Diabetic neuropathy: symptoms, causes and treatment

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Definition

What is diabetic neuropathy?

Diabetic neuropathy is serious nerve damage that occurs as a result of diabetes mellitus. This condition indicates that there have been further complications of diabetes.

This condition is also known as diabetic neuropathy. Usually, it occurs because of uncontrolled blood sugar for years. This high blood sugar level is what ultimately damages the nerves from the hands and feet.

Diabetic neuropathy is a complication of diabetes with quite disturbing symptoms. Increasingly, this condition can inhibit the activities of diabetics and reduce their quality of life.

How common is this condition?

Diabetic neuropathy is a common complication in diabetic patients. According to the American Academy of Family Physicians, an estimated 30-50% of people with diabetes develop diabetic neuropathy.

This complication is most likely to occur in diabetic patients who have had the disease for a long time or in patients who have not been properly treated.

Signs & symptoms

What are the signs and symptoms of diabetic neuropathy?

Besides the general diabetes symptoms, there are other signs that suggest diabetic neuropathy in diabetic patients. Symptoms that appear are usually distinguished by type.

Symptoms of peripheral neuropathy

Peripheral neuropathy is the most common type of diabetic neuropathy. This condition first affects the nerves in the legs and then spreads to the hands and arms.

Symptoms include:

• Numbness and reduced ability to feel pain or changes in temperature
• A burning or tingling sensation appears
• Severe cramps
• Muscle weakness and pain and loss of reflexes, especially in the wrist
• Diabetes appears, such as ulcers and infections
• Poor body balance and coordination
• In some people, the feet or hands are more sensitive to touch, and can even cause pain

The symptoms of peripheral neuropathy mentioned above usually get worse at night. This causes diabetes patients to have difficulty sleeping well.

Symptoms of autonomic neuropathy

Autonomic neuropathy is a type of diabetic neuropathy that affects the "automatic" nerve response of the internal organs of the body (autonomic nerves). This autonomic nervous system controls the functions of the heart, bladder, stomach, sex organs, and eyes.

Symptoms that result from autonomic neuropathy are:

• Bladder problems, be it a urinary tract infection or incontinence (being unable to hold back the urge to urinate)
• Constipation, diarrhea, or both
• Slow gastric emptying (gastroparesis), causing nausea, vomiting, bloating, and loss of appetite
• Difficulty swallowing
• Often sweating or otherwise rarely sweating because the body has problems controlling body temperature
• Heart rate increases while resting
• The eye has difficulty adjusting the room lighting from light to dark
• Decreased sexual desire due to erectile dysfunction due to diabetes or vaginal dryness
• Blood pressure drops sharply after sitting or standing which can cause dizziness and even loss of consciousness.

Symptoms of radiculoplexus neuropathy (diabetic amyotrophy)

Radiculoplexus neuropathy is a type of diabetic neuropathy that affects the nerves around the thighs, hips, buttocks, and legs. This condition is very common in people with type 2 diabetes mellitus who are older.

Radiculoplexus neuropathy has many other names, namely diabetic amyotrophy, femoral neuropathy, or proximal neuropathy. Common symptoms of this condition are:

• Severe pain in the hips, thighs, or buttocks that lasts for a day or more
• Shrinking and weakening of the thigh muscles
• Difficulty getting up from a sitting position
• There is swelling in the stomach and decreased appetite

Symptoms can improve slowly or get worse. Initially, symptoms attack one side of the body, when they worsen to the other side.

Symptoms of focal neuropathy

Focal neuropathy or also known as mononeuropathy is a type of diabetic neuropathy that attacks the facial nerves, midsection, and legs. This complication is very common in the elderly.

Symptoms of focal neuropathy include:

• There is pain in the legs, lower back, front of the thigh, chest, or stomach
• Difficulty seeing an object with focus
• Vision becomes shadowed
• Pain behind the eye, usually on one side
• Facial nerve paralysis (Bell's palsy)
• Have carpal tunnel syndrome, which is severe numbness or tingling in the fingers and wrist

Symptoms of focal neuropathy are often sudden and severe. You may not be able to hold an object or drop it.

Symptoms go away for several weeks or months without treatment, but don't cause long-term problems.

When should I see a doctor?

Immediately visit a doctor if you experience the symptoms of diabetic neuropathy described above. Especially if you experience the following conditions:

• The wound does not heal and causes pus
• There is a tingling feeling, numbness, a burning sensation in the hands and feet that interferes with activities
• Feeling dizzy with digestive and sexual function problems

The signs and symptoms that appear do not necessarily mean that you have diabetic neuropathy. However, it could be a sign of another condition that requires medical treatment.

Early diagnosis and treatment of health conditions provide the best chance of controlling diabetes and preventing these complications in the future.

Cause

The cause of diabetic neuropathy is uncontrolled high blood sugar levels. Over time, this condition will damage nerves and interfere with the body's ability to send signals.

In addition, high blood sugar also weakens the walls of the capillaries that supply nerves with oxygen and nutrients.

Quoted from the Mayo Clinic, health experts also mention that diabetic neuropathy can be caused by various factors, such as:

• Inflammation of the nerves caused by the immune system mistaking the nerves for a foreign substance that harms the body
• Genetic factors
• Smoking and drinking alcohol without a rule can damage nerves and blood vessels

Risk Factors

Who is at risk for this condition?

Anyone can experience diabetic neuropathy. However, the following factors make a person more at risk of developing diabetic neuropathy, namely:

• Diabetes patients who do not control blood sugar levels in their body properly, such as a bad diet or do not follow medication as recommended by a doctor
• Have a history of gestational diabetes during pregnancy
• Diabetic patients with kidney problems
• Diabetes patients who still smoke, drink alcohol, and are underweight

Diagnosis

How do doctors diagnose this condition?

Before determining a diagnosis, your doctor will review your symptoms and medical history. The doctor will then check your overall body muscle strength, body sensitivity to touch and vibration, and tendon reflexes.

In addition to a physical exam, your doctor will recommend medical tests to help diagnose diabetic neuropathy, such as:

• Filament test (rubbing nylon fibers gently against the skin to test for sensitivity)
• Quantitative sensory testing to determine the condition of nerves in response to vibrations and temperature changes
• Electromyography (EMG) and nerve conduction to measure the electrical discharge generated by the muscles
• Autonomous testing to determine changes in blood pressure at certain body positions

Treatment

What are the drug options for diabetic neuropathy?

If you often experience leg cramps, you can treat it by massaging the part of the leg that feels stiff.

However, if it is accompanied by pain, you may be able to take a pain reliever, such as acetaminophen, aspirin, or ibuprofen. Use a low dose to treat the occasional cramping symptoms.

However, there are also other treatment options as a way to relieve foot pain in diabetics, such as:

1. Antidepressant drugs

Apart from treating depression, antidepressants are also often prescribed to treat nerve pain due to diabetic neuropathy. These drugs can affect the action of chemicals in the brain that are responsible for providing pain signals.

Your doctor may recommend tricyclic antidepressants for the treatment of diabetic neuropathy, such as:

• Amitriptyline (Elavil)
• Imipramine (Tofranil)
• Desipramine (Norpramin)
• Venlafaxine (Effexor)
• Duloxetine (Cymbalta)

2. Anticonvulsant drugs

Apart from antidepressants, drugs that are used as a way to relieve leg pain in diabetics are anti-seizure drugs. Anti-seizure drugs have another function as anti-pain medications caused by neurological disorders.

Anti-seizure drugs that are commonly used in the treatment of diabetic neuropathy are:

• Pregabalin
• Gabapentin
• Phenytoin
• Carbamazepine

3. Opioid pain medications

Medicines that are stronger for treating nerve pain due to diabetic neuropathy are opioid drugs. This is a last resort, if the previous medication was not effective in dealing with symptoms.

The opioid drugs that are usually prescribed in the treatment of diabetic neuropathy are oxycodone (Oxycontin) and tramadol (Conzip, Ultram).

4. Topical pain relievers

How to get rid of foot pain in diabetics can not only be overcome by taking medication, but pain can also be relieved with patches or patches that can help relieve pain. The choice of patch drugs for the treatment of diabetic neuropathy is lidocaine which is affixed to the skin.

5. Alternative medicine

Several alternative therapies have been studied for managing pain due to diabetic neuropathy, although they have not been shown to be effective. Alternative treatments that can be a way to get rid of foot pain in diabetics are:

• Supplements like acids alpha lipoic and acetyl-L-carnitine
• Biofeedback (sensory therapy for the body)
• Meditation
• Acupuncture
• Hypnosis

Home remedies

What are the home remedies that can be done to treat this condition?

Nerve damage from diabetic neuropathy can cause pain, but it can also affect your ability to feel pain. Apart from doctor's treatment, you also need to do home care.

Diabetic neuropathy treatments that you can apply at home are:

1. Doing foot care

• Check your feet daily for sores, swelling, and other problems. You probably won't notice the problem until your foot is completely infected.
• Wash your feet daily with warm water and dry afterward. Apply a moisturizer so that the skin does not dry out and breaks easily. Don't rub moisturizer between your toes.
• Wear shoes that are comfortable, flexible, and fit your feet and give them room to move. Wear special shoes if your regular shoes don't match.
• Always cover your feet with thick shoes, sandals, or socks to protect them and prevent injury.

2. Maintain normal blood sugar levels

The first step to treating pain due to your diabetic neuropathy is to control a normal blood sugar number. This treatment can prevent the damage from spreading and getting worse.

You may be asked by your doctor to lower your blood sugar by 70-130 mg / dL before meals and less than 180 mg / dL blood sugar after meals.

3. Live a healthy lifestyle

Doctor's treatment must be combined with adopting a healthy lifestyle to treat the symptoms of diabetic neuropathy. You need to rearrange food choices for diabetes, portions, and meal times.

In addition, do the exercises that are recommended for diabetes regularly. This physical activity is a great method for controlling blood sugar as well as body weight.

It is very emphasized for diabetics to quit smoking. If you have trouble, don't hesitate to ask a doctor for help.

Prevention

How can you prevent diabetic neuropathy?

The best way to prevent diabetic neuropathy is to keep blood sugar normal to avoid early nerve damage. Follow your doctor's recommendations for diet, exercise, and treatment.