Diabetic Neurpathy

Learn About Diabetic Neuropathy

Diabetic nerve damage, or neuropathy, refers to nerve disorders caused by diabetes. People with diabetes (abnormally high blood sugar, or hyperglycemia) can, over time, develop nerve damage throughout the body.  Nerve problems can occur in every organ system.  Peripheral neuropathy, or DPN, the most common type of diabetic neuropathy, causes tingling, numbness, pain, or loss of feeling in the toes, feet, legs, hands, and arms.  

About 60 to 70 percent of people with diabetes have some form of neuropathy. People with diabetes can develop nerve problems at any time, but the risk rises with age and longer duration of illness. The highest rates of neuropathy are among people who have had diabetes for at least 25 years. DPN appears to be more common in people who have problems controlling their blood sugar, who smoke, and who are obese.

The cause of DPN is likely due to a combination of factors:  Metabolic factors such as high blood sugar; long duration of diabetes; abnormal blood lipid levels; neurovascular factors leading to damage to the blood vessels that carry oxygen and nutrients to nerves; autoimmune factors that cause inflammation in nerves; and lifestyle factors such as smoking or alcohol use.  However, the fundamental mechanism of pain production appears to be related to the process of nerve damage and regeneration, itself due to damage to the tiny blood vessels that nourish the nerves.  This damage to small blood vessels, or vasculopathy, seems to underlie most, if not all, of the long-term complications of poorly regulated blood sugar.

The first symptoms of DPN are often numbness, tingling, or pain in the feet, because the sensory nerves located there, the longest in the body, are particularly vulnerable to the vasculopathy of diabetes. Symptoms are often minor at first, and because most nerve damage occurs over several years, mild cases may go unnoticed for a long time.  Other symptoms of nerve damage may include wasting and weakness of the muscles of the feet, numbness or insensitivity to pain or temperature, a tingling, burning, or prickling sensation, sharp pains or cramps, and extreme sensitivity to even light touch.  DPN can cause loss of reflexes, especially at the ankle, leading to changes in the way a person walks. Foot deformities, such as hammertoes and the collapse of the midfoot, may occur. Blisters and sores may appear on numb areas of the foot because pressure or injury goes unnoticed. If an infection occurs and is not treated promptly, the infection may spread to the bone, and the foot may then have to be amputated. Many amputations are preventable if minor problems are caught and treated in time.

Doctors diagnose neuropathy on the basis of symptoms and a physical exam. During the exam, the doctor may check muscle strength, reflexes, sensitivity to position changes, vibration, temperature, and light touch.  People diagnosed with peripheral neuropathy need more frequent foot exams. A comprehensive foot exam assesses the skin, muscles, bones, circulation, and sensation of the feet. The doctor may assess protective sensation or feeling in the feet. People who cannot sense pressure have lost protective sensation and are at risk for developing foot sores that may not heal properly. The doctor may also check temperature perception or use a tuning fork, which is more sensitive than touch pressure, to assess vibration perception.

The first step in the treatment of DPN is to bring blood sugar levels within the normal range to help prevent further nerve damage. Diabetes medicines or insulin will help control blood sugar levels. Good control may also help prevent or delay the onset of further problems.

 Painful DPN is treated with a number of medications, including the tricyclic antidepressants such as amitriptyline and other types of antidepressants such as duloxetine (Cymbalta) – people do not have to be depressed for an antidepressant to help relieve nerve pain – anticonvulsants, such as pregabalin (Lyrica); opioids and opioid-like drugs, such as oxycodone, an opioid and tramadol (Ultram), an opioid that also acts as an antidepressant.  Duloxetine and pregabalin are approved by the U.S. Food and Drug Administration specifically for treating painful diabetic peripheral neuropathy.

People with neuropathy need to take special care of their feet. Loss of sensation in the feet means that sores or injuries may not be noticed and may become infected. Cleaning the feet daily using warm—not hot—water and a mild soap is recommended; however 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 is advisable, as is always wearing shoes or slippers to protect the feet from injuries. Wearing thick, soft, seamless socks can prevent skin irritation.  People who need help taking care of their feet should consider making an appointment to see a podiatrist.

In summary, DPN is a nerve disorder caused by many of the abnormalities common to diabetes, such as high blood sugar; but most directly due to disease of the vasa nervorum, the network of tiny blood vessels that supply the nerves with nourishment.  DPN causes numbness and sometimes pain in the hands, arms, feet, or legs.  Treatment involves first bringing blood glucose levels within the normal range, which may help prevent or delay the onset of further problems.  Medication such as antidepressants, anticonvulsants, and opiates provide symptomatic management.  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.  Smoking increases the risk of foot problems and amputation.

Developed with help from the following Source from NIM

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