Diabetes and Nerves

What is diabetic neuropathy?

Disease of the nerves caused by abnormally high blood glucose levels is called diabetic neuropathy. It is said that approximately 60 to 70% of patients with diabetes will get some form of diabetic neuropathy. The risk rises with age and the duration of diabetes. Nerve problems can occur in every organ system, including the digestive tract, heart, and sex organs.

What are the symptoms of diabetic neuropathy?

There are different types of diabetic nerve diseases and they have different symptoms. Some patients may not have any symptoms initially. For others, the first symptom is often numbness, tingling, or pain in the feet. Symptoms are often minor at first. However, in some types of neuropathy, the onset of pain may be sudden and severe.

Symptoms of nerve damage may include

• numbness, tingling, or pain in the toes, feet, legs, hands, arms, and fingers
• weakness and wasting of the muscles of the feet or hands
• indigestion, nausea, or vomiting
• diarrhoea 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

How is neuropathy diagnosed?

Doctors diagnose neuropathy on the basis of symptoms and a physical exam. During the exam, the doctor may check blood pressure, heart rate, muscle strength, reflexes, and sensitivity to position changes, vibration, temperature, or light touch. People with diabetes should have a comprehensive foot exam each year to check for peripheral neuropathy. People diagnosed with peripheral neuropathy need more frequent foot exams

Your doctor may also do other tests like Nerve Conduction studies or electromyography to assess the type and extent of nerve damage diabetic neuropathy

How can I prevent diabetic neuropathy?

The best way to prevent neuropathy is to keep blood glucose levels as close to the normal range as possible. Maintaining safe blood glucose levels protects nerves throughout the body.

What should I do if I have diabetic neuropathy?

The first treatment step is to bring blood glucose levels within the normal range to help prevent further nerve damage. Blood glucose monitoring, meal planning, physical activity, and diabetes medicines or insulin will help control blood glucose levels. Symptoms may get worse when blood glucose is first brought under control, but over time, maintaining lower blood glucose levels helps lessen symptoms. Your doctor might prescribe medications for pain relief.

To relieve mild symptoms of gastroparesis— indigestion, belching, nausea, or vomiting— doctors suggest eating small, frequent meals; avoiding fats; and eating less fiber. When symptoms are severe, doctors may prescribe medications.

Sitting or standing up slowly may help prevent the light-headedness, dizziness, or fainting associated with blood pressure and circulation problems. Raising the head of the bed or wearing elastic stockings may also help. Some people benefit from increased salt in the diet and treatment with salt-retaining hormones.

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 sensation in the feet means that sores or injuries may not be noticed and may become ulcerated or infected. Circulation problems also increase the risk of foot ulcers. Smoking increases the risk of foot problems and amputation.

More than 60 percent of all leg amputations (without a trauma or accident) happen in people with diabetes.

Careful foot care involves

• Cleaning the feet daily using warm— not hot—water and a mild soap. Soaking the feet should be avoided. A soft towel can be used to dry the feet and between the toes.
• Inspecting the feet and toes every day for cuts, blisters, redness, swelling, calluses, or other problems. Using a mirror—handheld or placed on the floor—may be helpful in checking the bottoms of the feet, or another person can help check the feet.
• Using lotion to moisturize the feet. Getting lotion between the toes should be avoided.
• Filing corns and calluses gently with a pumice stone after a bath or shower.
• Cutting toenails to the shape of the toes and filing the edges each week or when needed.
• Always wearing shoes or slippers to protect feet from injuries.
• Wearing shoes that fit well and allow the toes to move. New shoes can be broken in gradually by first wearing them for only an hour at a time.
• Looking shoes over carefully before putting them on and feeling the insides to make sure the shoes are free of tears, sharp edges, or objects that might injure the feet.

How can we help?

Our centre can help you in various ways

1. Assessing the status of your neuropathy and blood flow to the leg with doppler and biothesiometer
2. Foot care advice
3. Preventive podiatry procedures like corn/callus removal, nail clipping for hard nails etc
4. Minor wound dressings
5. Controlling risk factors like high blood sugars and hypertension