Description
In general, the term neuropathy refers to damage to the nerves. Diabetic neuropathy is defined as the damage of nerves which occurs as a result of diabetes. Since the diabetic condition is having prolonged high blood glucose levels, nerves are much prone to damage. It affects the different locations of our body, especially nerves of ganglia, outside of the skull, spinal chord, and all those cause impacts on the organs such as heart, kidney, bladder, stomach, and intestine. Diabetic neuropathy stands as common complications of the diabetic disease. It usually affects the peripheral nerves that are in limbs and those that control automatic functions of the body are digestion and heart rate.
Necrotic tissues in the foot
Based on the damage locations diabetic neuropathy can be categorized as follows:
Peripheral neuropathy: Diabetic neuropathy that most commonly affects the peripheral nervous system such as in the feet, legs, and hands.
Autonomic neuropathy: By this type of neuropathy, the nerves that control involuntary movements such as digestion, heart rate, and bladder muscles for voiding are getting affected by diabetes.
Proximal neuropathy: Proximal neuropathy, which affects the nerves which are passing through the thighs, hip, and buttocks.
Focal neuropathy: In this type, any nerves at any site can be damaged due to diabetes.
Pathophysiology
As a consequence of the prolonged hyperglycemia, the flux of polyol pathway increases and enhances the formation of glycation end products. Advanced glycation act on specific receptors in the vascular cells, induces monocytes and endothelial cells to express adhesion molecules and cytokines. These factors activate the protein kinase C and exaggerate oxidative stress.
The metabolic pathway in the Diabetic neuropathy (NO-Nitric oxide)
All these cascade processes develop glucose intolerance in the vascular tissue and damages the nerve fibers that are ending in the vascular lining. Thus, nerve fibers undergo fast degeneration or impaired regeneration and they exert exciting impulses with the positive symptoms such as pain or paresthesia. When the fiber has completely degenerated the loss of touch and pain sensation will take place. At last, the severity of sensory loss will be augmented (negative symptoms).
Causes and Risk factors for Diabetic neuropathy
- Obesity and high triglycerides
- Hypercholesterolaemia
- Smoking increases the risk factor for developing kidney problems. Which limits the proper excretion of certain unwanted toxins and cause nerve damage that eventually leads to diabetic neuropathy.
- High blood pressure
- Low levels of HDL cholesterol (good) and high levels of LDL cholesterol (bad) will also boost the risk for diabetic peripheral neuropathy
- High body-mass index
- Age plays a role, people above 50 years are most prone to develop diabetic neuropathy.
- Genetic risk;
- Having prolonged diabetes
- Coronary heart disease
- Excessive alcohol intake
Epidemiology
Diabetic polyneuropathy is the most common neuropathy in the Western world. In the US, DN is the primary cause of diabetic foot problems and ulceration, the leading cause of diabetes-related hospital admissions and nontraumatic amputation. It is estimated that approximately 50% of people with diabetes will develop DN during their lifetime, although estimates vary from 10% to 90%.
Symptoms
The symptoms of diabetic neuropathy appear gradually. Initially, it affects the foot nerves and thus it results in symptoms such as the sensation of pin and needles in feet. Symptoms may vary depending upon the nerve damage may include:
- Loss of sensation
- Excessive sweating
- Problem with urination
- Weakness
- Numbness, tingling or pain in legs, toes, hands, arms, and fingers
- Vomiting, indigestion, and nausea
- Erectile dysfunction in men and virginal dryness in women
- Diarrhea or constipation
- Wasting of the muscles and feet
- Dizziness and faintness due to a drop in blood pressure after sitting or standing up
- Blotting and difficulty in swallowing
- Rapid resting heart beat
Symptoms may vary depending upon the type of neuropathy that you experiencing
Foot ulcer
Complications of Diabetic Neuropathy
The patient should be aware of the risk of diabetic neuropathy. Some of the complications that are associated with the diabetic neuropathy are as follows:
- Diabetic foot ulcer
- Bladder and kidney disease
- Digestive problems
- Sexual dysfunction
- Low blood pressure
- Hypoglycemia
- Problem in sweat glands
Diagnosis and test
The diabetic neuropathy is diagnosed based on your symptoms and physical exam. Some of the exams doctors may conduct such as muscle strength, reflexes, blood pressure, heart rate and sensitivity due to temperature, position changes, or light touch.
Your doctor may also conduct tests as follows:
- Foot test your doctor may do Comprehensive foot exam assesses the skin, muscles, bones, circulation, and sensation of the feet. The doctor may assess protective sensation or feeling in the feet by touching them with a nylon monofilament.
- Nerve conduction studies or electromyography studies can be conducted to measure the nerves and arms electrical signals and to measure the electrical discharges that produced in your muscle. These tests are rarely needed to diagnose neuropathy
- Heart rate check-up shows variability that how heart responds to a deep breath and to changes in the blood pressure and posture
- Ultrasound uses sound waves to produce an image of internal organs. An ultrasound of the bladder and other parts of the urinary tract, for example, can be used to assess the structure of these organs and show whether the bladder empties completely after urination.
Treatment and medications
While diabetic neuropathy cannot be cured, there are treatments available to help manage some of the symptoms. Another treatment goal is keeping blood glucose levels under good control through a combination of diet and medication so that the neuropathy does not worsen. Keeping blood glucose levels under control has been shown to improve symptoms and prevent worsening of the pain.
The pain of diabetic neuropathy can sometimes be managed with certain medications. Certain prescription antidepressants and antiseizure medications have been shown to be effective in relieving pain that originates in the nerves.
For example:
- Duloxetine (Cymbalta) is an antidepressant that can relieve the pain of diabetic neuropathy in some people. The tricyclic antidepressant drugs, including nortriptyline (Pamelor, Aventyl) and desipramine (Norpramin), have also been used for this purpose.
- Anti-seizure drugs such as gabapentin (Neurontin), carbamazepine (Tegretol), and pregabalin (Lyrica) are drugs that can also work to relieve pain in people with diabetic neuropathy.
Prevention of Diabetic Neuropathy
There is no guarantee that you won’t develop diabetic neuropathy in your feet. But maintaining a blood sugar glucose level also reduces the risk of developing diabetic neuropathy. Some of the preventive steps that reduce the decreases the rick such as follow:
- Daily check your bottom of feet for any injuries
- Do regular check by your doctor at least once a year or twice a year
- Wear durable cushioned shoes all times even at your home
- Quit smoking
- Trim your toenails carefully
- Monitor your blood sugar level frequently