May 22, 2012

What Is Diabetic Neuropathy? - Part 1

Apparently there is more added to diabetic neuropathy recently, and there has been some new classifications added or revised. This article dated May 11, 2012 has some terms I have not encountered recently. Therefore, I think this could be very enlightening for others and especially members of our informal group.

Diabetic neuropathy refers only to people with any type of diabetes. Reading the first sentence only can be misleading. Therefore, I am quoting the conditions and definitions for clarity and accuracy.

“Different nerves are affected in varying ways. Relatively familiar conditions, which may be associated with diabetic neuropathy, include:
  • Third Nerve Palsy: When the individual cannot move his eye normally due to damage of a cranial nerve.
  • Mononeuropathy: When only a single nerve is affected - the nerve is physically compressed, resulting in a lack of blood supply.
  • Amythrophy: Muscle pain due to progressive waste and weakening of muscle tissues.
  • Mononeuropathy multiplex: Profound aching soreness regularly felt in the lower back, hips or legs, resulting in sharp loss of sensory function of the nerves. This can slowly develop over a number of years.
  • Polyneuropathy: Most commonly, this disorder results in weaker hands and feet, as well as some loss of sensation in the affected areas. Some patients complain of a burning needles-like pain. This disorder occurs when many nerves throughout the body simultaneously malfunction. The patient might step on something that should hurt, but feel nothing. It can appear either without warning or steadily over a long period.
  • Autonomic neuropathy: The visceral nerve is affected, which may impact on the heart rate, digestion, respiration, salivation, perspiration, blood vessels, and sexual arousal. This occurs when there is a failure from the heart arteries to adjust heart rate and vascular tone to keep blood flowing continually to the brain. Dizziness or fainting when standing up rapidly is common.
  • Sensory motor neuropathy: When sensory nerve loss affects the face; in some cases it may spread to the upper arms.”

Read my blog here for comparison of terms and notice the increase in terms used in this article. I am not sure if some of these were extracted from some of the prior used terms or are new definitions that needed to be explained. Terminology has increased from four to seven.

Recent studies have found that approximately 50 percent of people with diabetes develop diabetic neuropathy. The disturbing part of this is the signs (diagnosed by a doctor) and symptoms (felt by the patient and needs to be told to a doctor) tend not to be experienced for 10 to 20 years after diabetes diagnosis. Even more frustrating is that the majority of individuals with neuropathy symptoms do not realize what is happening until the complications are severe or possibly permanent.

Because of their importance, again I will quote from the article, “Some of the signs and symptoms associated with diabetic neuropathy:
  • Numbness, electric pain, tingling and (or) burning sensations starting in the extremities and continuing up the legs or arms
  • Heartburn and bloating
  • Nausea, constipation or diarrhea
  • Problems swallowing
  • Feeling full when eating small amounts of food
  • Throwing up after a few hours of having eaten
  • Orthostatic Hypotension (feeling light-headed and dizzy when standing up)
  • Faster heart rate than normal
  • Chest pains, which sometimes can be a warning of an impending heart attack
  • Sweating excessively even when temperature is cool or the individual is at rest
  • Bladder problems - difficulty in emptying the bladder completely when going to the toilet, leading to incontinence
  • Sexual dysfunction in men
  • Sexual problems in women with vaginal dryness and lack of orgasms
  • Dysesthesia - the patient's sense of touch is distorted
  • Significant facial and eyelid drooping
  • Eyesight may be affected
  • Muscle weakness
  • Speech impairment
  • Muscle contractions"

How is diabetic neuropathy diagnosed? This is where a patient needs to communicate with the doctor when some of the symptoms (more than one) of the above are noticed. The doctor should do or recommend some diagnostic tests before making a definitive diagnosis. The doctor should also ask some very specific questions and the patient needs to answer them honestly.

If your doctor orders an MRI, you should question the validity for doing this as it is not the tool for definitive diagnosis as discussed in my blog here. The doctor may order an electromyogram (EMG). This records the electrical activity in the muscles. The doctor may also request a Nerve Conduction Velocity test (NCV). This test records the speed at which induced signals pass through the nerves. Both are excellent definitive tests and less expensive than an MRI.

During the physical examination, the doctor will check your ankle reflexes, for loss of sensation in your feet, changes in skin texture and color, and for a sudden drop in blood pressure when you stand up from the prone position. The doctor may also use the filament test and the vibration test to check for loss of sensation.

Next blog will cover treatments and complications.

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