How does diabetes effect your nerves?
You notice that lately your legs and feet have been numb and tingling intermittently. Occasionally, you also have been having a cramping sensation in your feet. At first, you don’t think much of it, but you notice that it is happening more frequently. What is going? Is there anything you can do to prevent it?
Definition
Diabetic neuropathy is a complication of diabetes. It is when your nerves become damaged as a result of chronic high blood sugar (glucose) levels. The damage interferes with your nerves ability to send their signals to and from different parts of your body. There are four different types, each one affects different nerves throughout your body and it is possible to have more than one type at a time. For all of them, symptoms develop gradually. Symptoms vary depending on the nerves that are involved. Peripheral neuropathy is the most common type and affects your feet and legs, then your hands and arms. Symptoms are typically worse at night and include numbness, reduced ability to feel pain/temperature changes, tingling/burning sensations, sharp pain/cramps, increased sensitivity to touch, muscle weakness, loss of reflexes, loss of balance/coordination and foot problems (ex. ulcers and infections). Autonomic neuropathy is when the nerves of your autonomic nervous system are affected. This portion of your nervous system controls the parts of your body that you don’t have conscious control over, such as your heart, bladder, stomach, intestines, sex organs and eyes. The symptoms related to this type can vary significantly. Some possible symptoms include bladder problems (retention or incontinence), constipation or uncontrolled diarrhea, slowing of digestive system, difficulty swallowing, problems controlling body temperature, changes to your vision, heart rate and blood pressure issues, erectile dysfunction and vaginal dryness. Radiculoplexus neuropathy is more common in individuals with type 2 diabetes who are older. It affects the nerves that are in your thighs, hips, buttocks or legs. Symptoms usually start on one side of the body and can spread to the other. They include severe pain in your hip/thigh/buttock, weakness/shrinking of thigh muscle, difficulty getting up from a sitting position, abdominal swelling and weight loss. Mononeuropathy is also known as focal neuropathy and is when damage occurs to nerves in your face, middle of your body or legs. It is most common in older adults and strikes suddenly, but it isn’t long-term with symptoms disappearing in a few weeks to months. Symptoms include severe pain in the area affected, such as shin/foot, lower back/pelvis, front of thigh and chest/abdomen. If your facial nerves are involved, you may have difficulty focusing your eyes, double vision, pain behind one eye or Bell’s palsy (paralysis on one side of your face).
The complications of diabetic neuropathy can be very serious. Nerve damage can make it challenging to be aware of changes that are going on within your body. If the damage is severe enough in your feet and legs, you might not be aware of an infection and this can result in you needing to have an amputation of your toe, foot or lower leg. Changes to your bladder function can result in frequent urinary tract infections. If your heart rate and blood pressure are affected, you could easily get injured if you pass out from them suddenly decreasing. For some individuals, they become unaware of the symptoms when their blood sugar is too low, which puts them at risk for a hypoglycemic event. There are many more complications, it just depends on the type of diabetic neuropathy you have. Certain things can place you at increased risk for developing diabetic neuropathy. The number one risk factor is having poor control of your blood sugar. Some other factors are how long you have been diagnosed with diabetes (your chances increase the longer you have had it), having kidney issue (which can be common for diabetics), being overweight and smoking.
Treatment
Unfortunately, there is no cure for diabetic neuropathy, so the goal of treatment is to slow progression, relieve pain, manage complications and restore function. The best thing you can do is to maintain control of your blood sugar. Your doctor will help you figure out what range is best for you. In order to help control your blood sugar and blood pressure, your doctor is going to recommend eating a healthy diet and get regular exercise. There are many medications available to help with pain that is associated with diabetic neuropathy. Sometimes, your doctor may decide to try medications that are intended for treating something else but have been proven to help individuals with neuropathy (this is known as off-label use), such as anti-seizure medications and antidepressants. In order to manage any complications, you might have to see a specialist for that specific area of your body, like a urologist for urinary tract issues or a cardiologist for any heart issues. Your doctor may also refer you to a physical/occupational therapist to help with restoring bodily functions.
Prevention
The two most important things you can do to prevent diabetic neuropathy are managing your blood sugar effectively and taking care of your feet. It is vital to keep your blood sugar in the target range discussed by you and your doctor and to have glycosylated hemoglobin (A1C) test twice a year at a minimum. This test measures your average blood sugar for a couple month period (the goal is to have an A1C under 7 percent) and is an indicator of how well control your blood sugar has been. By practicing good foot care, you will notice if there are any changes that you should seek treatment for sooner rather than later. Be sure to inspect your feet daily for any sores or changes, keep them clean/dry, wash your feet daily (don’t soak), moisturize your feet to prevent cracking (don’t get lotion between your toes because this can lead to fungal infections), be careful while trimming toenails, wear clean/dry socks and wear well cushioned shoes that fit appropriately.
Diabetic neuropathy is unpleasant and can have serious complications. With the information you have now, you should be able to prevent or slow the progression of it. If you have any questions or concerns, please speak with your doctor. If you would like more information, please visit the American Diabetes Association’s Neuropathy page at http://www.diabetes.org/living-with-diabetes/complications/neuropathy/