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Diabetic Neuropathy: Causes, Types, Symptoms, Diagnosis & Treatment

Diabetes has become one of the largest global health care problems affecting 415 million people worldwide and it is predicted that the number would double by 2030. One of the most common complications of diabetes is diabetic neuropathy. It occurs when there is a rise in blood sugar levels and it most often damages the nerves in the legs and feet.

Let's get into the detail of what causes diabetic neuropathy and how to treat it.

What Causes Diabetic Neuropathy [1]

Diabetic neuropathy is a type of nerve damage that occurs when your body has high blood sugar levels. A rise in blood sugar levels can damage the nerves and interfere with their function; it can also damage the small blood vessels that supply the nerves with oxygen and nutrients.

However, a combination of other factors can also cause nerve damage which includes genetic factors, inflammation in the nerves, smoking and alcohol abuse.

Types Of Diabetic Neuropathy

  • Peripheral symmetric neuropathy - It is the most common form of diabetic neuropathy, which affects the hands and feet [2]
  • Autonomic neuropathy - It damages the nerves that control the internal organs of the body. This can lead to problems in the digestive system, sweat glands, eyes, heart rate and blood pressure [3] .
  • Proximal neuropathy - It damages the nerves in specific parts of the body such as the thighs, hips, buttock and legs [4] .
  • Mononeuropathy - It damages a single nerve in the face or torso, or leg. This leads to loss of movement, sensation and other functions in the nerve and this occurs as a result of injury [5].

Symptoms Of Diabetic Neuropathy [1]

  • Numbness or pain or tingling sensation in the arms and feet
  • Loss of muscle tone in the hands and feet
  • Loss of balance
  • Heartburn
  • Bloating
  • Difficulty in speaking and swallowing
  • Nausea
  • Constipation
  • Diarrhoea
  • Sexual dysfunction
  • Excessive sweating
  • Muscle contraction
  • Aching behind the eyes
  • Weight loss
  • Vaginal dryness
  • Increased heart rate
  • Sensitivity to touch
  • Loss of sense of touch

Risk Factors Of Diabetic Neuropathy [6]

  • Overweight - If your body mass index (BMI) is more than 24 it may increase diabetic neuropathy risk.
  • Kidney disease - Diabetes damages the kidneys and once the kidneys are damaged, they send the toxins into the bloodstream leading to nerve damage.
  • High blood sugar levels - Uncontrolled blood sugar levels can put you at risk of nerve damage.
  • Smoking - It is a risk factor of diabetic neuropathy because it narrows and hardens the arteries, thereby reducing blood flow to the legs and feet. This causes damage to the peripheral nerves.
  • History of diabetes - If you have been diagnosed with diabetes, it may put you at risk of diabetic neuropathy, especially when your blood sugar isn't well-controlled.

Complications Of Diabetic Neuropathy

  • Loss of toe, foot or leg
  • Joint damage
  • Urinary tract infections
  • Low blood pressure levels
  • Digestive problems
  • Sexual dysfunction

When To See A Doctor

You should consult a healthcare professional if you

have a cut or sore on your foot that is taking time to heal,

experience dizziness,

see changes in digestion, urination or sexual function and

experience burning, tingling, weakness or pain in the hands or feet.

Diagnosis Of Diabetic Neuropathy

The doctor will first physically examine you and carefully review your symptoms and medical history. The doctor will then check for overall muscle strength and tone, tendon reflexes, and whether you are sensitive to touch and vibration.

The tests for diagnosing diabetic neuropathy includes the following:

  • Electromyography (EMG) - It measures and records the electrical activity produced by the muscles [7] .
  • Filament test - To test your sensitivity to touch, the doctor will brush a soft nylon fibre over certain areas of the skin [8] .
  • Quantitative sensory testing - The test is done to evaluate how your nerves respond to vibration and temperature changes [9] .
  • Nerve conduction velocity test - It is an electrical test used to measure the speed of conduction of an electrical impulse through a nerve [10] .

Treatment Of Diabetic Neuropathy [11]

The first treatment of diabetic neuropathy is to manage blood pressure, blood sugar and blood cholesterol levels. Some medications and physical therapy can help in relieving the pain of diabetic neuropathy.

Medications

According to The American Diabetes Association, antiseizure drugs like pregabalin, gabapentin, and carbamazepine can help in the treatment of diabetic neuropathy. However, having these medicines may cause side effects like dizziness, swelling and drowsiness.

Antidepressant medications like amitriptyline, desipramine and imipramine can provide relief from diabetic neuropathy symptoms. The side effects of these medications are sweating, weight gain, dizziness, constipation and dry mouth.

Physical Therapy

Physical therapy, when used in combination with medicines, aids in relieving pain and help alleviate muscle cramps, sexual dysfunction, muscle weakness, burning and tingling sensation in the legs and feet.

Electrical nerve stimulation is a type of physical therapy that helps lower the feelings of stiffness and promotes the healing of foot ulcers.

A good physical therapist is required for diabetic neuropathy patients to ensure that your exercises will not hurt the feet.

View Article References
  1. [1] Bansal, V., Kalita, J., & Misra, U. K. (2006). Diabetic neuropathy.Postgraduate medical journal,82(964), 95-100.
  2. [2] Azhary, H., Farooq, M. U., Bhanushali, M., Majid, A., & Kassab, M. Y. (2010). Peripheral neuropathy: differential diagnosis and management.Am Fam Physician,81(7), 887-892.
  3. [3] Bhuyan, A. K., Baro, A., Sarma, D., & Choudhury, B. (2019). A study of cardiac autonomic neuropathy in patients with type 2 diabetes mellitus: A Northeast India experience.Indian journal of endocrinology and metabolism,23(2), 246.
  4. [4] Pascoe, M. K., Low, P. A., Windebank, A. J., & Litchy, W. J. (1997, December). Subacute diabetic proximal neuropathy. InMayo Clinic Proceedings(Vol. 72, No. 12, pp. 1123-1132). Elsevier.
  5. [5] Dyck, P. J. B., Hunder, G. G., & Dyck, P. J. (1997). A case-control and nerve biopsy study of CREST multiple mononeuropathy.Neurology,49(6), 1641-1645.
  6. [6] Papanas, N., & Ziegler, D. (2015). Risk Factors and Comorbidities in Diabetic Neuropathy: An Update 2015.The review of diabetic studies : RDS,12(1-2), 48-62.
  7. [7] Lamontagne, A., & Buchthal, F. (1970). Electrophysiological studies in diabetic neuropathy.Journal of neurology, neurosurgery, and psychiatry,33(4), 442-452.
  8. [8] Dros, J., Wewerinke, A., Bindels, P. J., & van Weert, H. C. (2009). Accuracy of monofilament testing to diagnose peripheral neuropathy: a systematic review.Annals of family medicine,7(6), 555-558.
  9. [9] Jia, Z. R., Wang, T. T., & Wang, H. X. (2014). Significance of quantitative sensory testing in the diagnosis of diabetic peripheral neuropathy.Journal of clinical neurophysiology,31(5), 437-440.
  10. [10] Tehrani K. (2018). A Study of Nerve Conduction Velocity in Diabetic Patients and its Relationship with Tendon Reflexes (T-Reflex).Open access Macedonian journal of medical sciences,6(6), 1072-1076.
  11. [11] Javed, S., Petropoulos, I. N., Alam, U., & Malik, R. A. (2015). Treatment of painful diabetic neuropathy.Therapeutic advances in chronic disease,6(1), 15-28.

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