Diabetic neuropathies are a family of nerve disorders caused by diabetes. People with diabetes can, over time, have damage to nerves throughout the body. Neuropathies lead to numbness and sometimes pain and weakness in the hands, arms, feet, and legs. Problems may also occur in every organ system, including the digestive tract, heart, and sex organs. People with diabetes can develop nerve problems at any time, but the longer a person has diabetes, the greater the risk.
An estimated 50 percent of those with diabetes have some form of neuropathy, but not all with neuropathy have symptoms. The highest rates of neuropathy are among people who have had the disease for at least 25 years.
Diabetic neuropathy also appears to be more common in people who have had problems controlling their blood glucose levels, in those with high levels of blood fat and blood pressure, in overweight people, and in people over the age of 40. The most common type is peripheral neuropathy, also called distal symmetric neuropathy, which affects the arms and legs.
The causes are probably different for different varieties of diabetic neuropathy. Researchers are studying the effect of glucose on nerves to find out exactly how prolonged exposure to high glucose causes neuropathy. Nerve damage is likely due to a combination of factors:
Metabolic factors, such as high blood glucose, long duration of diabetes, possibly low levels of insulin, and abnormal blood fat levels
Neurovascular factors, leading to damage to the blood vessels that carry Oxygen and nutrients to the nerves.
Autoimmune factors that cause inflammation in nerves.
Mechanical injury to nerves, such as carpal tunnel syndrome.
Inherited traits that increase susceptibility to nerve disease.
Lifestyle factors such as smoking or alcohol use.
Symptoms depend on the type of neuropathy and which nerves are affected. Some people have no symptoms at all. For others, numbness, tingling, or pain in the feet is often the first sign. A person can experience both pain and numbness. Often, symptoms are minor at first, and since most nerve damage occurs over several years, mild cases may go unnoticed for a long time. Symptoms may involve the sensory or motor nervous system, as well as the involuntary (autonomic) nervous system. In some people, mainly those with focal neuropathy, the onset of pain may be sudden and severe.
Symptoms may include numbness, tingling, or pain in the toes, feet, legs, hands, arms, and fingers, wasting of the muscles of the feet or hands, indigestion, nausea, or vomiting, diarrhea or constipation, dizziness or faintness due to a drop in postural blood pressure, problems with urination, erectile dysfunction (impotence) or vaginal dryness, weakness.
In addition, the following symptoms are not due to neuropathy but nevertheless often accompany it: weight loss and depression
Types of Diabetic Neuropathy can be classified as peripheral, autonomic, proximal, and focal. Each affects different parts of the body in different ways.
Peripheral neuropathy causes either pain or loss of feeling in the toes, feet, legs, hands, and arms.
Autonomic neuropathy causes changes in digestion, bowel and bladder function, sexual response, and perspiration. It can also affect the nerves that serve the heart and control blood pressure. Autonomic neuropathy can also cause hypoglycemia (low blood sugar) unawareness, a condition in which people no longer experience the warning signs of hypoglycemia.
Proximal neuropathy causes pain in the thighs, hips, or buttocks and leads to weakness in the legs
Focal neuropathy results in the sudden weakness of one nerve, or a group of nerves, causing muscle weakness or pain. Any nerve in the body may be affected.
Neuropathy Affects Nerves Throughout the Body
Peripheral Neuropathy affects the toes, feet, legs, hands, arms.
Autonomic Neuropathy affects the heart and blood vessels, digestive system, urinary tract, sex organs, sweat glands, eyes.
Proximal Neuropathy affects the thighs, hips, buttocks.
Focal Neuropathy affects the eyes facial muscles, ears, pelvis and lower back, thighs, and abdomen.
Neuropathy is diagnosed on the basis of symptoms and a physical exam. During the exam, the doctor may check blood pressure and heart rate, muscle strength, reflexes, and sensitivity to position, vibration, temperature, or a light touch.
Nerve conduction studies check the transmission of electrical current through a nerve. With this test, an image of the nerve conducting an electrical signal is projected onto a screen. Nerve impulses that seem slower or weaker than usual indicate possible damage. This test allows the doctor to assess the condition of all the nerves in the arms and legs.
Electromyography (EMG) shows how well muscles respond to electrical signals transmitted by nearby nerves. The electrical activity of the muscle is displayed on a screen. A response that is slower or weaker than usual suggests damage to the nerve or muscle. This test is often done at the same time as nerve conduction studies.
Quantitative sensory testing (QST) uses the response to stimuli, such as pressure, vibration, and temperature, to check for neuropathy. QST is increasingly used to recognize sensation loss and excessive irritability of nerves.
The first step in treatment is to bring blood glucose levels within the normal range to prevent further nerve damage. Blood glucose monitoring, meal planning, exercise, and oral drugs or insulin injections are needed to control blood glucose levels. Although symptoms may get worse when blood glucose is first brought under control, over time, maintaining lower blood glucose levels helps lessen neuropathic symptoms. Importantly, good blood glucose control may also help prevent or delay the onset of further problems.
People with neuropathy need to take special care of their feet. The nerves to the feet are the longest in the body and are the ones most often affected by neuropathy. Loss of sensation in the feet means that sores or injuries may not be noticed and may become ulcerated or infected. Circulation problems also increase the risk of foot ulcers.
More than half of all lower limb amputations in the United States occur in people with diabetes, 86,000 amputations per year. Doctors estimate that nearly half of the amputations caused by neuropathy and poor circulation could have been prevented by careful foot care.
Here aresome steps to follow:
Clean your feet daily, using warm—not hot—water and a mild soap. Avoid soaking your feet. Dry them with a soft towel; dry carefully between your toes.
Inspect your feet and toes every day for cuts, blisters, redness, swelling, calluses, or other problems. Use a mirror (laying a mirror on the floor works well) or get help from someone else if you cannot see the bottoms of your feet. Notify your health care provider of any problems.
Moisturize your feet with lotion, but avoid getting it between your toes.
Always wear shoes or slippers to protect your feet from injuries. Prevent skin irritation by wearing thick, soft, seamless socks.
Wear shoes that fit well and allow your toes to move. Break in new shoes gradually by wearing them for only an hour at a time at first.
Before putting your shoes on, look them over carefully and feel the insides with your hand to make sure they have no tears, sharp edges, or objects in them that might injure your feet.
If you need help taking care of your feet, make an appointment to see a a podiatrist.
Remember that foot pain is not normal. Healthy, pain-free feet are a key to your independence. At the first sign of pain, or any noticeable changes in your feet, seek professional podiatric medical care. Your feet must last a lifetime, and most Americans log an amazing 75,000 miles on their feet by the time they reach age 50. Regular foot care can make sure your feet are up to the task. With proper detection, intervention, and care, most foot and ankle problems can be lessened or prevented. Remember that the advice provided in this page should not be used as a substitute for a consultation or evaluation by a podiatric physician.
Disclaimer: Portions of this web page were copied from the American Podiatric Medical Association's (apma.org) web site. NEOFASA, Inc. makes no claims as to being the orginial author of some portions of this web page. Please feel free to visit the apma.org web site for further infomation on this subject.
