DIABETIC PERIPHERAL NEUROPATHY
What is Diabetic Peripheral Neuropathy:
Definition:
A common complication of diabetes mellitus in which nerves are damaged as a result of hyperglycemia (high blood sugar levels).
A common complication of diabetes mellitus in which nerves are damaged as a result of hyperglycemia (high blood sugar levels).
Alternative Names: Nerve damage - diabetic
Causes, incidence, and risk factors:
People with diabetes commonly develop temporary or
permanent damage to nerve tissue. Nerve injuries are caused by decreased
blood flow and high blood-sugar levels, and are more likely to develop if
blood-glucose levels are poorly controlled. Some diabetics will not develop
nerve damage, while others may develop this condition relatively early. On
average, the onset of symptoms occurs 10 to 20 years after diabetes has been
diagnosed. Approximately 50% of people with diabetes will eventually develop
nerve damage.
Peripheral nerve injuries may affect cranial nerves or
nerves from the spinal column and their branches. This type of neuropathy
(nerve injury) tends to
develop in stages. Early on, intermittent pain and tingling is noted in the extremities, particularly the feet. In later stages, the pain is more intense
and constant. Finally, a painless neuropathy develops when pain sensation is lost to an area. This greatly increases the risk of severe tissue injury because
pain no longer alerts the person to injury.
develop in stages. Early on, intermittent pain and tingling is noted in the extremities, particularly the feet. In later stages, the pain is more intense
and constant. Finally, a painless neuropathy develops when pain sensation is lost to an area. This greatly increases the risk of severe tissue injury because
pain no longer alerts the person to injury.
Autonomic neuropathies affect the nerves that regulate
involuntary vital functions, including the heart muscle, smooth muscles and
glands. Low blood pressure, diarrhea, constipation, sexual impotence, and
other symptoms can be caused by autonomic neuropathies.
Symptoms:
Numbness
Tingling
Decreased sensation to a body part
Loss of sensation to a body part or area
Diarrhea
Constipation
Loss of bladder control
Impotence
Facial drooping eyelid
Drooping mouth
Vision changes
Dizziness
Weakness
Swallowing difficulty
Speech impairment
Muscle contractions
Note: Symptoms vary depending on the nerve(s) affected and may include symptoms other than those listed. Symptoms usually develop gradually over years.
Tingling
Decreased sensation to a body part
Loss of sensation to a body part or area
Diarrhea
Constipation
Loss of bladder control
Impotence
Facial drooping eyelid
Drooping mouth
Vision changes
Dizziness
Weakness
Swallowing difficulty
Speech impairment
Muscle contractions
Note: Symptoms vary depending on the nerve(s) affected and may include symptoms other than those listed. Symptoms usually develop gradually over years.
Signs and tests:
Physical examination, including neurological and sensory
tests, may reveal many neuropathies. A common early finding is the absence
of ankle reflexes.
Treatment:
The goals of treating diabetic neuropathy are to prevent
progression and reduce the symptoms of the disease. Tight control of glucose
is important to prevent progression. To reduce the symptoms, topical
treatment with Capsaicin or oral medication like amitriptyline, gabapentin,
and carbamazepine have been used successfully. Analgesics (pain medications)
are rarely of much benefit in the treatment of painful neuropathy.
Regular foot exams are important to identify small
infections and prevent progression. If foot injuries go unnoticed for too
long, amputation may be required.
Expectations (prognosis):
The mechanisms of diabetic neuropathy are poorly
understood. At present, treatment alleviates pain and can control some
associated symptoms, but the process is generally progressive.
Complications:
There is an increased risk of injury to the feet because
of loss of sensation. Small infections can progress to ulceration (skin and
soft tissue breakdown)
and require amputation. In addition, motor nerve damage can lead to muscle breakdown and imbalance.
and require amputation. In addition, motor nerve damage can lead to muscle breakdown and imbalance.
Calling your health care provider:
Call your health care provider if signs and symptoms of
diabetic neuropathy develop.
Prevention:
It is clear now that tight control of blood sugar level
(Hemoglobin A1C < 7.0) prevents the development of neuropathy in 60% of type
1 diabetics and decreases the severity of symptoms. In addition, regular
foot care can prevent a small infection from progressing.