Jaya V Patil,
Dietitian, Dept of Endocrinology,
M S Ramaiah Medical Teaching Hospital
Diabetic neuropathy or nerve damage caused by high blood sugar, is a common complication of diabetes. While not all forms of neuropathy causepain, the form of neuropathy known as sensory neuropathy often does.
Sensory neuropathy typically affects the nerve in the feet, legs, hands and arms.
Symptoms of sensory neuropathy vary from person to person and can include tingling or burning pain in the affected body part, a numbness or coldness in the extremities and hypersensitivity to touch. Symptoms tend to worsen at night and can be severe enough to make even the weight of bedcovers unbearable.
A person's risk of developing any type of nerve damage increases with the duration of diabetes. High blood pressure and high blood sugar also increases the risk of developing nerve damage. Tight blood glucose control has been shown to delay and even prevent the onset and progression of diabetic neuropathy.
Normally, nerve fibers carry electric impulses (messages) throughout the body, signaling different muscles and organ to respond. These fibers, called axons, are surrounded by an insulating membrane called the myelin sheath, which helps nerve transmit the electric signals. Presence of high blood sugar damages the part of the nerve that transmits messages. Or in some cases, nerve damage appears with blood vessel damage. When blood vessels supplying oxygen and nutrients to particular nerves become damaged those nerves may not receive adequate nutrients and are damaged. The third reason could be when blood glucose levels are high, glucose molecules are more likely to attach to protein on cell that make up the myelin sheath or nerve fibers and thus affect the nerve function.
Diabetic neuropathy appears in several forms, depending on which nerves are involved in any particular area or organ.
The most common type of neuropathy is that which affects hands and legs. In most cases several nerves are damaged simultaneously and nerves on both sides of the body are affected. Peripheral neuropathy can affect the sensory nerves which normally detect pain, pressure or change in temperature and the motor nerves, which control voluntary movement.
Damage to the sensory nerves can lead to painful sensation or loss of sensation in the hand, feet, legs and arms. Damage to motor nerves can lead to muscle weakness and wasting. Nerve damage may be due to blockage of blood supply to a nerve in specific part of the body such as an eye or an arm or a leg. When a limb is affected, it suddenly becomes week. In some cases nerves that control heartbeat, blood pressure, digestion and urination are also affected. Damage to such nerves can lead to slow stomach emptying, diarrhea, bladder problems, excessive sweating, dry skin and impotence. It might also reduce the person's ability to recognize the symptoms of low blood sugar.
Painful neuropathy resulting from damage to sensory commonly occur around feet, ankles, hands and wrist. The resulting pain has been described as "tingling", "electric like", "burning"," stabbing", and has been compared to the feeling of pins and needles.
Screening Test: A simple test doctors use to check for loss of sensation in the lower extremities involves touching of different parts of the foot with a pin or tuning fork. People who do not feel these stimuli in certain areas have lost protective sensation in those areas and are at risk for developing ulcers or other types of injuries.
The best way to prevent diabetic neuropathy is to maintain tight blood glucose control. Some evidence show that bringing blood sugar to normal range when they have been high can improve or reverse the symptoms of existing diabetic neuropathy. Best recommendation to keep nerves healthy is by exercising regularly and eating foods rich in minerals and vitamins.
Smoking contributes to blood vessel damage and may raise a person's risk for developing neuropathy. Alcohol has a toxic effect on nerves, so intake should be minimized. Hence smoking and alcohol consumption should be stopped.
Drugs: A number of drugs are used to treat painful neuropathic symptoms. However, no one drug is effective for everyone. Pain is more than a physical phenomenon. It can also take a toll psychologically. When chronic pain interferes with a person's social life or daily activities or when it causes high levels of stress or depression, relaxation techniques can help reduce pain and increase the person's ability to cope. Relaxation training and meditation are 2 techniques that can be practiced either at home or in group setting.
When nerve damage results in decreased sensation in the feet, small wounds may go undetected and turn out into more problematic ulcers or infections.
Here are some tips for preventing foot problems: Check your feet and toes daily. Look for swollen, red areas, cuts or other breaks in the skin. Also note very cold areas, which may indicate poor circulation and very warm areas which may indicate infection. If you cannot see or reach your feet easily, ask your family member to inspect for you.
Wash your feet every day using a mild soap and dry them thoroughly. Use cold cream or moisturizer to prevent dry skin. Never go barefoot. Use clean cotton socks everyday. Wear comfortable, well fitting shoes. Before putting on your shoes, check inside for foreign objects that can rub against your feet. Cut toe nails straight across to prevent ingrown toenails. Do not attempt "home surgery" to remove calluses, corns or warts yourself. Ask your doctor for treatment. At each doctor appointment, take off your shoes and socks and ask your doctor to examine the feet.