A Comprehensive Overview of Diabetic Neuropathy

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Diabetic neuropathy is a common complication of both type 1 and type 2 diabetes. Being a multi-system disorder, diabetes can produce symptoms in many different parts of the body. When it causes nerve damage, the condition is called diabetic neuropathy (manifesting itself as peripheral neuropathy and retinal neuropathy). These neuropathies occur when high blood sugar levels have been left uncontrolled for prolonged periods of time. The condition takes time to manifest, and often the symptoms are discernible only after a couple of years. Unfortunately, about 50-60% of patients with diabetes end up with neuropathy at some point of time during the course of the disease. In fact, diabetes is the most prevalent cause of neuropathy in individuals worldwide.

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What are the symptoms of diabetic neuropathy?

The symptoms of neuropathy tend to appear gradually. Many a time, the first onset of nerve damage involves the nerves of the limbs. This can trigger symptoms like numbness, or a feeling of ‘pins and needles’ in the feet. Common symptoms of diabetic neuropathy are as follows:

• -Nausea and indigestion
• -Dizziness upon standing
• -Incessant sweating
• -Muscle weakness or atrophy (waste away)
• -Difficulty with coordination and balance when walking
• -Loss of sensation of touch
• -Vaginal dryness in women
• -Erectile dysfunction in men
• -Numbness in your extremities
Symptoms vary according to the type of nerves affected.

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What causes diabetic neuropathy?
Development of nerve damage in diabetes is usually related to consistent presence of uncontrolled blood sugar. Other factors that can lead to neuropathy are as follows:
• -Damage to blood vessels, similar to that caused by high cholesterol levels
• -History of sustained periods of glycemic imbalance
• -Hypertension (high blood pressure)
• -Mechanical injury, including injuries occurring from carpal tunnel syndrome
• -Ischemic (damage to or dysfunction of tissue)heart disease
• -Age more than 40 years
• -Certain lifestyle choices, such as excessive smoking or alcohol use
• -Low levels of cyanocobalamin (vitamin B-12)
Certain medications like metformin that are taken to mitigate the symptoms of diabetes may reduce levels of vitamin B-12. Hence, it is advisable to have a routine blood test to identify any vitamin deficiencies.
How is diabetic neuropathy diagnosed?

Diagnosis of diabetic neuropathy typically includes a comprehensive physical examination, and a general discussion about the patient’s symptoms and medical history. During the physical exam, your health care provider will check your reflexes, as well as your ability to perceive different sensations, such as temperature, touch and vibration. They will also check your blood pressure, muscle tone, and heart rate, to adjudge the degree of diabetes complication. Additionally, your doctor may perform a filament test as well, to detect the sensitivity in your limbs. At the time of this test, the doctor will use a nylon fiber in order to check your feet for loss of sensation. Alternatively, a tuning fork can be used to detect your vibration threshold. The doctor may even test your ankle reflexes.

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How is diabetic neuropathy treated?

While neuropathy is not reversible, its symptoms are manageable to a certain extent. If you are already suffering from nerve damage, there are many things you can do to slow down the rate of progression. Maintaining normal glucose level, as well as optimum blood pressure and cholesterol level have been shown to halt the progression of neuropathy. Quitting smoking and exercising daily can also provide relief from symptoms. While there is no cure for diabetic neuropathy, treatment can definitely help you manage common symptoms like indigestion and pain. It is absolutely crucial to understand the options of treatment with your doctor. The doctor will be able to work with you to come down to a solution that suits your needs and condition best.

Other Treatment options include:

• -Capsaicin: Capsaicin is a topical cream that is applied over areas commonly affected by neuropathy. This cream is aderivative of pepper, hence it’s important for people with diabetic neuropathy to do a small patch test first in order to find out if they’re allergic to capsaicin before using it in a significant quantity.

• -Neurontin (gabapentin capsules): One of the most effective and commonly used medications, Neurontin is given to provide relief from the pain caused by nerve damage in neuropathy. This drug has relatively few side effects, hence it is very helpful for some people with diabetes.

• -Antidepressants:Unusual as it sounds, researchers have recently discovered that antidepressants are extremely helpful in reducing the pain from neuropathy. So in case, the doctor prescribes it for you, it’s not because they think you are depressed. This medication acts by blocking pain receptors and desensitizing the feeling of pain. It usually takes about a month or so to be effective. A number of antidepressants have been proven to be helpful in treatment of neuropathy, and many of them have been specifically approved by the FDA.

• -Alternative treatments: A few people with diabetic neuropathy have found relief from non-conventional forms of pain management, such as meditation, acupuncture, Reiki healing and biofeedback.

Managing complications

Neuropathy resulting from diabetes can get complicated without treatment. If you are facing issues with digestion due to your neuropathy, your health care provider may recommend eating smaller meals more often, as well as limiting fiber and fat intake. If you are experiencing vaginal dryness, the doctor may prescribe lubricants for you. Alternatively, if you have erectile dysfunction, they may give you medication manage the symptoms.
Diabetes is considered to be one of the leading reasons of limb amputation from non-traumatic events in the U.S. Thus, if you have peripheral neuropathy, it is imperative to take proper care of your feet.

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