Diabetes--------

Diabetes and neuropathy

What is diabetic neuropathy and who does it affect?

Neuropathy is a medical term which refers to a nerve disorder. Diabetic neuropathy is nerve disorder caused by either type 1 or type 2 diabetes. Over time, diabetics who do not strictly control their condition, may develop damage to the nerves around the body. Incidences are more common in patients with poor control, overweight, have higher levels of blood fat and blood pressure, and are over the age of 40. The longer a person has diabetes, the greater the risk becomes of developing neuropathies.

Neuropathies are manifested as a numbness or pain in the hands, feet, arms or legs. However, they may also affect the organs, including the heart and sex organs. The scale of the complication is immense, with an estimated half of all diabetics suffering from some form of neuropathy. The most common type of neuropathy is peripheral (distal symmetric neuropathy).

What exactly causes diabetic neuropathy?

The exact affect of glucose on the nervous system is still not known. However, prolonged exposure to higher than normal glucose levels certainly damages the nerves, causing neuropathy. A combination of factors contributes:

Lifestyle: Depending on diet and exercise, smoking and alcohol use
Metabolic: High blood pressure, low insulin levels, abnormal blood fat concentration
Neurovascular: Damage of the blood vessels carrying oxygen and nutrients to the nerves
Autoimmune: Inflammation of the nerves
Inherited: Preconditions that increase vulnerability to nerve disease

What are the symptoms of diabetic neuropathy?

The symptoms of diabetic neuropathy will depend entirely on the form of neuropathy present, and which nerves are being affected. In some people, no symptoms will manifest themselves.
Common symptoms of neuropathy include numbness, tingling and pain. These may be minor at first, and therefore may remain unnoticed as the condition develops gradually. However, in some types of diabetic neuropathy, the onset of the pain will be sudden and severe. Further symptoms include:

wasting of muscles in feet or hands
indigestion, nausea and vomiting,
diarrhoea/constipation
Urinary problems
Impotence or vaginal dryness
Faintness or dizziness
Weakness of the limbs

What types of diabetic neuropathy could I be at risk from?

The different types of diabetic neuropathy are detailed below:

How do I prevent diabetic neuropathy?

Maintaining consistently normal blood glucose levels is the best way to prevent diabetic neuropathy. Keeping levels stable protects the nerves.

What You Can Do If You Have Diabetic Neuropathy ?

There's a lot you can do to prevent or delay nerve damage. And, if you already have diabetic neuropathy (nerve damage), these steps can prevent or delay further damage and may lessen your symptoms.

Keep your blood glucose levels in your target range.

Meal planning, physical activity and medications, if needed, all can help you reach your target range. There are two ways to keep track of your blood glucose levels:

• Use a blood glucose meter to help you make decisions about day-to-day care
  
• Get an A1C test (a lab test) at least twice a year to find out your average blood glucose for the past 2 to 3 months

Checking your blood glucose levels will tell you whether your diabetes care plan is working or whether changes are needed.

• Report all possible signs of diabetic neuropathy.
  
• If you have problems, get treatment right away. Early treatment can help prevent more problems later on. For example, if you take care of a foot infection early, it can help prevent amputation.
  
  
• Take good care of your feet. Check your feet every day. If you no longer can feel pain in your feet, you might not notice a foot injury. Instead, use your eyes to look for problems. Use a mirror to see the bottoms of your feet. Use your hands to feel for hot or cold spots, bumps or dry skin. Look for sores, cuts or breaks in the skin. Also check for corns, calluses, blisters, red areas, swelling, ingrown toenails and toenail infections. If it's hard for you to see or reach your feet, get help from a family member or foot doctor.
  
  
• Protect your feet. If your feet are dry, use a lotion on your skin but not between your toes. Wear shoes and socks that fit well and wear them all the time. Use warm water to wash your feet, and dry them carefully afterward.
  
  
• Get special shoes if needed. If you have foot problems, Medicare may pay for shoes. Ask your health care team about it.
  
  
• Be careful with exercising. Some physical activities are not safe for people with neuropathy. Talk with a diabetes clinical exercise expert who can guide you.

How is diabetic neuropathy diagnosed?

Diagnosis will occur on the basis of your individual symptoms and a physical exam. The doctor may test your blood pressure, heart rate, strength, reflexes and sensitivity. Foot examinations are recommended for all diabetics.
Other tests such as nerve conduction studies, EMG (electromyography) and QST (quantitative sensory testing) may also be applied.

How is diabetic neuropathy treated?

Bringing blood glucose levels within normal range is essential. Strictly managing diabetes is the first stage in treating the condition. Diet and exercise will almost certainly play a role in treating the condition.

Specific types of neuropathy (such as cranial neuropathy, autonomic neuropathy, compression mononeuropathy, femoral neuropathy, and thoracic neuropathy) and their resultant complications may all be treated in specific ways.

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