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 25 years.

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 causing Neuropathy.

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 of Insulin.
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 disease.
Lifestyle Factors, like smoking or alcohol abuse.

There are four type of Neuropathy Diabetic, Peripheral, Autonomic and Focal.

Peripheral Neuropathy:

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.

Autonomic Neuropathy:

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 Hypoglycemia Unawareness.

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 at night.

Proximal Neuropathy:

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.

Focal Neuropathy:

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 urination.

Foot Examinations:

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 vibration perception.

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.

Ulceration:

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 Care.

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 tract.

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 include:

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 ulcer).
Venous Ulcer, a wound thought to occur due to improper functioning of valves in the veins.
Ulcerative Sarcoidosis, a cutaneous condition affecting people with sarcoidosis.
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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