It is a peripheral nerve disorder caused by diabetes or poor blood sugar control. High blood sugar can injure nerve fibers throughout your body; but diabetic neuropathy most often damages nerves in your legs and feet. Depending on the affected nerves, symptoms of diabetic neuropathy can range from pain and numbness in in the feet or lower legs to problems with your digestive system, urinary tract, blood vessels and heart. In some people, these symptoms are mild while in others they can be painful and disabling.Left untreated the condition could even be fatal. The pain can be intense and require treatment. The loss of sensation in the feet may also increase the possibility of foot injuries going unnoticed and developing into ulcers or lesions that become infected. In some cases, diabetic neuropathy can be associated with difficulty walking and some weakness in the foot muscles. There are other types of diabetic-related neuropathies that affect specific parts of the body. For example, diabetic amyotrophy causes pain, weakness and wasting of the thigh muscles, or cranial nerve infarcts that may result in double vision, a drooping eyelid, or dizziness. Diabetes can also affect the autonomic nerves that control blood pressure, the digestive tract, bladder function, and sexual organs. Problems with the autonomic nerves may cause lightheadedness, indigestion, diarrhea or constipation, difficulty with bladder control, and impotence.
Diagnosis of diabetic neuropathies is based on history, clinical examination and supporting laboratory investigations. These include electromyography with nerve conduction studies, skin biopsies to evaluate cutaneous nerve innervation, and nerve and muscle biopsies for histopathological evaluation.
Treatment of diabetic neuropathies depends on optimum diabetic control, exercise and weight loss to reduce insulin resistance and symptomatic control. Neuropathic pain can be treated with anti-seizure medications, antidepressants, or analgesics. To deal with severe painful conditions doctors at GIN may adopt a multidisciplinary approach to pain management.
Treatment for diabetic neuropathy focuses on:
Slowing progression of the disease
Managing complications and restoring function
Slowing progression of the disease
Consistently keeping blood sugar within a narrow target range can help delay the progression of peripheral neuropathy and may even cause an improvement in symptoms you already have. With intense glucose control you may reduce your overall risk of diabetic neuropathy by as much as 60 percent.
To help slow nerve damage your doctor at GIN will advise you to
Take good care of your feet
Keep your blood pressure under control
Follow a healthy-eating plan
Get plenty of physical activity
Maintain a healthy weight
For relieving pain several medications are used but they don’t work for everyone and most have side effects that must be weighed against the benefits they offer. There are also a number of alternative therapies, such as capsaicin cream (made from chili peppers) and acupuncture that may help with pain relief. Doctors frequently use them in conjunction with medications, but some may be effective on their own.
Specific treatments exist for many of the complications of neuropathy including urinary tract problems. Antispasmodic medications (anticholinergics), behavioral techniques such as timed urination, and devices such as pessaries — rings inserted into the vagina to prevent urine leakage — may be helpful in treating loss of bladder control. A combination of therapies may be most effective.
Gastroparesis can usually be helped by eating smaller, more-frequent meals, reducing fiber and fat in the diet, and, for many people, eating soups and pureed foods. Diarrhea, constipation and nausea may be helped with dietary changes and medications.
Low blood pressure on standing is often helped with simple lifestyle measures, such as avoiding alcohol, drinking plenty of water and standing up slowly. Your doctor may recommend an abdominal binder, a compression support for your abdomen, and compression stockings. Several medications, either alone or together, also may be used to treat orthostatic hypotension.
Filament test: Sensitivity to touch may be tested using a soft nylon fiber called a monofilament. If you’re unable to feel the filament on your feet, it’s a sign that you’ve lost sensation in those nerves.
Nerve conduction studies: This test measures how quickly the nerves in your arms and legs conduct electrical signals. It’s often used to diagnose carpal tunnel syndrome.
Electromyography (EMG): Often performed along with nerve conduction studies, electromyography measures the electrical discharges produced in your muscles.
Quantitative sensory testing: This noninvasive test is used to assess how your nerves respond to vibration and changes in temperature.
Autonomic testing: If you have symptoms of autonomic neuropathy, your doctor may request special tests to look at your blood pressure in different positions and assess your ability to sweat.