinence. Damage to the nerves that control the bladder can lead to problems with its complete emptying. This enables the bacteria to proliferate in the bladder and kidneys, which leads to the infection of the urinary tract. Nerve damage can also affect the ability to feel when you need to urinate or control the muscles that release urine.
Hypoglycemia. Usually, when blood sugar levels drop too low – below 70 milligrams per deciliter (mg / dl) or lower than 3.9 millimoles per liter (mmol / l), – having symptoms such as tremors, sweating and rapid heartbeat. These signs warn of the problem so that you can take steps to raise blood sugar levels quickly. Autonomic neuropathy can interfere with your ability to notice these symptoms. This is very serious – uncontrolled hypoglycemia can be fatal.
Low blood pressure. Damage to the nerves that control the blood circulation can affect the body’s ability to regulate blood pressure. This may cause a sharp drop in pressure when you get (orthostatic hypotension) that may result in dizziness, and fainting.
Digestive problems. Damage to the nerves in the digestive system can cause a variety of problems, including severe constipation or diarrhea – or bouts of variables constipation and diarrhea – as well as nausea, vomiting, bloating and loss of appetite. One particularly serious digestive problem is gastroparesis, a condition in which the stomach empties too slowly or not at all empty. It may interfere with digestion, cause nausea and vomiting, and seriously affect the blood sugar level.
Sexual dysfunction. Autonomic neuropathy often damages nerves that affect the genitals, which leads to erectile dysfunction in men and problems with lubrication and arousal in women.
Increased or decreased sweating. When the sweat glands do not function properly, your body is unable to regulate its temperature properly obrazom.Umenshennie or no perspiration (anhidrosis) can be life-threatening. Autonomic neuropathy also causes excessive sweating, especially at night.
Social isolation. Pain, disability and embarrassment caused by damage to nerves can rob people – especially the elderly – their independence, leaving them increasingly isolated and depressed.
Diagnosis of neuropathy
Diabetic neuropathy is usually diagnosed based on symptoms, your medical history and physical examination. During the exam, your doctor will check your muscle strength and tone, tendon reflexes, and sensitivity to touch, temperature and vibration.
Other tests include:
Sensitivity to touch can be checked with a soft nylon fibers called filaments. If you are unable to feel the threads on the legs, it’s a sign that you’ve lost feeling in these nerves.
Nerve conduction studies. This test measures how quickly the nerves in your arms and legs conduct electrical signals. It is often used for the diagnosis of carpal tunnel syndrome.
Electromyography (EMG). Often done with nerve conduction studies. Electromyography measures the electrical discharges produced by muscles.
Quantitative sensory testing. This noninvasive test used to measure how your nerves respond to vibrations and temperature changes.
Autonomous testing. If you have symptoms of autonomic neuropathy, your doctor may request special tests to assess blood pressure in different positions and levels of sweating.
It is also recommended a comprehensive inspection of feet – a neurologist or orthopedist. Feet should be checked for status of the requested bones, and the presence of ulcers, cracked skin, calluses and blisters.
Treatment focuses on diabetic neuropathy:
Slowing disease progression
Treatment of complications and recovery functions
Consistently keeping blood sugar levels within a narrow target range can help delay the progression of peripheral neuropathy and may even lead to improvement of symptoms. With intensive glucose control it is possible to reduce the risk of diabetic neuropathy by 60 percent.