Diabetic neuropathy is nerve damage caused by diabetes. This damage often occurs to nerves in the limbs, although it can also affect organ systems. This group of disorders is called peripheral neuropathy because these areas are all connected to the peripheral nervous system (not the central nervous system).
Neuropathy is the most common complication resulting from diabetes. The majority of diabetics experience nerve damage at some point in their lifetime. Older patients and those who have had diabetes for a long time are at higher risk of diabetic neuropathy. Other risk factors include being overweight, having high blood pressure, and high blood levels of fat and sugar.
Chronically elevated blood sugar levels are believed to be the underlying cause of diabetic nerve damage. However, the mechanism is not well understood. Other processes in the body may also contribute to nerve damage, including the immune system attacking nerves, damage to the blood vessels supplying nerves, genetic factors, and lifestyle choices (e.g. smoking).
The type and severity of symptoms are highly variable. The first thing most patients notice is pain, tingling, or numbness in the limbs. This usually happens in the feet and lower legs, but sometimes the hands and arms are affected as well. Other common symptoms include insensitivity to pain or temperature, sensitivity to touch, loss of coordination, and muscle weakness. Symptoms are often symmetrical. Although not directly caused by the neuropathy, weight loss and depression are also common.
This is a progressive disease – though symptoms may initially be mild or nonexistent, they are bound to become more severe over time. Symptoms often begin with a decrease in sensation, though they can expand to problems with motor skills and autonomic functions. If the autonomic nerves are affected, symptoms vary depending on which organ system is supplied by the damaged nerves. For example, if nerves supplying the bladder are damaged, the patient may experience incontinence.
If the patient has no sensory feedback from a part of the body, they are likely to accidentally injure that body part. Loss of sensation in the feet often leads to injuries and infection, which in severe cases can require amputation.
Early signs of diabetic peripheral neuropathy can often be detected before the patient experiences symptoms. A physical exam can reveal slight deficits in reflexes, sensation, and motor functions. If diabetic peripheral neuropathy is suspected, a comprehensive foot exam should take place to make sure the patient has enough sensation in the feet to protect against damage. Physical exams can also show whether autonomic functions (like heart rate and blood pressure) are normal and respond to stimuli. If there seems to be damage to autonomic nerves, ultrasound images can help physicians assess the structure and function of internal organs.
Treatment for diabetic peripheral neuropathy aims to relieve symptoms and prevent further nerve damage. One of the most effective strategies is to manage blood sugar levels. Being physically active and maintaining a healthy weight can help delay onset of further symptoms. All diabetics should take care of their feet to prevent and manage injuries. This can be accomplished with daily cleaning and inspection of feet, use of lotion, and wearing well-fitting shoes or slippers.
Because patients experience different types of nerve damage, treatments to manage the resulting symptoms may vary. Mild pain can be treated with over-the-counter medications. However, acetaminophen (Tylenol) and ibuprofen (Advil) are not thought to be effective for diabetic peripheral neuropathy and may cause side effects. Prescription medications for relief of severe diabetic nerve pain are available, including antidepressants, anticonvulsants, and opioids. Other possible interventions to relieve pain include acupuncture, biofeedback, topical treatments (creams and patches), and physical therapy. If the feet are sensitive, a bed cradle could be used to prevent irritation from bed covers. Many patients also find elastic compression socks useful.
We offer medications, chiropractic, physiotherapy, active exercises, ultrasound, or IFC, acupuncture, auricular acupuncture, Biofeedback, psychotherapy and assistive devices like braces, TENS/MET devices, and orthotics.
Sources:
“Types of Peripheral Neuropathy – Pre-diabetic/Diabetic.” Available on: http://peripheralneuropathycenter.uchicago.edu/learnaboutpn/typesofpn/diabetes/diabetes.shtml
“Diabetic Neuropathy.” Available on: http://www.medicinenet.com/diabetic_neuropathy/article.htm
“Peripheral Nauropathy.” Available on: http://www.medicinenet.com/peripheral_neuropathy/article.htm#peripheral_neuropathy_facts