What Are Diabetic Neuropathies?
Diabetic Neuropathies are a family of nerve disorders caused by Diabetes
and anyone with Diabetes can develop nerve damage throughout the body;
it can occur in any organ system, including the digestive tract, heart
and sex organs; Diabetics can develop nerve problems at any time, but
the risk rises with age and the duration of Diabetes; the highest rates
of Neuropathy are amongst people who have had Diabetes for at least
Diabetic Neuropathies appear to be more common in people who have problems
controlling their blood sugar levels, those with high levels of blood
fat, those with high blood pressure and those who are overweight; it
starts because when blood glucose levels are too high, the blood becomes
sticky and causes damage to blood vessels and nerves, which ends up
What Are The Symptoms Of Diabetic Neuropathies?
Unfortunately, some Diabetics with nerve damage have no symptoms at
all, others may have symptoms such as:
Tingling or pain in the toes, feet, legs, hands, arms or fingers.
Numbness, such as a loss of feeling in the hands, arms, feet or legs.
Wasting of the Muscles of the feet or hands.
Indigestion, Nausea, or Vomiting.
Diarrhea or Constipation.
Dizziness or Faintness due to a drop in blood pressure after standing
or sitting up.
Problems with Urination.
Erectile Dysfunction in men or Vaginal Dryness in women.
Excessive Tiredness or Weakness.
Symptoms are often minor at first and because most nerve damage occurs
over several years, mild cases may go unnoticed for a long time; symptoms
can involve the sensory, motor and autonomic or involuntary nervous
systems; in some people, mainly those with Focal Neuropathy, the onset
of pain may be sudden and severe; problems that often accompany Diabetic
Neuropathies include weight loss and depression and statistics show
that around (60 to 70)% of all Diabetics have some form of Neuropathy.
What Causes Diabetic Neuropathies?
The causes differ depending on the type of Diabetic Neuropathy, but
is likely caused by a combination of factors, such as:
Metabolic Factors, like high blood sugar levels,
a long duration of Diabetes, abnormal blood fat levels and low levels
Neurovascular Factors, leading to damage to the blood
vessels that carry oxygen and nutrients to nerves.
Autoimmune Factors that cause inflammation in nerves.
Mechanical Injury to Nerves, like carpal tunnel syndrome.
Inherited Traits that increase susceptibility to nerve
Lifestyle Factors, like smoking or alcohol abuse.
There are four type of Neuropathy Diabetic, Peripheral,
Autonomic and Focal.
This is the most common type of Neuropathy and is also known as Distal
Symmetric Neuropathy or Sensorimotor Neuropathy; it is nerve damage
that causes pain or loss of feeling in the toes, feet, legs, hands and
arms; your feet and legs are likely to be affected before your hands
and arms; it may also cause muscle weakness and loss of reflexes, especially
at the ankle, leading to changes in the way a person walks.
Foot deformities, such as hammertoes and the collapse of the midfoot,
may occur; blisters and sores may appear on numb areas of the foot because
pressure or injury goes unnoticed; if foot injuries are not treated
promptly, the infection may spread to the bone and the foot may then
have to be amputated; some experts estimate that half of all such amputations
are preventable if minor problems are caught and treated in time.
Symptons can include a numbness or insensitivity to pain or temperature,
a tingling, burning, or prickling sensation, sharp pains or cramps,
extreme sensitivity to touch, even a light touch and a loss of balance
and coordination; these symptoms are often worse at night.
This form of Neuropathy causes changes in digestion, bowel and bladder
function, sexual response and perspiration; it can also affect the nerves
that serve the heart and blood vessels, which help to regulate blood
pressure, the digestive system, stomach & intestines, the respiratory
function, the bladder & urinary tract, the sex organs, the sweat glands,
the eyes and the lungs; it can also affect blood sugar levels and cause
The heart and blood vessels are part of the cardiovascular system, which
controls blood circulation and damage to nerves in the cardiovascular
system interferes with the body's ability to adjust blood pressure and
heart rate; as a result, blood pressure may drop sharply after sitting
or standing, causing a person to feel light-headed or even to faint;
damage to the nerves that control heart rate can mean that your heart
rate stays high, instead of rising and falling in response to normal
body functions and physical activity.
Nerve damage to the digestive system most commonly causes constipation;
the damage can also cause the stomach to empty too slowly, a condition
called gastroparesis; severe gastroparesis can lead to persistent nausea
and vomiting, bloating, and loss of appetite; gastroparesis can also
make blood sugar levels fluctuate widely, due to abnormal food digestion.
Nerve damage to the esophagus may make swallowing difficult, while nerve
damage to the bowels can cause constipation alternating with frequent,
uncontrolled diarrhea, especially at night; problems with the digestive
system can also lead to weight loss.
Nerve damage can prevent the bladder from emptying completely, allowing
bacteria to grow in the bladder and kidneys and causing urinary tract
infections; when the nerves of the bladder are damaged, urinary incontinence
may result because a person may not be able to sense when the bladder
is full or control the muscles that release urine.
Nerve damage can also gradually decrease sexual response in men and
women, although the sex drive may seem unchanged; a man may be unable
to have erections or may reach sexual climax without ejaculating normally
and a woman may have difficulty with arousal, lubrication, or orgasm.
Nerve damage can affect the nerves that control sweating and when nerve
damage prevents the sweat glands from working properly, the body cannot
regulate its temperature as it should; it can also cause profuse sweating
at night or while eating.
Nerve damage can affect the pupils of the eyes, making them less responsive
to changes in light; as a result, a person may not be able to see well
when a light is turned on in a dark room or may have trouble driving
This form of Neuropathy is also known as Lumbosacral Plexus Neuropathy,
Femoral Neuropathy and Diabetic Amyotrophy; it causes pain in the thighs,
hips, or buttocks and often occurs on one side of the body and leads
to weakness in the legs and the inability to go from a sitting to a
standing position without help; this type of Neuropathy is more common
in those with Type 2 Diabetes
and in older adults with Diabetes.
This form of Neuropathy results in the sudden weakness of one nerve
or a group of nerves, causing muscle weakness or pain; any nerve in
the body can be affected; it may cause the inability to focus the eye,
double vision, aching behind one eye, paralysis on one side of the face,
called Bell's palsy, severe pain in the lower back or pelvis, pain in
the front of a thigh, pain in the chest, stomach, or side, pain on the
outside of the shin or inside of the foot, chest or abdominal pain that
is sometimes mistaken for heart disease, a heart attack, or appendicitis.
Focal Neuropathy is painful and unpredictable and occurs most often
in older adults with Diabetes; however, it tends to improve by itself
over weeks or months and does not always cause long term damage; Diabetics
also tend to develop nerve compressions, also called entrapment syndromes;
one of the most common is carpal tunnel syndrome, which causes numbness
and tingling of the hand and sometimes muscle weakness or pain; other
nerves susceptible to entrapment may cause pain on the outside of the
shin or the inside of the foot.
How Can I Prevent Diabetic Neuropathies?
The best way to prevent Neuropathy is to keep your blood sugar levels
as close to the normal range as possible because maintaining safe blood
sugar levels protects the nerves throughout your body.
How are Diabetic Neuropathies diagnosed?
Doctors diagnose Neuropathy on the basis of symptoms and a physical
examination; during the examination, your doctor may check your blood
pressure, heart rate, muscle strength, reflexes, sensitivity to position
changes, vibration, temperature and light touch; a check of heart rate
variability shows how the heart responds to deep breathing and to changes
in blood pressure and posture; ultrasound uses sound waves to produce
an image of internal organs and an ultrasound of the bladder and other
parts of the urinary tract, for example, can show how these organs preserve
a normal structure and whether the bladder empties completely after
Foot Care is really important for
Diabetics and to check your feet medical experts recommend that Diabetics
have a comprehensive foot examination each year to check for Peripheral
Neuropathy; people diagnosed with Peripheral Neuropathy need more frequent
foot examinations; a comprehensive foot examination assesses the skin,
muscles, bones, circulation and sensation of the feet; your doctor may
assess protective sensation or feeling in your feet by touching your
foot with a nylon monofilament, which is similar to a bristle on a hairbrush
attached to a wand or by pricking your foot with a pin; people who cannot
sense pressure from a pinprick or monofilament have lost protective
sensation and are at risk of developing foot sores that may not heal
properly; your doctor may also check temperature perception or use a
tuning fork, which is more sensitive than touch pressure, to assess
How Are Diabetic Neuropathies Treated?
The first treatment step is to bring blood sugar levels within the normal
range to help prevent any further nerve damage; blood sugar level monitoring,
meal planning, physical activity and Diabetes medicines or insulin will
help control blood sugar levels; at first when the blood sugar levels
are brought under control the symptoms may get worse, but over time,
the lower blood sugar levels will help to lessen the symptoms; pain
relief medication and skin creams may also be prescribed.
People with Neuropathy need to take special care of their feet; the
nerves to the feet are the longest in the body and are the ones most
often affected by Neuropathy; loss of pain sensation in the feet means
that extreme heat and cold, sores and injuries may not be noticed and
may then become ulcerated or infected; circulation problems also increase
the risk of foot ulcers; many lower limb amputations occur in Diabetics
and Doctors estimate that nearly half of the amputations caused by Neuropathy
and poor circulation could have been prevented by careful Foot
Prolonged high blood sugar levels can lead to Neuropathy,
which can lead to a loss of sensation, which means that you may not
realise it if you damage say your legs or your feet, which could then
lead to an Ulceration, more commonly known as an Ulcer; this is a sore
on the skin or a mucous membrane, accompanied by the disintegration
of tissue; they can result in complete loss of the epidermis (skin)
and often portions of the dermis and even subcutaneous fat; they are
most common on the skin of the lower extremities and in the gastrointestinal
An ulcer that appears on the skin is often visible as an inflamed tissue
with an area of reddened skin; a skin ulcer is often visible in the
event of exposure to heat or cold, irritation, or a problem with blood
circulation; they can also be caused due to a lack of mobility, which
causes prolonged pressure on the tissues; this stress in the blood circulation
is transformed to a skin ulcer, commonly known as bedsores or decubitus
ulcers; Ulcers often become infected and pus forms.
Skin ulcers appear as open craters, often round, with layers of skin
that have eroded; the skin around the ulcer may be red, swollen and
tender; patients may feel pain on the skin around the ulcer and fluid
may ooze from the ulcer; in some cases, ulcers can bleed and some patients
experience fever; Ulcers sometimes seem not to heal, but healing, if
it does occur, tends to be slow; Ulcers that heal within 12 weeks are
usually classified as acute and longer lasting ones as chronic.
Ulcers develop in stages, in stage 1 the skin is red with soft underlying
tissue; in stage 2 the redness of the skin becomes more pronounced,
swelling appears and there may be some blisters and a loss of outer
skin layers; in stage 3, the skin may become necrotic down through the
deep layers of skin and the fat beneath the skin may become exposed
and visible; in stage 4, deeper necrosis usually occurs, the fat underneath
the skin is completely exposed and the muscle may also become exposed;
in the last two stages the sore may cause a deeper loss of fat and necrosis
of the muscle; in severe cases it can extend down to bone level, destruction
of the bone may begin and there may be sepsis of joints.
Common Forms Of Ulceration:
Chronic ulcers may be painful; most patients complain of constant pain
night and day; symptoms usually include increasing pain, friable granulation
tissue, foul odour and wound breakdown instead of healing; symptoms
tend to worsen if the wound has become infected; common forms of Ulcers
Ulcer (Dermatology), a discontinuity of the skin or a break in the
skin Bedsores, also known as pressure ulcers.
Genital Ulcer, an ulcer located on the genital area.
Ulcerative Dermatitis, a skin disorder associated with bacterial growth
often initiated by self-trauma due to a possible allergic response.
Corneal Ulcer, an inflammatory or infective condition of the cornea.
Mouth Ulcer, an open sore inside the mouth Aphthous ulcer, a specific
type of oral ulcer also known as a canker sore.
Peptic Ulcer, a discontinuity of the gastrointestinal mucosa (stomach
Venous Ulcer, a wound thought to occur due to improper functioning of
valves in the veins.
Ulcerative Sarcoidosis, a cutaneous condition affecting people with
Ulcerative Lichen Planus, a rare variant of lichen planus.
Ulcerative Colitis, a form of inflammatory bowel disease.
Ulcerative Disposition, a disorder or discomfort that causes server
abdominal distress; often times it can be associoated with chronic gastritis
In 2012 it was estimated that around 59 000 people in England and 10
000 in Scotland have foot ulcers at any given time and if an ulcer is
left untreated, it can become infected, leading to, in extreme cases,
to gangrene and amputation.
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