Neuropathy or Nerve Damage.
This can effect nearly every part of the body, with the exception of the brain and spinal nerves. Your nerves are the messenger system between the brain and the body. When they are damaged the messages come through much slower than normal, come through garbled, or do not get through at all.
Nobody appears to know exactly why high blood sugar levels cause nerve damage. It is suspected that somehow the glucose affects the proteins in the nerve cells by changing the chemical balance or altering the blood flow.
We will leave the technicalities to the scientists (in the vague hope that they will find out enough to produce a cure!). All we need to worry about, and that is quite enough thank you, is that this does happen and the repercussions can be serious.
Neuropathy can be divided into two categories:-
1. Diffuse, meaning it affects many parts of the body.
2. Focal, meaning it affects a single, specific nerve or set of nerves and therefore a specific part of the body.
Types of diffuse neuropathy.
Peripheral neuropathy Alternate terms:-
Distal Symmetric Neuropathy or Distal symmetrical polyneuropathy, because it affects the long nerves that go from the spinal cord to the arms and legs.
Sensory Neuropathy, because it affects the sensory nerves - those that sense pain, hot, cold etc or Diabetic Polyneuropathy.
The irritating part about peripheral neuropathy is the way it can impact on your daily life, making many, normally simple, tasks so much more difficult. One of the worst disasters for many people is that they can no longer safely drive their cars.
Peripheral neuropathy may start with tingling, burning or prickling sensations in your hands or feet. This is often worse at night and in cold weather. Feet problems seem to develop first, probably because the nerves to you feet are the longest ones in your body - ask any overweight person, they can tell you just how far away their feet are!
Good news!!! - At this stage tight control of your blood sugars may well reverse the problem. However if you do not control them the symptoms will progress.
You may experience:-
Shooting pains.
Severe cramps.
Extreme sensitivity to touch, even light touch such as a sheet or blanket.
Numbness.
Insensitivity to pain or temperature.
Loss of balance and co-ordination.
Although numbness and insensitivity may seem a relief after the previous pain you have experienced it is actually very dangerous.
Without feeling you do not notice injuries, even minor ones like cuts, blisters and splinters. These can become infected and develop into much more serious problems. If untreated the infection can spread into the bone where it is almost impossible to treat and amputation is the only solution.
Neuropathic Arthropathy.
A condition resulting from peripheral neuropathy, known as Charcot foot. Once the sensation in the foot is lost a person can no longer sense what the actual position of the foot is. Along with this can go weakening of the muscles, so the joint is no longer properly supported. No alteration in walking or footware is made to compensate for this (you can't feel anything wrong!). Injuries such as twisted or sprained ankles, even breaks, can go undetected. The foot will eventually heal by itself but it will be deformed.
Swelling, heat and redness of the foot are warning signs to look out for.
Foot care is so important that I intend to do a section purely dealing with that - watch this space!!!
Until then and in brief:-
It is suggested that diabetics examine their feet every day, do not go barefoot, even indoors, wear well fitting shoes and have at least an annual foot check-up.
Treatment.
For relief of painful peripheral problems many people swear by ointments made with capsaicin, (which is the ingredient that burns your mouth when you eat hot red peppers). These creams block pain signals - Anything is worth a try!
If there is an infection oral or intravenous antibiotics may be prescribed.
Sometimes your doctor may prescribe an anti-depressant for bad neuropathy pain. If you immediate response to that is "Why an anti-depressant, does he think I am nuts and just imagining this pain?" don't worry.
He is aware how real the pain is. It is just that some anti-depressants, for some reason, help to take away the pain of neuropathy. This has nothing to do with their action as anti-depressants.
Mind you, if we are suffering the tortures of the damned from neuropathy pain, I think we have a reason to be depressed so maybe we can gain in two ways from this medication!
Treatment by Complementary Medicine.
Some new treatments have arrived that involve taking supplements, particularly Alpha Lipoic Acid or ALA. This link will take you to the supplement home page. Read it and then go to the ALA link at the bottom of that page.
Proximal Neuropathy.
The word 'proximal' tells us that this neuropathy occurs close to the trunk. Researching this can get very confusing as often the different types of proximal neuropathy are mixed together and there seem to be conflicting statements. I will separate them for better understanding.
1. Femoral neuropathy.
This is found most often in type 2 diabetics. It is usually asymmetrical i.e. on one side of the body only. Severe pain usually develops in the front of one thigh, though occasionally it can be felt in the hip and buttock. Muscle weakness follows, and the affected muscles waste away.
2. Diabetic amyotrophy.
For some reason this appears more often in older type 2 diabetic males. For once we woman are on a winning streak! Unlike femoral neuropathy it is bilateral (occurs on both sides of the body) and there is little pain.
Weakness occurs in the pelvis and thighs as the muscles atrophy and patients experience difficulty in sitting down or standing up without help and negotiating stairs is a nightmare. Even walking may become difficult. Sometimes the calf muscles can also be affected.
A loss of appetite and of weight usually accompanies this condition along with a loss of the patellar reflex - tapping your knee does not result in a leg jerk. Recovery is spontaneous in a few months, but this condition can come back again.
3. Thoracic or lumbar radiculopathy.
This is very like femoral neuropathy, except that instead of affecting the thighs it affects a band of muscles, either asymmetrically or bilaterally, of the chest or the abdominal wall.
Again it occurs more often in people with type 2 diabetes and again it spontaneously improve with time.
Autonomic neuropathy.
The autonomic nervous system is in charge of those bodily functions that take place without our conscious control eg. digestion, breathing etc. The nerves affected by diabetic neuropathy are those that serve the heart and internal organs and those that regulate blood pressure and blood glucose control.
1. Cardiovascular.
This system regulates your blood pressure and heart rate. If the nerves are damaged your may suffer from orthostatic hypotension - in other words your blood pressure may drop sharply after sitting or standing, with the result you may feel dizzy, light-headed and may even faint.
This is because it is your nerves that tell your blood vessels to constrict when you stand up, stopping all your blood from draining to your feet - thus defying gravity! If the nerves are damaged and the message to constrict does not get through fast enough too much blood drains downwards, depriving the brain.
If you have orthostatic hypotension you need to learn to stand up slowly, get out of bed slowly, and try not to sit still for too long. Your heart rate may be out of kilter.
You may not feel the pain that precipitates a heart attack. In fact you could have a minor heart attach without being aware of it. Likewise the pain of angina will not be felt. Both the above are warning signs of more serious trouble to come, and you will be unaware of it.
2. Digestion.
When the vagus nerve is affected the stomach can empty too slowly. This is called gastric stasis. In it's most severe form it is known as gastroparesis. Symptoms of this are constant nausea, vomiting, feeling full after eating very little, loss of appetite.
It can cause severe complications for insulin dependant diabetics or those on sulphonylureas because they need to balance the medication to their food intake. If the food sits in the stomach too long they will experience a low, and then a high when it is suddenly dumped. It can also cause some very confusing random fluctuations in your BG levels.
Oesophageal nerve damage may make it difficult to swallow. Also the oesophagus may become sluggish, food may not be moved along fast enough and heartburn can result.
Bowel nerve damage can cause severe diarrhoea alternating with constipation, especially at night.
The diarrhoea occurs when the small intestine is either over-stimulation by the stomach suddenly emptying a lot of food into it, or by the food spending too long in it.
The constipation occurs when the large intestine is affected. If there is a loss of movement in the large intestine the stool remains within it too long, with the result that too much water is absorbed from it.
Neuropathy affecting the rectum and anus can cause faecal incontinence.
Digestive neuropathy of all kinds can result in weight loss.
Treatment can start with a change in diet - adding more fibre is often recommended. There are also medications to help empty the stomach and for the control of constipation and diarrhoea.
3. Urination Tract & Sexual Organs.
These are some of the more common organs affected and really disturb people as they can cause a number of embarrassing complaints. If the nerves to the bladder are affected you may loose the awareness of when you need to urinate and the ability to control this need, leading to incontinence.
Diabetics with this problem will find that, disrupting as it may be to their daily routine, going to the toilet every hour or two, come hell or high water, (oops, maybe 'high water' was not quite the right term to use here), will avoid the embarrassment of an 'accident'.
There are also some drugs and operative procedures that may help. The bladder may also not empty properly and that means increased bacterial growth and infections, especially in the outlet from the bladder.
Another result of autonomic nerve damage is gradual loss of sexual response in both men and women, although libido is unchanged. A man may become impotent and a woman may find she lacks vaginal lubrication, has trouble becoming aroused and achieving orgasm.
If impotence occurs suddenly it is usually of a temporary nature, possible brought about by very high or very low BG levels and is thus reversible. However symptoms of impotence that come on gradually and progress usually result in the development of a permanent condition, while gradual and progressive symptoms usually signal the development of permanent impotence.
Men may find help in drugs such as Viagra, mechanical devices or surgical implants. Your doctor can best advise you on these. For woman lubricating gels are readily available from pharmacies.
4. Perspiration (or sweating if you prefer the term).
If neuropathy affects the nerves that control the sweat glands the regulation of body temperature can go haywire. Some people complain of intense sweating during the night and yet others while eating. The latter is termed Gustatory sweating and causes excessive sweating in the face and head. In others the sweating decreases, frequently causing dry, cracked feet.
5. Eyes.
The pupils of the eyes may be affected. They do not respond properly to changes in light so you may have trouble driving at night or being able to adjust when a light is suddenly turned on in a dark room.
6. Blood glucose control.
Autonomic neuropathy can also cause a condition known as Hypoglycemia Unawareness, where people no longer experience the warning signs of hypoglycemia. The person has no idea they are so low and can go into a coma and even die if untreated.
Focal Neuropathy Also called Mononeuropathy.
As stated previously this is when a specific nerve is affected, for example in the head, or the leg or the chest. The onset can be sudden, unpredictable and very painful but the advantage - we diabetics learn to look for the good in bad situations - is that it frequently gets better spontaneously in about three months to a year and does not cause long term damage.
Rarely, and I sincerely hope none of you readers fit into this category, it can last for years. It is found mostly in older diabetics.
Cranial Mononeuropathy (Focal neuropathy in the head) may cause:-
Double vision, inability to focus and dull ache at the back of the eye. Also eye paralysis which presents first as pain on one side of the face which is followed by paralysis of the eye muscle, resulting in double vision and a drooping eyelid. Hearing difficulties. Bell's palsy - one side of the face becomes paralysed. This sort of neuropathy usually appears in people over 50.
Focal neuropathy in the torso may cause:-
Pain in the lower back.
Pain in the pelvis (the pain in this and the lower back can be very bad)
Chest pain - similar to that of angina or heart attack.
Abdominal pain - often mistaken for appendicitisStomach pain(These sorts of neuropathy pain are often worse at night for some reason).
A type of focal neuropathy in the torso is Diabetic Truncal neuropathy Also called Diabetic truncal radiculoneuropathy. This less common neuropathy is usually seen in middle aged to elderly diabetics, both type1 and type 2.
Symptoms are pain, either tingling or burning, in a specific area on the front or back of the chest or abdomen. The patients says it feels as if that area has been scalded by something. This patch becomes very sensitive and even the touch of clothing can hurt. Spontaneous recovery usually occurs after a number of months.
Focal neuropathy in the limbs may cause:-
Pain in the front of a thigh. Difficulty in getting a leg to lift. Pain on the outside of the shin or inside the foot Weakness in your hand, making it difficult to grip things.
Compression Neuropathy Also called Entrapment Syndromes.
This reasonably common form of focal neuropathy occurs when a single nerve is damaged. This can happen either by the nerve being compressed, or 'squashed' if you prefer, as it passes through a tight space or over a lump of bone or when blood flow to the nerve is diminished.
The most common one is Carpal tunnel syndrome. This occurs when the median nerve of the forearm is compressed at the wrist.
Symptoms are numbness, swelling, or tingling in the fingers, with or without pain. Repetitive actions tend to make it worse - knitting was my nemesis! It is often worse at night and sometimes simply hanging your arm by your side will stop the pain. Also wrist splints can be worn to relieve symptoms. In severe cases an operation can give complete relief from pain.
Ulnar neuropathy.
The ulnar is a major nerve in your arm that runs from your shoulder down into your hand. At the elbow we call it the 'funny bone'. When it becomes compressed it can cause numbness, tingling, or pain into the arm and hand on the side of the little finger.
Unilateral foot drop.
When this occurs you cannot pick your foot up. It occurs from damage to the peroneal nerve of the leg by compression or blood vessel disease. Foot drop can improve with time.