Diabetic Neuropathy


What is diabetic neuropathy?

Diabetic neuropathy is a nerve disorder commonly caused by diabetes. Over time, high blood sugar levels from diabetes can damage nerves throughout your body.

There are several types of diabetic neuropathy.

* Peripheral neuropathy results from damage to the peripheral nervous system. It reduces your ability to sense pain, touch, temperature, and vibration in certain parts of the body and may sometimes affect movement and muscle strength. It most often affects the feet and lower legs and may contribute to serious foot problems, such as ulcers, infection, and bone and joint deformities. It is the most common form of diabetic neuropathy.
* Autonomic neuropathy is caused by problems with the autonomic nervous system. These nerves control the involuntary functions of your body, such as heartbeat, blood pressure, sweating, digestion, urination, and some aspects of sexual function. This is also a common form of diabetic neuropathy.
* Focal neuropathy affects a single nerve, most often in the wrist, thigh, or foot. It may also affect the nerves of the back and chest and those that control the eye muscles. It is often associated with conditions that compress or pinch the nerves such as carpal tunnel syndrome. However, carpal tunnel syndrome also frequently occurs in people who have diabetes but do not have focal neuropathy. Focal neuropathy usually develops suddenly and is the most rare form of diabetic neuropathy.

What causes diabetic neuropathy?

Over time, high blood sugar levels from diabetes can damage nerves throughout your body. The higher your blood sugar levels, the greater your risk of developing neuropathy. The risk of nerve damage also increases as you age and the longer you have diabetes. Smoking and excessive use of alcohol may further increase the risk. Around 50% of people who have diabetes will eventually develop diabetic neuropathy.1
What are the symptoms?

Symptoms vary according to which nerves are injured. Diabetic neuropathy can interrupt the normal flow of nerve signals through the legs, arms, and other parts of the body. This may limit your ability to feel pain, which is one way the body protects itself against injury. The sensation of pain tells your brain to pull your hand off a hot stove or to remove the rock from your shoe.

When the internal organs and body systems are affected by neuropathy, it can cause:

* Digestive system problems, such as frequent bloating, belching, constipation, nausea and vomiting, diarrhea, and abdominal pain.
* Temperature regulation problems, such as profuse sweating of the torso, face, or neck at night or while eating certain foods, such as spicy foods and cheese. Alternatively, some people may have reduced sweating, especially in their feet and legs.
* Urinary system problems, such as difficulty sensing when the bladder is full or difficulty emptying the bladder completely.
* Sexual problems, such as erection problems in men and vaginal dryness in women.
* Heart and blood vessel problems, leading to poor circulation or low blood pressure. This may cause dizziness, weakness, or fainting when you stand or sit up from a reclining position.
* Difficulty sensing when your blood sugar is low.

How is diabetic neuropathy diagnosed?

A diagnosis of diabetic neuropathy is based largely on your symptoms, your medical history, and a physical examination. Tests such as electromyogram (EMG) and nerve conduction studies may be done to confirm the diagnosis. Additional tests may be needed to identify which type of neuropathy you have and the organ or system affected, and to help guide treatment.
How is it treated?

There is no cure for diabetic neuropathy. Treatment focuses on slowing the progression of the disease by consistently keeping your blood sugar levels within a narrow and tightly controlled target range and taking proper care of your feet to keep them free from sores and infections. Tight blood sugar control means an average level of hemoglobin A1c (HbA1c) of less than 7% over 2 to 3 months.

Treatment will be tailored to your symptoms.

* Medications, physical therapy, or acupuncture may be used to relieve pain associated with peripheral neuropathy.
* Medications for digestive system problems or blood vessel problems, elastic stockings, and devices to improve erections or lubricating creams for vaginal dryness may be prescribed for autonomic neuropathy.
* Treatment for focal neuropathy may include a splint or brace for a compressed nerve, or sometimes surgery is needed to relieve pressure.

Can diabetic neuropathy be prevented?

Keeping your blood sugar levels within a narrow target range may help prevent neuropathy from ever developing. However, once you have diabetic neuropathy, early detection of foot problems and maintaining target blood sugar levels may prevent neuropathy from becoming more severe and may reduce your risk of complications.


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