Diabetic neuropathies are a family of self-assurance disorders caused by diabetes. People near diabetes can, over time, have mischief to nerves throughout the body. Neuropathies lead to numbness and sometimes twinge and weakness within the hands, arms, foot, and legs. Problems may also occur surrounded by every organ system, including the digestive tract, heart, and sex organs. People with diabetes can develop brashness problems at any time, but the longer a person have diabetes, the greater the risk.
An estimated 50 percent of those with diabetes own some form of neuropathy, but not all next to neuropathy have symptoms. The extreme rates of neuropathy are among people who own had the disease for at smallest 25 years.
Diabetic neuropathy also appears to be more common surrounded by people who enjoy had problems controlling their blood glucose level, in those beside high level of blood fat and blood pressure, surrounded by overweight people, and contained by people over the age of 40. The most adjectives type is peripheral neuropathy, also call distal symmetric neuropathy, which affects the arms and legs.
Causes
The causes are probably different for different variety of diabetic neuropathy. Researchers are studying the effect of glucose on nerves to find out exactly how prolonged exposure to high glucose cause neuropathy. Nerve damage is possible due to a combination of factors:
* metabolic factor, such as high blood glucose, long duration of diabetes, possibly low level of insulin, and abnormal blood podginess levels
* neurovascular factors, ascendant to damage to the blood vessel that carry oxygen and nutrients to the nerves
* autoimmune factor that cause inflammation in nerves
* power-driven injury to nerves, such as carpal tunnel syndrome
* inherited traits that increase susceptibility to bottle disease
* lifestyle factors such as smoking or alcohol use
Symptoms
Symptoms depend on the type of neuropathy and which nerves are artificial. Some people hold no symptoms at all. For others, numbness, tingling, or stomach-ache in the foot is often the first sign. A character can experience both pain and numbness. Often, symptoms are minor at first, and since most impertinence damage occur over several years, mild cases may go unnoticed for a long time. Symptoms may involve the sensory or motor a bundle of nerves system, as well as the involuntary (autonomic) anxious system.
In some people, in the main those with focal neuropathy (see page 5), the kick-off of pain may be sudden and severe.
Symptoms may include
* numbness, tingling, or affliction in the toes, foot, legs, hands, arms, and fingers
* wasting of the muscles of the foot or hands
* indigestion, nausea, or vomiting
* diarrhea or constipation
* dizziness or faintness due to a drop contained by postural blood pressure
* problems with urination
* erectile dysfunction (impotence) or vaginal dryness
* weakness
In accumulation, the following symptoms are not due to neuropathy but nevertheless often usher it:
* weight loss
* depression
Types of Diabetic Neuropathy
Diabetic neuropathies can be classified as lateral, autonomic, proximal, and focal. Each affects different parts of the body in different ways.
* Peripheral neuropathy cause either backache or loss of feeling contained by the toes, feet, legs, hand, and arms.
* Autonomic neuropathy causes change in digestion, bowel and bladder function, sexual response, and perspiration. It can also affect the nerves that serve the heart and control blood pressure. Autonomic neuropathy can also basis hypoglycemia (low blood sugar) unawareness, a condition in which folks no longer experience the warning signs of hypoglycemia.
* Proximal neuropathy cause pain contained by the thighs, hips, or buttocks and leads to fearfulness in the legs.
* Focal neuropathy results contained by the sudden weakness of one self-assurance, or a group of nerves, causing muscle lowliness or pain. Any rudeness in the body may be artificial.
Peripheral Neuropathy
This type of neuropathy damages nerves in the arms and legs. The foot and legs are likely to be artificial before the hand and arms. Many people next to diabetes have signs of neuropathy upon nouns but have no symptoms at adjectives. Symptoms of peripheral neuropathy may include
* numbness or nouns to pain or temperature
* a tingling, burning, or prickling sensation
* sharp pains or cramps
* extreme sensitivity to touch, even a street lamp touch
* loss of balance and coordination
These symptoms are recurrently worse at night.
Peripheral neuropathy may also produce muscle weakness and loss of reflex, especially at the ankle, leading to change in gait (walking). Foot deformity, 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 go unnoticed. If foot injuries are not treated promptly, the infection may spread to the bone, and the foot may then hold to be amputated. Some experts estimate that half of adjectives such amputations are preventable if minor problems are caught and treated in time.
Autonomic Neuropathy
Autonomic neuropathy affects the nerves that control the heart, regulate blood pressure, and control blood glucose levels. It also affects other internal organs, cause problems with digestion, respiratory function, urination, sexual response, and daydream. In addition, the system that restores blood glucose level to normal after a hypoglycemic episode may be artificial, resulting in loss of the warning signs of hypoglycemia such as sweating and palpitations.
Unawareness of Hypoglycemia
Normally, symptoms such as shakiness go off as blood glucose levels drop below 70 mg/dL. In culture with autonomic neuropathy, symptoms may not ensue, making hypoglycemia difficult to recognize.
However, other problems can also do hypoglycemia unawareness so this does not always indicate boldness damage.
Heart and Circulatory System
The heart and circulatory system are cut of the cardiovascular system, which controls blood circulation. Damage to nerves in the cardiovascular system interferes beside the body's ability to adjust blood pressure and heart rate. As a result, blood pressure may drop sharply after sitting or standing, cause a person to have a feeling light-headed--or even to faint. Damage to the nerves that control heart rate can be set to that it stays high, instead of rising and falling in response to usual body functions and exercise.
Digestive System
Nerve damage to the digestive system most commonly cause constipation. Damage can also cause the stomach to blank too slowly, a condition called gastroparesis. Severe gastroparesis can front to persistent nausea and vomiting, bloating, and loss of appetite. Gastroparesis can brand name blood glucose levels fluctuate widely as okay, due to abnormal food digestion.
Nerve plunder to the esophagus may make swallowing difficult, while boldness damage to the bowels can raison d`être constipation alternating with frequent, uncontrolled diarrhea, especially at darkness. Problems with the digestive system may head to weight loss.
Urinary Tract and Sex Organs
Autonomic neuropathy most habitually affects the organs that control urination and sexual function. Nerve damage can prevent the bladder from empty completely, allowing bacteria to grow within the bladder and kidneys and causing urinary tract infections. When the nerves of the bladder are worn out, urinary incontinence may result because a person may not know how to sense when the bladder is full or control the muscles that release urine.
Neuropathy can also gradually fall off sexual response in men and women, although the sex drive is untouched. A man may be unable to own erections or may reach sexual climax short ejaculating generally. A woman may have difficulty beside lubrication, arousal, or orgasm.
Sweat Glands
Autonomic neuropathy can affect the nerves that control sweating. When nerve damage prevents the sweat glands from working properly, the body cannot regulate its heat properly. Nerve damage can also inflict profuse sweating at night or while consumption.
Eyes
Finally, autonomic neuropathy can affect the pupils of the eyes, making them less responsive to change in pale. As a result, a person may not know how to see well when the night light is turned on in a brown room or may have trouble driving at darkness.
Proximal Neuropathy
Proximal neuropathy, sometimes called lumbosacral plexus neuropathy, femoral neuropathy, or diabetic amyotrophy, starts beside pain surrounded by either the thighs, hips, buttocks, or legs, usually on one side of the body. This type of neuropathy is more adjectives in those beside type 2 diabetes and in elder people. It cause weakness within the legs, manifested by an inability to stir from a sitting to a standing position without lend a hand. Treatment for weakness or headache is usually needed. The length of the recovery term varies, depending on the type of bottle damage.
Focal Neuropathy
Occasionally, diabetic neuropathy appears suddenly and affects specific nerves, most regularly in the go before, torso, or leg. Focal neuropathy may cause
* inability to focus the eye
* double vision
* aching bringing up the rear one eye
* paralysis on one side of the face (Bell's palsy)
* severe backache in the lower backbone or pelvis
* pain within the front of a thigh
* pain within the chest, stomach, or flank
* pain on the outside of the shin or inside the foot
* chest or abdominal cramp that is sometimes mistaken for heart disease, heart attack, or appendicitis
Focal neuropathy is raw and unpredictable and occurs most recurrently in elder people. However, it tend to improve by itself over weeks or months and does not make happen long-term damage.
People next to diabetes also tend to develop nerve compressions, also call entrapment syndromes. One of the most common is carpal tunnel syndrome, which cause numbness and tingling of the hand and sometimes muscle spinelessness or pain. Other nerves susceptible to entrapment may lead to pain on the outside of the shin or the inside of the foot.
Diagnosis
Neuropathy is diagnosed on the cause of symptoms and a physical exam. During the exam, the doctor may check blood pressure and heart rate, muscle strength, reflexes, and sensitivity to position, tremor, temperature, or a lantern touch.
The doctor may also do other tests to lend a hand determine the type and extent of nerve violate.
* A comprehensive foot exam assesses skin, circulation, and sensation. The test can be done during a routine organization visit. To assess protective sensation or emotion in the foot, a nylon monofilament (similar to a bristle on a hairbrush) attached to a wand is used to touch the foot. Those who cannot sense pressure from the monofilament hold lost protective sensation and are at risk for developing foot sores that may not heal properly. Other test include checking reflexes and assessing pulsation perception, which is more sensitive than touch pressure.
* Nerve conduction studies check the transmission of electrical current through a impertinence. With this test, an print of the nerve conducting an electrical signal is projected onto a blind. Nerve impulses that appear slower or weaker than usual indicate possible damage. This check allows the doctor to assess the condition of all the nerves in the arms and legs.
* Electromyography (EMG) shows how very well muscles respond to electrical signals transmitted by nearby nerves. The electrical amusement of the muscle is displayed on a screen. A response specifically slower or weaker than usual suggests damage to the chutzpah or muscle. This test is recurrently done at the same time as sassiness conduction studies.
* Quantitative sensory testing (QST) uses the response to stimuli, such as pressure, convulsion, and temperature, to check for neuropathy. QST is increasingly used to see sensation loss and excessive irritability of nerves.
* A check of heart rate variability shows how the heart responds to adjectives breathing and to changes within blood pressure and posture.
* Ultrasound uses sound waves to produce an picture of internal organs. An ultrasound of the bladder and other parts of the urinary tract, for example, can show how these organs preserve a normal structure and whether the bladder empty completely after urination.
* Nerve or skin biopsy involves removing a sample of resolve or skin tissue for examination by microscope. This try-out is most often used contained by research settings.
Treatment
The first step is to bring blood glucose levels inwardly the normal capacity to prevent further nerve harmed. Blood glucose monitoring, meal planning, exercise, and oral drugs or insulin injections are needed to control blood glucose level. Although symptoms may get worse when blood glucose is first brought below control, over time, maintaining lower blood glucose level helps lessen neuropathic symptoms. Importantly, upright blood glucose control may also help prevent or rearrangement the onset of further problems.
Additional treatment depends on the type of cheek problem and symptom, as described in the following section.
Foot Care
People with neuropathy involve to take special aid of their feet. The nerves to the foot are the longest in the body and are the ones most repeatedly affected by neuropathy. Loss of sensation within the feet process that sores or injuries may not be noticed and may become ulcerated or infected. Circulation problems also increase the risk of foot ulcer.
More than half of adjectives lower limb amputations contained by the United States occur surrounded by people beside diabetes--86,000 amputations per year. Doctors estimate that nearly half of the amputations cause by neuropathy and poor circulation could have be prevented by careful foot precision. Here are the steps to follow:
* Clean your feet each day, using warm--not hot--water and a mild soap. Avoid soaking your feet. Dry them near a soft towel; dry carefully between your toes.
* Inspect your foot and toes every day for cuts, blisters, reddishness, swelling, calluses, or other problems. Use a mirror (laying a mirror on the floor works well) or acquire help from someone else if you cannot see the bottoms of your foot. Notify your health meticulousness provider of any problems.
* Moisturize your feet next to lotion, but avoid getting it between your toes.
* After a bath or shower, folder corns and calluses benignly with a pumice stone.
* Each week or when needed, cut your toenails to the shape of your toes and record the edges with an emery board.
* Always wear shoes or slippers to protect your foot from injuries. Prevent skin irritation by wearing thick, soft, seamless socks.
* Wear shoes that fit powerfully and allow your toes to move. Break in contemporary shoes gradually by wearing them for single an hour at a time at first.
* Before putting your shoes on, look them over carefully and quality the insides with your paw to make sure they hold no tears, sharp edges, or objects in them that might injure your foot.
* If you need oblige taking care of your foot, make an appointment to see a foot doctor, also call a podiatrist.
For additional information under your own steam care, contact the National Diabetes Information Clearinghouse at 1-800-860-8747. Materials are also available at http://ndep.nih.gov/ materials/pubs/feet/feet.htm.
Pain Relief
To relieve strain, burning, tingling, or numbness, the doctor may suggest aspirin, acetaminophen, or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. (People with renal disease should use NSAIDs simply under a doctor's supervision.) A topical cream call capsaicin is another option. Tricyclic antidepressant medication such as amitriptyline, imipramine, and nortriptyline, or anticonvulsant medications such as carbamazepine or gabapentin may relieve dull pain in some empire. Codeine may be prescribed for a short time to relieve severe headache. Also, mexiletine, used to regulate heartbeat, has be effective contained by treating pain within several clinical trials.
Other pain treatments include transcutaneous electronic fortitude stimulation (TENS), which uses small amounts of electricity to block pain signals, as capably as hypnosis, relaxation training, biofeedback, and acupuncture. Walking regularly or using elastic stockings may also facilitate leg pain.
Gastrointestinal Problems
To relieve mild symptoms of gastroparesis--indigestion, belching, nausea, or vomiting--doctors suggest drinking small, frequent meals, avoiding fat, and eating smaller quantity fiber. When symptoms are severe, the doctor may prescribe erythromycin to speed digestion, metoclopramide to speed digestion and help relieve nausea, or other drugs to help out regulate digestion or reduce stomach sharp secretion.
To relieve diarrhea or other bowel problems, the doctor may prescribe an antibiotic such as tetracycline, or other medications as appropriate.
Dizziness and Weakness
Sitting or standing slowly may abet prevent the light-headedness, dizziness, or faint associated with blood pressure and circulation problems. Raising the commander of the bed or wearing elastic stockings may also assistance. Some people may benefit from increased brackish in the diet and treatment next to salt-retaining hormones. Others may benefit from high blood pressure medication. Physical therapy can back when muscle weakness or loss of coordination is a problem.
Urinary and Sexual Problems
To clear up a urinary tract infection, the doctor will probably prescribe an antibiotic. Drinking plenty of fluids will give a hand prevent another infection. People who have incontinence should try to urinate at regular intervals (every 3 hours, for example) since they may not know how to tell when their bladder is full.
To treat erectile dysfunction surrounded by men, the doctor will first do tests to rule out a hormonal incentive. Several methods are available to treat erectile dysfunction caused by neuropathy, including taking oral drugs, using a power-driven vacuum device, or injecting a drug called a vasodilator into the penis earlier sex. The vacuum and vasodilator raise blood flow to the penis, making it easier to hold and maintain an erection. Another preference is to surgically implant an inflatable or semirigid device in the penis. A constriction ring or penile sling may be of assistance.
Vaginal lubricants may be useful for women when neuropathy cause vaginal dryness. To treat problems with arousal and orgasm, the doctor may refer the woman to a gynecologist.
Points to Remember
* Diabetic neuropathies are impertinence disorders caused by tons of the abnormalities adjectives to diabetes, such as high blood glucose.
* Neuropathy can affect nerves throughout the body, cause numbness and sometimes pain contained by the hands, arms, foot, or legs, and problems with the digestive tract, heart, and sex organs.
* Treatment first involves bringing blood glucose level within the regular range. Good blood glucose control may lend a hand prevent or delay the start of further problems.
* Foot care is another major part of treatment. People near neuropathy need to inspect their foot daily for any injuries. Untreated injuries increase the risk of infected foot sores and amputation.
* Treatment also includes throbbing relief and other medication as needed, depending on the type of nerve deface.
* Smoking significantly increases the risk of foot problems and amputation. If you smoke, ask your health concern provider for help within quitting.
Hope Through Research
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the National Institute of Neurological Disorders and Stroke (NINDS) conduct and support research to help family with diabetes, including studies related to diabetic neuropathy. A complete encyclopaedia of clinical research studies can be found at http://ClinicalTrials.gov on the Internet.
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