Diabetic Neuropathy

Diabetic neuropathy causes, risk Factors, and Symptoms


 

Diabetic neuropathy (nerve damage) is one of the most debilitating complications of diabetes. It is a result of chronic high blood glucose which causes nerve damage over time. Glucose is fuel for cells but outside of cells it becomes an irritant causing irreversible damage over time. Neuropathy is a stressful condition because it is extremely painful and debilitating. Treatments are not always successful, the best course of action is to keep blood sugars as stable as possible.

The key to success when treating neuropathy is to minimize the amount of time nerves and vessels are expose to glucose. Exercise and weight control are also key factors in achieving this goal. Pain is a big issue with neuropathy and pain control should have special attention since pain management can be difficult to attain. To stay ahead of pain, one strategy is to use non narcotic pain relievers all day rather then wait until the pain becomes to unbearable. Some physicians like to use anti-depressants in order to take the edge of pain. There are some benefits for some patients since pain does have a psychological component.

Pain is not the only symptoms of neuropathy. Depending on what nerves have been damaged, a host of other symptoms can manifest in all organs as they can individually suffer nerve damage. Legs, gastrointestinal tract or any other part of the body may present unusual symptoms as they are affected by nerve damage.

  • Abdominal fullness, bloating, diarrhea, constipation, and nausea
  • Difficulty emptying the bladder can lead to frequent infections
  • Low blood pressure upon standing, faintness and dizziness
  • Deformities of the foot and foot ulcers
  • Trouble achieving and maintaining an erection

Although there are ways to control pain and other associated symptoms; the best remedy still is the maintenance of low blood sugar. A1c test lab results should be kept at least at 7.0% or lower. Neuropathy could develop if your A1c are consistently above 8.0%. The good news is that diabetics who consistently maintain their A1c readings in the lower range have a 50% decrease in the risk of nerve damage. Keeping your sugar levels under control may also limit further damage ounce it has already happened.

How diabetes causes neuropathy

The exact causes of neuropathy are unknown but something most agree is that nerve damage occurs after a long period glucose contact with vessels and nerves. Cells are surrounded by a tissue sheet called Schwann. Excess sugar circulating throughout the body interacts with enzymes in the Shcwann cells called aldose reductase which transform sugar into sorbitol. Water is drawn into the Schwann cells causing them to swell. This process pinches the nerves causing damage and pain. This process can be stopped by controlling blood glucose levels. In the nerve damaging process both Schwann cells and the nerves they protect end up dying.

Another theory is that exposure to glucose create certain intracellular metabolites such as myoinositol which becomes depleted leading to nerve damage. Another theory is being studied by George King, MD, Director of Research and Head of the Section on Vascular Cell Biology. It was shown that Protein kinase C pathway is triggered by chronic high blood glucose, resulting in several diabetes complications one of which include neuropathy.

Recent studies have shown that decreased blood flow to the nerves can contribute to diabetic nerve disease. Multiple studies are being conducted to improve blood flow to nerves in diabetic animals and humans. There are also two types of drugs being developed: 1) antioxidants and 2) PKC inhibitors. Preliminary studies have shown encouraging results.

Types of neuropathy

  • Sensory neuropathy
    • sometimes called peripheral neuropathy or simply neuropathy. Affects nerves that carry information to the brain. Sensations in various parts of the body are affected. This is what makes neuropathy so dangerous because it impairs the ability to sense when something is hot or cold or the sensation of a sharp object puncturing the skin.
    • Diabetes is not the only cause of sensory neuropathy. Nutritional deficiencies such as B-12 and folate, chemical exposures, pressure on nerves or medications can also cause it. Medications used in chemotherapy or AIDS treatment can also be a problem.
  • Autonomic neuropathy
    • Affect the normal function of involuntary organs. Nerves controlling the bladder, stomach, intestines and the heart are affected by nerves which no longer are able to transmit signaling well. Erectile dysfunction, diabetic diarrhea, bloated stomach can all result from this type of neuropathy.
  • Motor neuropathy
    • Direct signaling to motor nerves are affected. Activities such as walking and moving any part of the body are compromised. Muscle weakness is also part of this neuropathy. This is a rare form of neuropathy in diabetics.

 

Neuropathy may affect one side of your body and it is called  asymmetric. Affecting both sides is called symmetric. If only one kind of nerve is affected it is called mononeuropathy, and if several nerves are affected it is called polyneuropathy.

 

Other terms may be used based on what parts of the body are affected, including:

Diagnosis

If you are diabetic and have having these symptoms

  • constant pain
  • difficulty having and maintaining an erection
  • frequent urination
  • frequent urinary tract infections
  • re occurring diarrhea
  • constipation
  • fainting spells upon standing
  • vomiting or symptoms resembling ulcers

A physician may detect early signs of neuropathy. He or she may notice that knee and ankle jerk reflex tests show nerves aren’t as responsive as normal, or may observe a dip in blood pressure when you go from a reclining to sitting position. These are signs that increased attention to blood glucose are warranted to try to limit further problems.

A variety of tests, including electromyography (a test that measures the response of muscles to electrical impulses) and nerve conduction studies (a study of the flow of electrical current through the nerves) combined with clinical observations may help a physician rule out other possible causes of pain and diagnose neuropathy. To diagnose Charcot foot fracture, the doctor may take an X-ray and possibly conduct a bone scan.

Treatment

Unfortunately there are no definitive treatment for neuropathy. Treatments are often helpful but there is no way to replace nerves ounce they’ve been damaged. The most important is to keep blood glucose at normal levels (100 ml/dL). Exercise regularly and keep weight under control. Exercise seem to have a profound impact on neuropathy. Exercise will have the added benefit of keeping muscles that may be weakened by decreasing nerve activity to remain strong and toned. Christopher Gibbons, MD, of Joslin, says he finds that patients with painful neuropathy say the pain seems less severe if they get some simple exercise regularly.

Helpful medications are: Tylenol, ibuprofen. Treating pain, is available in over-the-counter topical salves that include ArthriCare® and Zostrix®.

Certain antidepressants also seem to be particularly helpful for pain, says Dr. Gibbons. Amitriptyline (Elavil®), desipramine (Norpramin®) or imipramine (Tofranil®) are members of the tricyclic antidepressant category of drugs.

Other types of drugs that sometimes help are anti-convulsants such as phenytoin (Dilantin®), carbamazepine (Tegretol®) or gabapentin (Neurontin®). Drugs such as mexiletine (Mexitil®) normally used to treat irregular heart rhythm sometimes relieve neuropathy pain. Drugs like metaxalone (Skelaxin®) that generally depress the central nervous system can help reduce muscle pain.

 


 

Videos

Diabetic neuropathy is nerve damage brought on by uncontrolled blood sugar. The feet and toes are most affected. The lack of sensation increases.


Watch and listen as Dr. Walter K. Crooks gives answers about the devastating condition known as Peripheral Neuropathy.
Learn as he talks about the different areas of the nervous system and how damage to those areas can cause the signs and symptoms of Peripheral Neuropathy in the arms, legs, hands and the feet.


Tips for using Arnica Theraeutic Concentrate to ease neuromuscular pain and inflammation.

 


part 1

part 2

Smoked cannabis was well tolerated and effectively relieved chronic neuropathic pain from HIV-associated sensory neuropathy.


 

References

Image credits: flickr.com

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