When you have diabetes mellitus, which is referred to as diabetes, your blood glucose level is consistently high. Untreated, a high sugar level damages your nerves. Blood vessels that take oxygen to your nerves are also damaged. Damaged nerves send messages slowly or at the wrong times, and nerves eventually stop sending messages to the brain. This damage is called diabetic neuropathy.
Diabetic neuropathy can occur in both Type 1 and Type 2 diabetes. In Type 1 diabetes, the body does not produce insulin. Insulin is needed to convert glucose into energy that the body needs. Type 2 diabetes is more common. In Type 2 diabetes, the body does not use insulin properly, which is called insulin resistance. The body begins to make extra insulin. Over time, the body cannot make enough insulin to keep the glucose level normal.
Neuropathy is a serious complication of diabetes, and it affects up to 70 percent of people with diabetes. Neuropathies can occur in any part of the body, including the eyes, heart, lungs and feet.
Peripheral neuropathy is the most common type and occurs slowly. Initially, it affects the foot. Peripheral neuropathy eventually spreads to the ankle and leg. Because nerves have been damaged, patients do not feel pain. Patients may be unaware of foot injuries, which can lead to open sores. If these sores don't heal or they become infected, they result in more complications. In severe cases, toes or the foot need to be amputated. Foot ulcers account for 85 percent of toe or foot amputations. Approximately 50 percent of amputees die within five years.
Neuropathy also results in muscle loss. This makes standing or walking difficult. People with neuropathy may become depressed and socially isolated. Neuropathy also decreases quality of life.
Symptoms of peripheral neuropathy
If any of the following statements apply to you, contact your doctor. Tests will be ordered to confirm whether you have diabetic neuropathy:
-- My feet tingle.
-- I feel "pins and needles" in my feet.
-- I have burning or shooting pains in my feet.
-- My feet are sensitive to touch.
-- My feet hurt at night.
-- My feet are numb and feel dead.
-- I don't feel pain in my feet.
-- I can't feel my feet when I'm walking.
-- I'm unsteady when I walk or stand.
-- My feet and hands get very cold or very hot.
-- I have open sores on my feet and legs that heal slowly.
-- It feels like the muscles and bones in my feet have changed.
What factors increase my chances of getting diabetic neuropathy?
People with diabetes can develop nerve problems at any time. The risk increases with age. The highest rates of nerve problems are among people who have had diabetes for at least 25 years.
Neuropathies are more common in people who are overweight and have high cholesterol levels. The risk increases when control of their blood glucose level is inadequate. Other risk factors include smoking, heavy alcohol use and being tall. Having both diabetes and high blood pressure greatly increases the risk for serious complications.
What is the treatment?
There is no cure for neuropathy. Nerve damage cannot be reversed. Treatment focuses on three goals. The first is to slow the progression of neuropathy. The second is to relieve pain. The third is to treat complications such as infections. To slow the progression, it is critical to bring blood glucose to a normal level. Glucose monitoring, meal planning, physical activity and medication help control the glucose level. Good glucose control prevents or delays the onset of future problems.
For patients with diabetic neuropathy, commonly used medications include antidepressants, anticonvulsants, prescription pain medication and topical agents. Many of these medications are approved for treating other conditions. They are used because of their positive effects. Antidepressants and anticonvulsants are generally used first. Depending on the medication, side effects may include constipation, dizziness, headache, nausea, dry mouth, fatigue, diarrhea, weight gain and insomnia.
Medications only partially relieve pain. Typically, pain is reduced by 30 percent to 50 percent. Your doctor may also prescribe medication to lower cholesterol levels. Patients interested in using supplements should first discuss this with their doctor. There is some evidence that L-carnitine and alphalipoic acid help reduce pain.
What can I do to prevent or control diabetic neuropathy?
Diabetic neuropathy can be prevented or controlled. Monitoring your glucose level and adopting a healthy lifestyle can decrease your risk for neuropathy by as much as 60 percent.
Recommendations for Patients with Diabetes
-- Get a foot examination at least once a year.
-- Lose excess weight. Exercise regularly and follow a healthy diet. Buy a cookbook with recipes for diabetics.
-- Limit alcohol use. Quit smoking.
-- Keep your blood pressure under control. Monitor it daily.
-- Examine your feet daily. Look for blisters, cuts, bruises, ingrown toenails and redness or swelling. Use a mirror to examine the bottoms of your feet.
-- Keep your blood glucose level in the range recommended by your doctor. Regularly monitor your glucose level according to your doctor's recommendation.
-- Get an A1C lab test twice a year. This test determines your average glucose level for the past two to three months.
-- Get an eye examination annually. Your doctor may recommend frequent examinations.
-- When complications occur, get treatment right away. Early treatment helps prevent additional complications.
-- Protect your feet. If your feet are dry, use lotion, but not between your toes. Wear shoes and socks that fit well. Use warm water to wash your feet, and dry them carefully. Avoid exposing your feet to hot and cold temperatures.
-- Use different shoes each day. Ask your doctor if you need special shoes. Avoid sandals, high heels and open toe shoes. Don't go barefoot.
-- Be careful when exercising. Some activities are not safe for people with neuropathy. Talk with a diabetes specialist who can give you an exercise plan.
-- Keep follow-up appointments even if your diabetes is well controlled.