Diabetic Neuropathy

What is diabetic neuropathy?

Neuropathy means nerve disease or damage. Diabetic neuropathy is nerve damage caused by diabetes. People with diabetes often have high blood sugar levels. Over time, high blood sugar levels can damage nerves throughout your body. There are three kinds of diabetic neuropathy.

• Autonomic neuropathy is damage to autonomic nerves. These nerves control things like your heartbeat, blood pressure, sweating, digestion, urination, and sexual function.
• Focal neuropathy affects just one nerve, usually in the wrist, thigh, or foot. It may also affect the nerves of your back and chest and those that control your eye muscles. This type of nerve damage usually happens suddenly.
• And the third is the focus of our discussion today - Peripheral neuropathy which is damage to peripheral nerves. These are the nerves that sense pain, touch, hot, and cold. They also affect movement and muscle strength. The nerves in the feet and lower legs are most often affected. This type of nerve damage can lead to serious foot problems. The damage usually gets worse slowly, over months or years.

What causes diabetic neuropathy and who is more likely to get it?

Over time, high blood sugar levels from diabetes can damage nerves throughout your body. The higher your blood sugar levels, the more likely you are to have nerve damage. So controlling your blood sugar throughout your life is very important.

The older you get, and the longer you have diabetes, the more likely you are to have nerve damage. People with diabetes who drink too much alcohol are also more likely to have nerve damage. Males are at higher risk as are African-Americans, Hispanics, and Native Americans. About half of all people with diabetes end up getting diabetic neuropathy.

What are the symptoms?

Diabetic neuropathy-especially peripheral neuropathy-initially may not cause any noticeable symptoms. If you have diabetes, it is important to have regular medical checkups to check for signs of neuropathy and treat problems before they become serious. Symptoms of diabetic neuropathy may vary depending on the type of neuropathy you have.

Peripheral neuropathy tends to develop slowly over months or years. Symptoms may get worse during pregnancy. In general, symptoms may include:

• Tingling, numbness, tightness, or burning, shooting, or stabbing pain in the feet, hands, or other parts of the body. Bone and joint deformities can develop, especially of the feet (such as Charcot foot).
• Reduced feeling or numbness, most often in the feet. Check your feet every day for skin problems (chapped, broken skin or excessive dryness) or minor injuries (blisters, calluses, or ingrown toenails). People who have had diabetes 10 or more years, who have poor blood sugar control, or who have blood vessel, kidney, or eye complications are at increased risk for foot and leg sores and possible amputation.
• Greatly reduced or greatly increased sensitivity to light touch or temperature.
• Weakness and loss of balance and coordination.

Can diabetic neuropathy be prevented?

Keeping your blood sugar levels near normal may help prevent neuropathy from ever developing. The best way to do this is by getting to and staying at a healthy weight by exercising and eating healthy foods.

What can I do at home to relieve symptoms?

In addition to having regular medical checkups, the best way to avoid the progression of diabetic neuropathy is to control your blood sugar, take good care of your feet, and practice wise health habits.

• Control your blood sugar level - The single most important step you can take to prevent the development and progression of diabetic neuropathy is to keep your blood sugar level consistently within a tightly controlled and narrow target range. Tight blood sugar control means a near normal level of hemoglobin A1c (HbA1c).
• Take care of your feet
- Diabetic neuropathy affects the feet more often than any other part of the body. Diabetes interferes with your body's ability to fight infection, so that even a minor foot injury such as a blister, a scratch, or athlete's foot can lead to serious infections or amputation. But serious foot problems are the most preventable complications of diabetes. Because the nerve damage caused by diabetic neuropathy may make you less likely to notice minor problems with your feet, it is wise to inspect your feet every day. Protect them from injury by wearing properly fitted shoes and socks at all times. If vision problems from diabetic retinopathy or another eye disease make it difficult for you to examine your feet, have someone assist you. You can also buy an Indicator Plaster Neuropad (IPN). This 10-minute exam results in a color change when neuropathy is present. Ask your doctor to check your feet at each visit, and have a thorough medical examination of your feet at least once a year.
• Practice wise health habits

Many doctors believe that you can further reduce your risk of getting severe neuropathy if you:

• See your doctor regularly. Your doctor will be able to note any changes in your health more easily when you plan regular visits. It will be easier for you and your doctor to find problems early and to take care of them right away.
• Exercise regularly and stay at a healthy weight. Exercise and weight control can help your body use insulin better. This helps keep your blood sugar level within a tightly controlled and narrow target range, which may help prevent the development and progression of nerve damage. Talk to your doctor and have a thorough exam of your feet before beginning an exercise program. Foot problems, blood pressure problems, or certain other problems associated with neuropathy may raise unique concerns about exercising safely, such as whether you should avoid repetitive, weight-bearing exercises.
• Limit your alcohol intake. Having four or more drinks a week may make neuropathy and its symptoms worse.
• Eat a balanced diet. Consider taking a daily multivitamin to ensure that you are meeting your nutritional needs. A balanced diet can also help you maintain a healthy weight.

How is diabetic neuropathy diagnosed?

Your doctor will check how well you feel light touch and temperature and will test your strength and your reflexes. Tests such as electromyogram and nerve conduction studies may be done to confirm the diagnosis. You may need other tests to see which type of neuropathy you have and to help guide your treatment. Doctors can't test for all types of nerve damage. So it’s important to tell your doctor about any pain or weakness you feel. Also mention heavy sweating or dizziness and any changes in digestion, urination, and sexual function.

How is it treated?

Treatment involves keeping blood sugar levels near normal. This will not cure the nerve damage, but it can help keep the damage from getting worse.

The type of treatment depends on your symptoms:

• Pain may be treated with medicines.
• Digestive system problems or blood vessel problems may be treated with medicines.
• Blood pressure problems may be treated with medicines and by wearing support stockings (also called compression stockings).
• A splint or brace may be used for a pinched nerve.

It is common in diabetes to lose some feeling in your feet. You could have a sore or other foot problem without noticing it. Check your feet every day. An untreated problem on your foot can lead to a serious infection or even amputation. Be clear with your doctor about what is helping you feel better and what is not. You and your doctor can work together to find the treatment that helps you the most.

Is there an alternative form of treatment?

When you’ve tried other options of treatment that haven’t worked, clinical trials are a good alternative. Clinical trials are research studies in which people help doctors and researchers find ways to improve health care. Each study tries to answer scientific questions and to find better ways to prevent, diagnose, or treat disease.

The purpose of a clinical trial is to find out whether a medicine or treatment regimen is safe and effective for the treatment of a specific condition or disease. Clinical trials compare the effectiveness of the study medicine or treatment against standard, accepted treatment, or against a placebo commonly know as a sugar pill, if no standard treatment exists.

If you are accepted into the clinical trial and you give your consent to participate, you will be given a structured program to follow. You will have a schedule of tests, doctor appointments, and treatments. You may also be asked to keep a diary of your experience during this time. It is important to carefully follow directions. If you do not understand what you are supposed to do next, call your doctor or the person responsible for your trial.

Clinical trials are important because they compare new treatments with accepted treatments. They allow researchers to determine whether a new treatment works better than accepted treatments. The new treatment might work as well as or better than standard therapies, and it might have fewer or better-tolerated side effects.

Clinical trials help pharmaceutical or biotechnology companies develop medicines that are safer and more effective with fewer side effects.

CNS Healthcare is conducting a research study for Diabetic Peripheral Neuropathy. If you have type 1 or type 2 diabetes and are between the ages of 18 and 70 and think you have this condition, give us a call. Qualified study participants will receive investigational medication and care and may be compensated for time and travel. Insurance is not required. Remember, insurance is not necessary, it’s completely confidential and you don’t need a referral from your doctor to participate.