What is Neuropathy?

Neuropathy is the term used to describe a problem with the nerves, or nerve damage due to some disease or may be accidental, usually the ‘peripheral nerves’ as opposed to the ‘central nervous system’ (the brain and spinal cord).

Three types of a nerve can be involved; autonomic nerves, motor nerves, and sensory nerves. Sometimes single nerves or nerve sets are affected. Bell’s palsy is a specific example of a neuropathy of the facial nerve, affecting the muscles and skin of the face.

Neuropathy in Diabetes:

Neuropathy is a complication of diabetes mellitus. Diabetic neuropathies are a family of nerve disorders caused by diabetes. People with diabetes can, over time, develop nerve damage throughout the body.

 Some people with nerve damage have no symptoms. Others may have symptoms such as pain, tingling, or numbness (loss of feeling) in the hands, arms, feet, and legs. Nerve problems can occur in every organ system, including the digestive tract, heart, and sex organs. Most commonly nerve problems in a foot.

What are causes of diabetic neuropathy?

  • The causes are probably different for various types of diabetic neuropathy. Researchers are studying how prolonged exposure to high blood glucose causes nerve damage. Nerve damage is likely due to a combination of factors:
  • Metabolic factors, such as high blood glucose, long duration of diabetes, abnormal blood fat levels, and possibly low levels of insulin.
  • Neurovascular factors, leading to damage to the blood vessels that carry oxygen and nutrients to nerves.
  • Autoimmune factors that cause inflammation in nerves.
  • Mechanical injury to nerves, such as carpal tunnel syndrome.
  • Inherited traits that increase susceptibility to nerve disease.
  • Lifestyle factors, such as smoking or alcohol use.

What are symptoms of diabetic neuropathy?

  • Tingling, or pain in the toes, feet, legs, hands, arms, and fingers.
  • Wasting of the muscles of the feet or hands.
  • Indigestion problem.
  • Nausea or vomiting.
  • Diarrhea or constipation.
  • Dizziness or faintness due to a drop in blood pressure after standing or sitting up.
  • Problems with urination.
  • Erectile dysfunction in men or vaginal dryness in women.

Peripheral neuropathies may affect following organs:

Autonomic neuropathies may involve:

  • Heart blood vessels.
  • Digestive system
  • Urinary system.
  • Sweat gland.
  • Sex organs.

Proximal neuropathies may involve:

  • buttocks

Preventions from neuropathies:

  • Normally, symptoms such as shakiness, sweating, and palpitations occur when blood glucose levels drop below 70 mg/dL. In people with autonomic neuropathy, symptoms may not happen, making hypoglycemia difficult to recognize. Problems other than neuropathy can also cause hypoglycemia unawareness.
  • Nerve damage to the digestive system most commonly causes constipation. Damage can also cause the stomach to empty too slowly; a condition called gastroparesis. Severe gastroparesis can lead to persistent nausea and vomiting, bloating, and loss of appetite. Gastroparesis can also make blood glucose levels fluctuate widely, due to abnormal food digestion.
  • Nerve damage to the esophagus may make swallowing difficult, while nerve damage to the bowels can cause constipation alternating with frequent, uncontrolled diarrhea, especially at night. Problems with the digestive system can lead to weight loss.

Pain relief:

 People with severe nerve pain may benefit from a combination of medications or treatments and should consider talking with a health care provider about treatment options.

Medications used to help relieve diabetic nerve pain include

  • tricyclic antidepressants, such as amitriptyline, imipramine, and desipramine (Norpramin, Pertofrane)
  • Other types of antidepressants, such as duloxetine (Cymbalta), venlafaxine, bupropion (Wellbutrin), paroxetine (Paxil), and citalopram (Celexa).
  • Anticonvulsants, such as pregabalin (Lyrica), gabapentin (Gabarone, Neurontin), carbamazepine, and lamotrigine (Lamictal).
  • Opioids and opioid like drugs, such as controlled-release oxycodone, an opioid; and tramadol (Ultram), an opioid that also acts as an antidepressant.
  • Treatments that are applied to the skin—typically to the feet—include capsaicin cream and lidocaine patches (Lidoderm, Lidopain). Studies suggest that nitrate sprays or patches for the feet may relieve pain. Studies of alpha-lipoic acid, an antioxidant, and evening primrose oil, suggest they may help reduce symptoms and improve nerve function in some patients.

Diabetic foot care:

  • Cleaning the feet daily using warm (not hot) water and a mild soap. Soaking the feet should be avoided. A soft towel can be used to dry the feet and between the toes.
  • Inspecting the feet and toes every day for cuts, blisters, redness, swelling, calluses, or other problems.
  • Using a mirror (handheld or placed on the floor) may be helpful in checking the bottoms of the feet, or another person can help check the feet. A health care provider should be notified of any problems.
  • Use lotion to moisturize the feet. Getting lotion between the toes should be avoided.
  • Filing corns and calluses gently with a pumice stone after a bath or shower.
  • Cutting toenails to the shape of the toes and filing the edges with an emery board each week or when needed.
  • Always wearing shoes or slippers to protect feet from injuries. Wearing thick, soft, seamless socks can prevent skin irritation.
  • Wearing shoes that fit well and allow the toes to move. New shoes can be broken in gradually by first wearing them for only an hour at a time.
  • Looking shoes over carefully before putting them on and feeling the insides to make sure the shoes are free of tears, sharp edges, or objects that might injure the feet.

Further tips:

  • Diabetic neuropathies are nerve disorders caused by many of the abnormalities common to diabetes, such as high blood glucose.
  • Neuropathy can affect nerves throughout the body, causing numbness and sometimes pain in the hands, arms, feet, or legs, and problems with the digestive tract, heart, sex organs, and other body systems.
  • Treatment first involves bringing blood glucose levels within the normal range. Good blood glucose control may help prevent or delay the onset of further problems.
  • Foot care is an important part of treatment. People with neuropathy need to inspect their feet daily for any injuries. Untreated injuries increase the risk of infected foot sores and amputation.
  • Treatment also includes pain relief and other medications as needed, depending on the type of nerve damage.
  • Smoking increases the risk of foot problems and amputation. A health care provider may be able to provide help with quitting.