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Diabetic Nerve Disease (Neuropathy)

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What is Diabetic Neuropathy?

Diabetic neuropathy is a complication of chronic diabetes in which the nervous system is affected. Nerve damage could either be restricted to certain parts of the body or happen throughout the body. It may affect the nerves that are responsible for sensation, muscle action and involuntary control of organs. Neuropathy can develop fairly early in diabetes if the glucose levels are high, but may only be acute. Permanent nerve damage is more often seen with long term and poorly controlled diabetes mellitus. Therefore the elderly are more likely to experience and suffer with this complication.

Diabetic Nerve Disease Symptoms

Diabetic neuropathy is of multiple types and the symptoms depend on the identity and location of the nerves that get affected.

Symmetric Polyneuropathy

This is the most common type of diabetic neuropathy and it affects the nerves of the feet and the hands. The symptoms include tingling and burning sensations or loss of sensations of touch, vibrations, balance and temperature. Feet might show ulcerations, infections, fractures and dislocations of joints. Muscle weakness might lead to loss of control over feet (foot drop).

Autonomic Neuropathy

This affects the autonomic nervous system that controls those body functions, like the heart beat and bowel functions, over which we do not have voluntary control. The symptoms include dizziness upon standing up, exercise intolerance, rapid heartbeats even during rest, difficulty in swallowing, nausea, vomiting, constipation, diarrhea, loss of voluntary control over defecation and urination, erectile dysfunction, retrograde ejaculation, and decreased vaginal lubrication.

Radiculopathy

This affects the nerves of the abdomen and the legs. Symptoms include abdominal pain or pain, weakness and wasting of the leg muscles.

Cranial Neuropathy

This affects the nerves of the head. Symptoms include double vision, drooping of eyelids, unequally sized pupils, or partial paralysis.

Mononeuropathy

This is when a single nerve is affected anywhere in the body. Symptoms include foot drop or weakness and numbness of fingers. Many nerves could be simultaneously affected in many parts of the body, leading to multiple symptoms. Mononeuropathy mostly affects older people and resolves itself over a few months.

Causes of Diabetic Neuropathy

One of the main features of diabetes is weakening of blood vessels throughout the body. Nerves get damaged due to lack of blood supply to the nerve cells (neurons) and also due to direct toxic effects of the high blood glucose levels.

Diabetic Neuropathy Treatment

It is important for diabetes patients to monitor their hands and feet regularly to note the onset of any symptoms such as tingling, numbness, burning sensation, pain, or swelling. Treatment is effective if started during the earliest stages of neuropathy. However, in the later stages the damage to the nerves may be permanent.

The primary line of treatment involves controlling the blood sugar levels. This can be achieved with oral medication and insulin injections. Dietary change and lifestyle modification, such as regular exercise, should also be continued even in the late stages of diabetic complications.

Treatment for the nerve damage itself mainly revolves around symptomatic relief. This may be achieved with drugs such as topical application of capsaicin cream, and administration of tricyclic anti-depressants, serotonin-norepinephrine reuptake inhibitors and anti-convulsants.


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