Introduction To Diabetic Neuropathy

Diabetic neuropathy is a complication of diabetes in which the nerves are damaged most commonly in the legs and feet which leads to impaired sensations. It is a common but a serious complication of diabetes mellitus and depending upon the nerves damaged the symptoms may range from pain and numbness in the extremities to problems with digestive system, blood vessels and heart and may even sometimes be fatal.

Clinical features:There are basically four types of diabetic neuropathies with different presenting symptoms. A patient may have symptoms of only type or may have overlapping symptoms.

1. Peripheral Neuropathy: In this type the patient usually have the legs and feet affected first followed by the hands and the arms. The nerve damage in the feet can lead to decreased sensation and increased chances of foot injury. Symptoms include:

• Numbness
• Reduced ability to feel pain or changes in temperature mainly in the feet and the toes.
• Tingling sensation
• Burning sensation
• Pain when walking
• Extreme sensitivity to light touch
• Repeated ulcers, infections in the foot.

Peripheral neuropathy most commonly occurs in patients who have poor;y controlled blood sugar levels and can be prevented by keeping good control on blood sugar, as well as taking good care for the feet and legs to prevent foot injury.

2. Autonomic Neuropathy: In this type the nerves of the autonomic nervous system that controls the heart, digestive system, bladder, sex organs and eye are damaged secondary to diabetes. Symptoms include:

• Constipation
• Bloating
• Diarrhea
• Lack of awareness when blood sugar levles falls
• Frequent urinary tract infections
• Urinary incontinence
• Heartburn
• Nausea and vomiting
• Loss of appetite
• Feeling of fullness of stomach due to delayed emptying.
• Sexual difficulties
• Sudden abnormal sweating
• Palpitations
• Problems in blood pressure regulation

The symptoms may be managed by strict diabetic control, eating small frequent meals, not to stand up quickly and with medications.

3. Diabetic Proximal Neuropathy: This type cause the proximal nerves to be damaged leading to pain in the buttocks. hip and thighs. More common in older adults and usually effects one side of the body. Managed by good sugar controls and physiotherapy.

4. Diabetic Focal Neuropathy: It involves damage to a specific nerve, most commonly in the head , torso or the legs. The symptoms depends upon the nerve damaged and include conditions like:

• Double vision
• Bell’s palsy ( paralysis of one side of the face due to facial nerve damage )
• Pain in front of the thigh
• Abdominal pain
• Eye pain etc

Focal neuropathy is usually very painful but it improves over time.

Diagnosis: Diabetic neuropathy is usually diagnosed by the patient’s history, examination and symptoms. However certain test helps in a more definitive diagnosis These include:

• Nerve conduction studies
• Electromyography
• Doppler studies
• Nerve and skin biopsy

Management: Although there is no definitive cure for diabetic neuropathy, there are treatments available that help manage the symptoms.

1. Pain can be controlled by medications like gabapentin, sodium valproate, certain antidepressants etc.

2. It is important to take good care of the feet and prevent any injuries. The feet should be examined at every visit. Patient should wear a comfortable foot wear and take care of the nails preventing any possible injuries

3. Counselling is important for sexual dysfunction, along with necessary medicines

4. Sometimes surgical options may be considered in non healing foot ulcers and intractable gastroperesis.