Diabetic Neuropathy

Strong relationship between diabetes mellitus and neuropathy

Diabetic neuropathy is a type of nerve damage that can occur if you have diabetes. High blood sugar can injure nerves throughout your body. Diabetic neuropathy most often damages nerves in your legs and feet.

Depending on the affected nerves, symptoms of diabetic neuropathy 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 have mild symptoms. But for others, diabetic neuropathy can be quite painful and disabling. Over time, high blood glucose and high levels of fats, such as triglycerides, in the blood from diabetes can damage your nerves and the small blood vessels that nourish your nerves, leading to peripheral neuropathy.

Poor blood sugar control is a major risk factor for diabetic neuropathy; uncontrolled blood sugar puts you at risk of every diabetes complication, including nerve damage.

Your risk of diabetic neuropathy increases the longer you have diabetes, especially if your blood sugar isn’t well-controlled.  Diabetes can damage the kidneys. Kidney damage sends toxins into the blood, which can lead to nerve damage. Being overweight may increase your risk of diabetic neuropathy while smoking narrows and hardens your arteries, reducing blood flow to your legs and feet. This makes it more difficult for wounds to heal and damages the peripheral nerves.

The type of condition and symptoms depend on which type of diabetic neuropathy you have. The condition may be chronic as most neurodegenerative disorders are chronic and develop over time.

Guillain-Barré syndrome is the most common acquired inflammatory neuropathy. Some peripheral neuropathy cases may take years before their symptoms begin to appear, while some patients may experience symptoms hours or days after their diagnosis.

Complications

Diabetic neuropathy can cause a number of serious complications, including loss of a toe, foot or leg; nerve damage can make you lose feeling in your feet. Foot sores and cuts may silently become severely infected or turn into ulcers. Even minor foot sores that don’t heal can turn into ulcers. In severe cases, infection can spread to the bone, and ulcers can lead to tissue death (gangrene). Amputation of a toe, foot or even the lower leg may be necessary. Nerve damage can cause a joint to deteriorate, causing a condition called Charcot joint. This usually occurs in the small joints in the feet. Symptoms include loss of sensation and joint swelling, instability and sometimes joint deformity. Prompt treatment can help you heal and prevent further joint damage.

Urinary tract infections and urinary incontinence may also develop. If the nerves that control your bladder are damaged, you may be unable to fully empty your bladder. Bacteria can build up in the bladder and kidneys, causing urinary tract infections. Nerve damage can also affect your ability to feel when you need to urinate or to control the muscles that release urine, leading to leakage (incontinence).

Low blood sugar normally causes shakiness, sweating and a fast heartbeat. But if you have autonomic neuropathy, you may not notice these warning signs. Damage to the nerves that control blood flow can affect your body’s ability to adjust blood pressure. This can cause a sharp drop in pressure when you stand after sitting (orthostatic hypotension), which may lead to dizziness and fainting.

If nerve damage strikes your digestive tract, you can have constipation or diarrhea, or bouts of both. Diabetes-related nerve damage can lead to gastroparesis, a condition in which the stomach empties too slowly or not at all. This can interfere with digestion and severely affect blood sugar levels and nutrition. Signs and symptoms include nausea, vomiting and bloating.

Nerve damage can disrupt how your sweat glands work and make it difficult for your body to control its temperature properly. Some people with autonomic neuropathy have excessive sweating, particularly at night or while eating. Too little or no sweating at all can be life-threatening.

Prevention

You can prevent or delay diabetic neuropathy and its complications by keeping tight control of your blood sugar and taking good care of your feet. Use an at-home blood sugar monitor to check your blood sugar and make sure it consistently stays within target range. It’s important to do this on schedule. Shifts in blood sugar levels can accelerate nerve damage. It is very important to follow your doctor’s recommendations for good foot care. Foot problems, including sores that don’t heal, ulcers and even amputation, are a common complication of diabetic neuropathy. But you can prevent many of these problems by having a comprehensive foot exam at least once a year, having your doctor check your feet at each office visit and taking good care of your feet at home.