Diabetic Neuropathy: What You Need To Know

Diabetic neuropathy can be physically and mentally overwhelming. It is the commonest consequence of diabetes that complicates health by paving way to problems like heart attack, foot ulcers, amputations and digestion problems. A timely visit to your physician’s clinic helps you to manage your symptoms and prevents the progression of diabetic neuropathy in a better way.

What Is Diabetic Neuropathy?

Nerve pain in patients with uncontrolled diabetes is diabetic neuropathy. It is one of the most common complications of diabetes. It causes loss of feeling or burning pain in the feet. If you are a diabetic, you could develop nerve problems at any time. Sometimes, nerve problems are one of the first symptoms that indicate diabetes.

If you are a type 1 diabetic for at least 5 years, it is advisable to undergo screening for diabetic neuropathy and if you are diagnosed with type 2 diabetes, you should check with your healthcare practitioner for diabetic neuropathy right away. The risk of diabetic neuropathy increases with the duration of diabetes.

What Causes Diabetic Neuropathy?

Our nerves are very important to send signals from and to the brain. As we all know uncontrolled diabetes is when the glucose levels are higher than the normal range. When the blood sugar levels are too high for a prolonged period of time, it eventually damages the nerves. The nerves present in the feet are more likely to be damaged first followed by other nerves.

Types Of Diabetic Neuropathy:

a) Peripheral Neuropathy:

Diiabetic peripheral neuropathy is a type of nerve damage occurring in the hands, legs, arms and feet. It develops gradually and worsens over time. Although nerve damage can occur anywhere in the body, the symptoms are more prominent in the feet and toes. 

Diabetic peripheral neuropathy increases the risk of foot ulcers. Since nerve damage numbs down the sensation of pain, diabetic people might not notice minor wounds and cuts that eventually worsen to the state and lead to foot amputation.

Some of the common symptoms of diabetic peripheral neuropathy include:

• Sharp and shooting pains
• Burning
• Tingling
• Numbness and inability to completely feel heat, cold or pain
• Muscle weakness
• Changes in foot shape
• Loss of balance
• Dry or cracked feet

b) Autonomic Neuropathy:

In autonomic neuropathy, the nerves which control the bladder, intestines and genitals are affected. When nerves lose control over these parts of the body, it results in problems like diarrhoea, erectile dysfunction, urinary tract infections, etc. 

Here are the symptoms of autonomic diabetic neuropathy:

• Indigestion
• Heartburn
• Nausea
• Vomiting
• Bloating
• Constipation
• Nervousness
• Trembling
• Night sweats
• Low blood pressure

c) Proximal Neuropathy:

Persistent high blood sugar and cholesterol levels damage your nerves and small blood vessels that provide nourishment to your nerves resulting in Proximal neuropathy. This type is comparatively rare and affects about 1% of diabetic patients. The main symptom is pain in the upper thigh that also involves lower back and hip.

This type of neuropathy weakens the lower limbs and also the upper limbs to some extent. Sometimes it makes a person look extremely ill and be unable to get out of the bed. Recovery time usually takes 12 months, but some nerves might undergo permanent damage. 

Common symptoms of proximal diabetic neuropathy are:

• Sudden and severe pain in hips, buttocks or thighs
• Weakness in the legs that causes difficulty while standing up
• Loss of muscle tissue
• Weight loss
• Automatic movement of lower leg when tapped below your knee.

d) Focal Neuropathy:

Focal neuropathy affects one nerve at a time and the pain and numbness occurs in that nerve. For example, if the nerves connecting the chest are affected, the symptoms of pain and numbness occur in the chest wall similar to that of a heart attack or appendicitis. Unlike other types that progress gradually, focal neuropathy is severe and sudden, but the patients eventually recover.

Some of the most common symptoms of focal neuropathy include:

• Pain in the thighs
• Severe pain in lower back
• Chest pain
• Inability to focus
• Double vision
• Paralysis
• Hearing problems

Diabetic Neuropathy Treatment

Diabetic neuropathy treatment primarily revolves around bringing blood sugar levels under control. Other treatment approaches include using medications that target and treat specific symptoms like pain, numbness, etc. While it is not always possible to reverse nerve damage, you could stop it from becoming worse.

If you feel pain or numbness in your feet, hands, or any part of the body, there are certain medications that alleviate these symptoms. Let your healthcare provider know what medications and supplements you are currently taking. Medications that are beneficial in diabetic neuropathy treatment include:

• Duloxetine: Duloxetine is an antidepressant and is the first choice for treating severe nerve pain. It is effective in reducing pain but should be used with caution if you have liver or kidney problems.
• Pregabalin: Pregabalin is an alternative to duloxetine for treating pain. It has better tolerance and lower risk of side effects.
• Gabapentin: Gabapentin is usually used to treat pain due to nerve damage and it is highly preferred to treat diabetic peripheral neuropathy.
• Tramadol: Tramadol is a painkiller medication that is associated with better symptom management and improvement in quality of life when used along with paracetamol, another painkiller.
• Benfotiamine: Benfotiamine is the synthetic form of vitamin B1 (thiamine) that works by reducing oxidative stress and improves symptoms. When it is used in combination with vitamin B6, it not only improves the symptoms, it also improves nerve signals.

Purchase shoes particularly designed for diabetic neuropathy and wear them regularly. Check your feet every time you visit your physician for consultation. Medications could reduce pain to a great extent but it is still possible to experience minute pain at times.

Consume foods high in fibre, protein and low in carbohydrates. Avoid soda, chips and other junk foods. Regular physical activity improves your body’s ability to utilize insulin and regulates your blood glucose levels. Ensure that you sleep well at night as inadequate sleep could make you crave carbohydrates.

Is It Possible To Prevent The Complications Of Diabetic Neuropathy?

Although it is not entirely possible to prevent diabetic neuropathy and its complications, there are many ways through which you can manage your condition effectively. Here are some tips for you to follow:

• Foot care: Check your foot condition everyday and if you notice any cuts or injury, attend them immediately. Ensure that your nails are healthy and clean. Do not bath with water that is too hot. Apply moisturizer regularly and wear comfortable footwear.
• Blood glucose control: If you are diagnosed with diabetes, you should regularly check with your physician to ensure that your blood sugar levels are under control. Purchase a glucometer and test your blood glucose levels at home regularly. Keeping blood sugar under control helps prevent nerve damage in the long run.
• Medications: Some medications might help manage your condition. Consult your doctor to know the right medicine for you.

Do Not Ignore Your Symptoms:

Studies show that hypertension and high cholesterol also contribute to diabetic neuropathy. When you visit your physician for a routine check-up, make sure that your cholesterol, triglycerides, blood pressure and body weight are under control as regulating blood sugar alone is not sufficient. If you have the habit of smoking, try to minimize the number of cigarettes you smoke per day until you quit completely.