January 16, 2012
Diabetic Neuropathy – Part 1
One of the more problematic complications of diabetes is diabetic neuropathy. It is a type of nerve damage where high blood sugars can damage the nerves most often in your feet and legs. Diabetic neuropathy can affect nerves in your entire body ranging from mild problems to painful that can be disabling or fatal.
There are four main types of diabetic neuropathy. All are the result of neglect of or poor diabetes management. You may have just one type or symptoms of several types. Most develop gradually, and you may not notice problems until considerable damage has occurred. For some people with type 2 diabetes, symptoms of neuropathy develop before diabetes is ever diagnosed. How well I know this as I had this at least four years before I was diagnosed.
Peripheral neuropathy. Peripheral neuropathy is the most common form. It affects the very ends of nerves first, starting with the longest nerves. That means your feet and legs are often affected first, followed by your hands and arms.
Signs and symptoms of peripheral neuropathy include - numbness or reduced ability to feel pain or changes in temperature, especially in your feet and toes. It can be a tingling or burning feeling or a sharp, jabbing pain that may be worse at night. It may be a pain when walking, extreme sensitivity to the lightest touch, and for some people, even the weight of a sheet can be agonizing. It can be muscle weakness and difficulty walking, serious foot problems, such as ulcers, infections, deformities, and bone and joint pain.
Autonomic neuropathy. The autonomic nervous system controls your heart, bladder, lungs, stomach, intestines, sex organs and eyes. Diabetes can affect the nerves in any of these areas, possibly causing - a lack of awareness that blood sugar levels are low (hypoglycemia unawareness). Bladder problems, including frequent urinary tract infections or urinary incontinence, constipation, uncontrolled diarrhea or a combination of the two may also happen. Slow stomach emptying (gastroparesis), leading to nausea, vomiting and loss of appetite is not uncommon. Erectile dysfunction in men, vaginal dryness and other sexual difficulties in women, increased or decreased sweating, and the inability of your body to adjust blood pressure and heart rate. This leads to sharp drops in blood pressure when you rise from sitting or lying down (orthostatic hypotension) that may cause you to feel lightheaded or even faint, and problems regulating your body temperature. It may cause changes in the way your eyes adjust from light to dark, difficulty exercising, and increased heart rate when you're at rest.
Autonomic neuropathy is most likely to occur in people who have had poorly controlled diabetes for many years.
Radiculoplexus neuropathy (diabetic amyotrophy). Instead of affecting the ends of nerves, like peripheral neuropathy, radiculoplexus neuropathy affects nerves closer to your hips or shoulders. Also called diabetic amyotrophy, femoral neuropathy, or proximal neuropathy, this condition is more common in people with type 2 diabetes and older adults. Though the legs are affected more often, this type of neuropathy may affect nerves in the arms or even the abdomen. Symptoms are usually on one side of the body, though in some cases symptoms may spread to the other side too. Most people improve at least partially over time, though symptoms may worsen before they get better.
This condition is often marked by - sudden, severe pain in your hip and thigh or buttock; eventual weak and atrophied thigh muscles; difficulty rising from a sitting position; unintentional weight loss; abdominal swelling, if the abdomen is affected.
Mononeuropathy. The term mononeuropathy means damage to just one nerve. The nerve may be in the arm, leg or face. Mononeuropathy, which may also be called focal neuropathy, often comes on suddenly. It's most common in older adults. Mononeuropathy can cause severe pain, but it usually does not cause any long-term problems. Symptoms usually diminish and disappear on their own over a few weeks or months.
Signs and symptoms depend on which nerve is involved and may include - difficulty focusing your eyes, double vision or aching behind one eye; paralysis on one side of your face (Bell's palsy); pain in your shin or foot; pain in the front of your thigh; chest or abdominal pain.
Mononeuropathy occurs when a nerve is compressed. Carpal tunnel syndrome is a common type of compression neuropathy in people with diabetes. Signs and symptoms of carpal tunnel syndrome include - numbness or tingling in your fingers or hand, especially in your thumb, index finger, middle finger and ring finger; a sense of weakness in your hand and a tendency to drop things; worsening of symptoms upon awakening or while gripping something.