Diabetic neuropathy is a complication associated with diabetes and is a progressive disease that leads to loss of nerve function. Diabetic neuropathy can affect the nerves of the autonomic and involuntary nervous system that controls the blood vessels, glands, heart and smooth muscle, but more often it is the peripheral nervous system that suffers. Because of this, diabetic neuropathy is often referred to as peripheral neuropathy.

It is difficult to determine the prevalence of diabetic neuropathy, but it is estimated that between twenty and forty percent of people who suffer from diabetes develop the disease. This doesn’t take into account the thousands of undiagnosed diabetics world wide.

A study conducted in the United Kingdom in the early 1990’s showed that diabetic neuropathy increases as diabetics age. The incident of neuropathy in diabetics between the ages of seventy and seventy-nine years was forty four percent.

Though the cause of peripheral neuropathy for non-diabetics is not known, people in this category do suffer from the disease. In diabetics the cause of neuropathy is poor control of blood sugar levels, which results in hyperglycemia. The longer the blood sugar level is elevated, the more severe the case of peripheral neuropathy. The precise link between high glucose levels and nerve damage hasn’t been determined. However, other factors such as cardiovascular disease and nerve growth factors are suspected to be contributing factors.

Metabolic Disturbances

Metabolic disturbances are thought to contribute to neuropathic disease in diabetics. A reduction in co-enzymes, which are important for metabolic processing, including fat metabolism, can change the metabolic balance in the body. This leads to cell structure damage, which causes nerve damage and loss of nerve functions.

It is also suspected that nerves starved of oxygen are a contributing factor to diabetic neuropathy because there isn’t sufficient blood supply to reach the extremities of the body. People who suffer from Type 2 diabetes suffer from heart attacks and strokes and peripheral neuropathy four times more often than non-diabetics.

Consequences

There are severe consequences suffered by diabetics who experience loss of nerve function because of diabetic neuropathy. Ten percent of those affected will experience chronic neuropathy pain when touched. Diabetic neuropathy also causes a high incident of problems with the feet and sufferers often contact “diabetic foot,” which includes infection, ulceration and soft tissue damage. These afflictions can result in amputation of one or both feet if treatment is unsuccessful.

Today, one hundred fifty million people word wide suffer from diabetes. Researchers estimate that approximately fifteen percent will at some time develop foot ulceration and infection as a result of diabetic or peripheral neuropathy. One percent of Europeans and North Americans and eleven percent of Africans who suffer from diabetes will develop active foot ulceration. Therefore, foot care in diabetics is an extremely important part of diabetic treatment. All diabetics should take special care to minimize the risk of foot trauma, ulceration and small cuts that could cause infection of one or both feet.

Symptoms

Diabetic neuropathy can involve either one nerve or a group of nerves, but most commonly affects numerous peripheral nerves. This condition is referred to as poly-neuropathy and affects the arms, hands, feet and legs. Diabetics most often experience more problems with feet and legs. The neuropathy affects sensory nerves, causing a loss of sensation. When testing for this, doctors run their finger along the bottom of the foot to discover whether or not the diabetic patient has lost feeling.

Symptoms can vary from mild to extreme, depending on the nerves being affected. Some diabetics may not experience any symptoms until complications become evident. One of the first symptoms that appear is numbness or pain in the ankles and feet, as well as burning or tingling. These symptoms often become worse when the diabetic is at rest or during the night. Other symptoms include muscle paralysis or weakness or the loss of reflexes. These symptoms may be present in the arms and hands as well.

The symptoms of diabetic neuropathy can appear suddenly or come about gradually. Diabetics need to be aware that symptoms can change as their diabetes progresses and the consequences they will experience if these symptoms are ignored. If diabetic neuropathy is managed in regular diabetic treatment and is detected early, advancement may be prevented or delayed from progressing to the next stage.

Prevention

Diabetics must pay attention and put preventative measures into place. These include intensive maintenance of blood glucose levels, regular visits to a diabetic clinic or specialist and plenty of exercise. Walking is a great way to help reduce the risk of neuropathy in the feet and legs.

Weakness

The loss of nerve function in the limbs makes everyday tasks difficult because of diminished dexterity and the sense of feeling and touch. Walking will transform from an automatic reflex to a difficult task associated with unsteadiness. Diabetic neuropathy may cause extreme weakness in the feet and legs. Nerve loss can cause specific conditions such as “drop foot,” which is the inability to raise the foot at the ankle. When this happens, diabetics experience extreme difficulty walking and can lead to wheelchair confinement.

Contributing Risk Factors

There are a number of contributing factors that increase the risk of diabetic neuropathy.

• Poor maintenance of blood glucose levels.

• The duration of diabetes.

• Age; risk factors increase with age.

• Smoking.

• Abnormal lipid metabolisms; this is caused by low levels of high density lipo-protein.

• Micro-vascular complications; people who suffer from other complications due to small blood vessel damage.

Proper Diagnosis

There are disorders and diseases other than diabetes that can cause neuropathy. Doctors should do testing to eliminate other causes before giving a diagnosis of diabetic neuropathy and beginning treatment.

Diabetic Assessment

Diabetics who attend diabetic clinics on a regular basis have blood glucose levels taken and recorded. The goal for all diabetics is to maintain a blood glucose level that is as close to normal as possible. In the United States, glucose levels should be no higher than 100 before eating and should never go above 150. In Canada blood glucose levels should run between 4.0 and 6.5. These blood glucose levels are identical. The difference appears because health care professionals in the two countries measure blood glucose levels in different ways.

Nerve Damage and Pain

The nerve damage that occurs with diabetic neuropathy can involve either complete or partial loss of sensory function, which may or may not result in pain. Diagnosis can be made on disturbed sensory function in areas that are affected by pain. This is most often in areas of the feet and legs. Some patients may not experience any symptoms, but upon assessment be found they have lost all feeling in their feet. Lack of symptoms prevents an early diagnosis of diabetic neuropathy.

Diabetic patients will use a wide variety of words to describe the pain they are suffering. It is important for the physician to listen carefully and get a detailed description of pain intensity. Questions should be asked to determine how pain affects the patient’s quality of life, mental well being, moods and sleep patterns and work and recreation. If your doctor has no time or fails to ask questions about how pain affects your daily life, seek the services of a different health care professional.

Tests

There are simple clinical tests that can be done to test sensory function and reflexes. These can aid the doctor in determining how much nerve damage has taken place. Celebrated tuning forks produce vibrations of different frequencies. Disposable neurological testing pins provide pain stimuli to the feet, legs and other areas to determine loss of feeling. Monofilaments are very fine filaments that are used to determine the pressure sensation threshold. A reflex hammer is used to determine the Achilles tendon reflex in the patient’s heel.

A standard neurological examination also includes the ability to tell the difference between blunt and sharp and hot and cold sensation. A more complex test is the electrical Nerve Conduction Study, known as NCS. This test records the speed that nerves are able to send signals, as well as the size of response to particular stimuli. It entails electrodes being placed on the skin of the area while a low but painless electrical current is applied to certain nerves. Responses are measured and recorded.

Electrical Muscle Study, also known as an EMG determines if muscular activity has been affected. Low electrical currents are applied to muscles through a small, thin needle. Responses are measured and recorded.

Doppler sonography is used to determine blood flow. This test reveals if the patient has peripheral vascular disease. The tests send a beam of ultrasound along the line of blood flow. The frequency of sound waves that are reflected from moving red blood cells is used to determine the speed of the blood’s flow.

Electroencephalograms, also known as an EEG measures electrical activity in the brain to determine if it is responding to sensory sensation normally.

Treatment

Treatment of diabetic neuropathy is used to slow the progression of the disease, to educate diabetics on foot care and to relieve painful symptoms. Treatment includes preventative measures and self-help. Diabetics should seek early treatment if any symptoms occur and talk to their diabetic health care professional about diabetic neuropathy as soon as they’re diagnosed with diabetes. This will ensure they are aware of the symptoms and consequences of the disease. A diabetic’s first priority should be to monitor blood glucose levels daily and keep readings at a near normal level. If these go well above normal, the patient should see their doctor as soon as possible.

Diabetics must make drastic lifestyle changes to prevent the development of cardiovascular disease, which significantly raises the risk of diabetic neuropathy. Changes include a healthy diet, lots of exercise and discontinuing the use of alcohol and tobacco. Regular checkups are necessary to check blood glucose levels, dietary behavior, blood pressure and cholesterol levels. Diabetics with good metabolic control should be checked twice a year if they have no risk of cardiovascular complications. All other diabetics should be checked every three months; more often if recommended by their physician.

Foot Care

• Good foot care is imperative for all diabetics. Always wear shoes or slippers. Never walk around in bare feet. This protects the feet from unnecessary cuts and injury.

• Soak feet before cutting toenails. Never cut toenails yourself and be sure the nail is never cut into the nail bed.

• Always dry your feet thoroughly, especially between the toes to prevent the growth of fungus.

• Keep feet well moisturized to prevent skin from cracking. Moisturizer or oil should be applied to feet each night before retiring.

• Watch for signs of cracking, bunions and corns. Report any change to your physician.

Pain Relief

There are pain management techniques that can be used by those suffering from diabetic neuropathy. However, it may be impossible to alleviate all pain because it is caused by damaged nerve function.

The use of prescription drugs can reduce pain associated with diabetic neuropathy, but physical and psychological therapies also need to be implemented. The combination of these therapies will work together to provide the best possible reduction in pain and to help the sufferer learn to cope with the remaining pain. If therapy doesn’t relieve the pain adequately, the diabetic patient should see a pain reduction specialist or attend a pain clinic on a regular basis.

Exercise

One of the best pain reducing treatments is exercise. Though the diabetic patient is often in severe pain, exercise is necessary. Walking is especially useful as pain reduction therapy. The sufferer should begin by walking short distances three to four times a day, and then walk longer distances as the pain is reduced, until they are walking twenty minutes three times a day. This should not be rushed, but done in small increments. By the time the diabetic has reached a walking time of ten minutes three times daily, neuropathy pain will be greatly reduced.

Behavioral Therapy

This involves setting goals and monitoring behavior patterns to assure they are being achieved within a reasonable time period. Negative thoughts must be reversed to positive. Expectations and goals have to be looked at from an optimistic point of view in order to change eating habits and other lifestyle changes to ensure that diabetic neuropathy sufferers don’t fall victim to amputation, heart attack or stroke.