Nerves (1) Summary
Neuropathy – Nerve Damage
Diabetic neuropathy is the term used to describe a multitude of problems that may arise as a result of nerve damage caused by the long term effects of diabetes.
People with diabetes may develop one or more types of neuropathy, and sometimes it is a transient problem, which resolves itself over the course of a few months.
Some forms of neuropathy involve damage to a single nerve and are called mononeuropathies (also called focal neuropathy). More commonly though, many nerves are affected, potentially causing any of a number of polyneuropathies.
Neuropathies are frequently referred to simply as being either somatic (sensorimotor) or autonomic; however classifications found in the medical literature more fully describe the multitude of problems that can arise.
Another term that is used is peripheral neuropathy; this is usually in the context of damage to nerves in the legs and feet.
The Summary Table shows one way in which diabetic neuropathies can be classified. Each of the various conditions are described in detail in either Part 2 – which looks at somatic (sensory) neuropathies – or Part 3 – which looks at autonomic neuropathies.
|???? Are you confused by the terminology – the technical language and the various medical terms used ????? Let me know!
A simple definition of diabetic neuropathy (DN) has been agreed upon in the medical community:
|“… the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes, after the exclusion of other causes.”
Diabetic neuropathy should not be diagnosed without first carrying out a careful clinical examination, including the evaluation of symptoms, and the performance of some diagnostic tests.
All people with diabetes should be screened for signs of neuropathy every year, as part of the routine Annual Review. This is a thorough health check that should be offered once a year, every year, to all people with diabetes living in New Zealand. Depending on the arrangements with your local DHB, this may be subsidised or even free of charge. But this should not preclude you from visiting your doctor at any time if you suspect that your are suffering from symptoms that may be related to diabetic neuropathy.
Stay on top of your diabetes by maintaining close contact with your health care team and address potential problems early, before things have chance to get out of hand. There are many treatments that can help to relieve problems associated with diabetic neuropathy – so seek help, don’t suffer in silence.
As with all complications of diabetes, one of the most important things that you can do to slow down any deterioration in health is to maintain good control of blood pressure and blood glucose levels. Stop smoking, and go easy on the alcohol too – smoking and/or too much alcohol can exacerbate problems related to nerve function in people with diabetes. Maybe it’s time to re-evaluate your lifestyle!
It’s not uncommon to suffer from a combination of different types of somatic (and/or autonomic) neuropathy; this can result in a pattern of symptoms (see below) that is somewhat confused by the interaction of the different neuropathies. Diagnosing the specific type(s) of neuropathy that you are suffering from may therefore not be quite so straightforward. You may be referred to a doctor that specialises in nerve disease (a neurologist) for some tests that check the ability of nerves to conduct signals and convey messages.
Once neuropathy has been diagnosed, it becomes even more important that you look after your feet on a regular, daily basis. Check out the section on legs and feet and the subsection on foot care.
Symptoms of Diabetic Neuropathy
Each nerve in the body has a highly specialised function, and a wide range of symptoms can occur, especially if a number of nerves are damaged.
Symptoms are often much worse at night
Pain, sensitivity to touch, pins and needles, prickling or tingling (“paraesthaesia“), burning sensation, numbness, paralysis (inability to move), cramps
Muscle weakness (note this is not the same as ‘fatigue’), muscle twitching, muscle wasting, balance problems, unsteadiness
Exercise intolerance, fatigue, dizziness, fainting, balance problems
Loss of appetite, bloating, nausea, vomiting, acid reflux, diarrhea, constipation, loss of bowel control
Loss of bladder control, recurrent urinary tract infections, erectile dysfunction in men, pain during sex, and/or vaginal dryness in women
Excessive sweating, dry skin, calloused or reddened patches of skin, loss of hair on limbs
Other ‘non-specific’ symptoms
Depression, anxiety, sleep disorders
What Causes Neuropathy?
How does diabetes cause such a huge range of conditions?!
Our nervous system is comprised of an extensive network of nerve cells and connections. High blood glucose levels can damage the blood supply to the nerve cells and interrupt the signals sent through the connections. This may mean that nerve cells are starved of oxygen and nutrients and die, or it may mean that the wrong signals are sent, or that the signals that are sent are interpreted incorrectly.
Much of today’s scientific research is focusing on damage caused by specific biochemical pathways, which are common to a number of complications of diabetes. See the section on Hyperglycaemia for more in-depth discussions.
Summary Table of Neuropathies
Use the Search facility (top right bar) if you are looking for a specific type of neuropathy and don’t recognise the technical terms in this table.
This table outlines a classification of diabetic neuropathies which has been based on that described by Thomas (REF). It has been adapted here, for ease of presentation such that the green shaded areas are described in Part 2 – Somatic Neuropathies and the yellow shaded areas are covered in Part 3 – Autonomic Neuropathies.