What is Diabetic Neuropathy

Neuropathy means a disease or dysfunction in your nerves that results in weakness or makes your nerves go numb and causes pain in the affected area. Diabetic Neuropathy is a type of nerve damage that can happen if you have diabetes. This damages explicitly nerves in your feet and legs. High Blood Sugar (Glucose) can injure nerves throughout your body.

Depending on the affected nerves, the symptoms can range from pain and numbness in your legs and feet to problems with your digestive system, urinary tract, blood vessels, and heart. Some people experience mild symptoms such as numbness of the feet and legs. For some people, Diabetic Neuropathy can cause a lot of pain and disability.

Diabetic Neuropathy is severe and can affect a lot of people that have diabetes. Still, you can prevent this from happening or slow its progress by managing your blood sugar level and maintaining a healthy lifestyle such as eating vegetables and fruits, drinking water, and working out.  

4 TYPES OF DIABETIC NEUROPATHY AND SYMPTOMS

There are four main types of Diabetic Neuropathy: Peripheral, Proximal, Autonomic, and Focal. You can also have one or more kinds of Neuropathy. The symptoms you will experience also depend on what type of Diabetic Neuropathy you have and what nerves are affected. You may not know that you have this condition at first, not until the nerve damage has occurred and affected your body.

1. Peripheral Neuropathy (Diabetic Nerve Pain)

Peripheral Neuropathy is also called Diabetic Nerve Pain or Distal Polyneuropathy. It's the most common type of Peripheral Neuropathy, and it occurs in the feet and legs, followed by hands and arms. Rare cases may also affect the abdomen and back.

Symptoms Include:

• Numbness or may reduce your ability to feel pain and change of temperature.
• Tingling or slight prickling 
• Burning occurs, especially at night.
• Increased sensitivity to touch, for some people, the weight of the bedsheet can even affect the sensitivity and causes pain.
• Foot problems such as ulcer, infection, bone, and joint pain.

Early symptoms usually get better when you take care of and control your blood sugar. There are medications and things you can do to relieve the discomfort.

Things to do:

• Examine your feet and legs daily
• Use lotion or moisturizing cream that can help reduce the dryness of your feet and legs
• Take care of your toenails, ask your doctor if you should go to a Podiatrist.
• Reduce wearing ill-fitting shoes that make your feet hurt, your feet should be comfortable, and the blood is circulating correctly.

2.  Proximal Neuropathy (Diabetic Amyotrophy)

Proximal Neuropathy is a rare condition that disables, weakens, or damages your hip, buttock, and thigh. This type of nerve damage usually affects the side of your body, and on some rare occasions, it can spread to the other side of your body. This is more common in men than women and more common in people aged 50 years old and older.

Symptoms Include:

• Sudden pain in your hip, buttock, or thigh
• Weakness of your legs and shrinking of thigh muscles that makes it difficult to stand from a sitting position
• Weight loss
• Loss of reflexes such as "Knee-jerk-reflex" is the sudden kicking movement of the lower leg as a reflex to a sharp tap on the area below your knee cap.
• Muscle wasting or the loss of muscle tissue or mass

After symptoms start, they usually get worse and gradually get better for months or years, but only in some cases. In most cases, the symptoms do not go away completely.

Things to do:

• Relieve the pain such as taking medications, talk to your doctor to find the best option for you to know what might work best for you
• Managing complications and restoring function, to work the difficulties, you may need care from different specialists, such as a doctor that treats the urinary tract problems (urologist) and a heart doctor (Cardiologist) who can help prevent further complications and treat them.
• Keep your blood pressure under control. Make sure that you get your blood pressure checked every time you go to your doctor.
• Make healthy food choices, such as eating vegetables and fruits.
• Be active every day. Try to exercise to help your blood flow.
• Stop smoking. Using tobacco in any form can make your blood circulation can develop poor blood circulation.

3. Autonomic Neuropathy

Autonomic Neuropathy is damage to your digestive system, especially in your stomach. These can also affect your blood vessels, the urinary system, which are kidneys, ureters, bladders and urethra, and sex organs.

Symptoms Include:

In your digestive system

• Bloating or the swelling of your stomach after eating
• Diarrhea, having loose or watery stools
• Heartburn, burning pain in the lower chest
• The feeling you overate food after taking a small intake of food
• Vomiting

In your Blood vessels

• Blacking out when you stand up quickly
• Having low blood pressure
• Feeling dizzy or unsteady
• Vomiting
• Faster heartbeat

In men

• They may not be able to keep an erection or have "Dry" or reduced ejaculations

In women

• Can lessen the vaginal lubrication and fewer or no orgasms at all

You may need to take in smaller amounts of foods and take medication to treat them. This can also cause decreased sexual response, so see your doctor know the proper medications and treatment that should be done.

Things to do:

• Change your posture, slowly stand up when you feel dizzy, flex your feet and make fists with your hands for a few seconds before standing up. This will help your blood flow.
• Elevate or raise the head of your bed about 4 inches
• Small food intake, increase the taking of fluids, choose low-fat and high-fiber foods that can help indigestion.
• Control your blood sugar

Things to do:

For men and women

• Vacuum erection device
• Medication, the medicine that you will take should be prescribed or recommended by your doctor
• Penile implant or injections
• Vaginal estrogen creams, suppositories, and rings
• Lubricants

4. Focal Neuropathy (Mononeuropathy)

Focal Neuropathy is a condition that damages a single nerve. There are two types of focal Neuropathy: cranial and peripheral; this often occurs in your hand, head, torso, and leg. This type of nerve damage is less common compared to peripheral or autonomic Neuropathy.

Symptoms Include:

• Aching or experiencing pain in the eyes
• Difficulty in focusing or having double vision
• Paralysis on one side of your face (Bell's palsy)
• Weakness in your hands that makes it hard for you to hold things long enough and causes you to drop it
• Numbness or tingling in your hand or fingers except for the pinkie or little finger

Focal Neuropathy doesn't cause long-term damage and tends to improve itself over weeks or months. This damage in the nerve is usually unpredictable, so it's better if you see a doctor if you are experiencing any symptoms.

How do doctors treat focal neuropathies:

• Wearing a splint or a brace to take pressure off the nerve and help the blood circulation
• Medicines that reduce inflammation and pain in the nerve
• If other treatments don't work, the best option is to do surgery

WHAT CAUSES DIABETIC NEUROPATHY?

Researchers think that uncontrolled high blood sugar levels cause diabetic Neuropathy sustained damage and affects the nerves causing it to interfere with their ability to send signals, leading to diabetic Neuropathy. High blood sugar also damages the walls of the small blood vessels, also called capillaries, which causes them to weaken. These are the vessels that supply oxygen and nutrients to the body.

RISK FACTORS

Anyone who has diabetes can develop Neuropathy, but these risk factors can make you more likely to get nerve damage.

• Poor blood sugar control- uncontrolled blood sugar means your blood sugar is too high and puts you at risk of every diabetes complication that can damage your nerves.
• Being overweight- a bodyweight greater than what is considered or healthy (Having a body mass of 25 and above) can increase your risk of diabetic Neuropathy.
• Smoking shrinks and hardens your arteries, causing you to reduce the blood flow in your legs and feet, resulting in difficulty in healing wounds in your body and damaging your peripheral nerves.
• Kidney Disease- the high level of sugar in the blood damages tiny filtering units of each kidney and eventually leads to kidney failure. Around 20 - 30 percent of people develop kidney disease, which can lead to nerve damage.
• A history of diabetes in the family- type 2 diabetes can be hereditary. This doesn't guarantee you will develop it if your mother or father has or has diabetes, but this just means that you have a greater chance of having type 2 diabetes.

COMPLICATIONS IN DIABETIC NEUROPATHY

Diabetic Neuropathy can cause several complications, including:

• Loss of a toe, foot, or leg - loss of a toe, foot, or leg is caused by nerve damage. Minor cuts can turn into sores or ulcers without you realizing it. In severe cases, an infection can spread to the bone or even lead to tissue death. Amputation or removal of a leg, toe or foot may be necessary in these cases.
• Hypoglycemia unawareness - Blood sugar levels that are lower or higher than 70 milligrams per deciliter (mg/dL) cause sweating, shakiness, and a fast heartbeat, but if you have autonomic Neuropathy. You may not notice these signs immediately.
• Urinary tract infections and urinary incontinence - You may be unable to fully clear your bladder if the nerves that control your bladder are damaged. Bacteria can build up in the bladder and kidneys that causing urinary infections to occur. Damage to the nerve can also affect your feeling when you urinate or control the muscles that release urine. This leads to leakage.
• Digestive problems - If nerve damage starts to spread or happens in your digestive tract, you can experience diarrhea or constipation, or even both. Diabetes-related nerve damage can lead to gastroparesis, a condition where the stomach cannot empty or is having a hard time opening in the normal way. Food passes through slower than usual.
• Sexual dysfunction - Autonomic Neuropathy damages the nerves that affect the sex organs to function well. Men may have a hard time ejaculating or erectile dysfunction, while women may have difficulty lubrication and arousal.
• Increased or decreased sweating - Nerve damage can affect how your sweat glands work, making it difficult to control the changes in your body's temperature.

THINGS TO REMEMBER:

• Half of the people who are experiencing or have diabetes can develop Neuropathy.
• The feet usually go numb, although many people experience significant discomfort and pain in other areas.
• Most people who have diabetic Neuropathy are unaware that they have nerve damage until they visit a doctor and get a screening or develop symptoms and complications.
• Although there is no exact cure in treating diabetic Neuropathy, early diagnosis and treatment can improve your lifestyle and reduce the risk of further complications.
• The nerves in the feet are most commonly affected by diabetic Neuropathy.

CAN DIABETIC NEUROPATHY BE PREVENTED?

It is better to be guided by a specialist or a doctor, but the suggestions that can reduce the risk of having diabetic Neuropathy include:

• Maintain blood sugar levels within the target range. This ranges within 70 to 99 mg/dL (3.9 to 5.5 mmol/L).
• Workout or exercise regularly, keep your body active this helps the blood to circulate in your body better.
• Maintain a weight that is suitable for your height.
• STOP SMOKING, smoking destroys your body, and your body needs to stay healthy to function well.
• Reduce your blood pressure and lipid (fat) by changing your lifestyle and diet. This may also involve medications that you need to take as prescribed by your doctor.
• Have an appointment with a doctor if you feel any early symptoms, including pain, numbness, and tingling in your feet, so that that prevention can be done.
• Have your feet checked by a specialist such as a doctor, podiatrist, or diabetes educator, or if you have symptoms and signs of problems with your feet and legs.

References:

• Diabetic neuropathy - Symptoms and causes
• Before She Was Diagnosed With Multiple Sclerosis, This Dancer and DJ Saw 14 Specialists | Health.com
• Diabetic Neuropathy: Types, Symptoms, Prevention, Treatment
• Things to Know About Diabetic Neuropathy | Southern Pain & Neurological    
• Focal Neuropathies | NIDDK 
• Early Supported Discharge (ESD) Service