CSN-CommunityPost-Diabetic Neuropathy

Up to 60% of people who have diabetes will complain of numbness, pain, or tingling in their hands or toes. These are symptoms of nerve damage identified as diabetic neuropathy.

"Diabetic neuropathies are the common form of non-traumatic neuropathies in industrialized nations," stated Dianna Quan, MD, professor of neurology in the University of Colorado School of Medicine in Denver. "Things that seldom go with diabetes, such as smoking, high blood pressure, increased triglycerides, and cholesterol, are also bad for nerves."

There are three broad forms of nerves: motor, sensory, and autonomic. Sensory nerves carry data about sensations from various parts of the body. This involves texture, temperature, or pain. Sensory nerves are commonly affected by diabetic neuropathy.

The autonomic nervous system's nerves control the "housekeeping" functions, such as the stomach, heart, intestine, and bladder activities.

Motor nerves instruct the muscles what to do when you transfer.

Peripheral nerves send sensory data from the body back to the spinal cord and brain. They also can send signals from the brain and spine to the muscles, instructing them to move. Same as static on your phone, neuropathies distort and interfere with these messages, resulting in numbness, weakness, pain, or tingling.

"Diabetic neuropathies are damages to the peripheral [outside of the spinal cord or brain] nerves that are secondary to the problem of diabetes," said Eva Feldman, MD, Ph.D., Russell N. DeJong, professor of neurology in Michigan Medical School University in Ann Arbor. "The classic form starts in the nerves in the tips of your toes and then slowly goes up the body."

This causes sense from a physical standpoint because the nerves in your fingers or toes are the farthest from their starting in the spinal cord. Think of them as great extension cords that might be stretched or cut.

Control is key

Neuropathies in diabetes are very often linked to a lack of adequate control of blood sugars. The longer you with diabetes and the consistently high your hemoglobin A1c (HbA1c) is, the more possible you will get diabetic neuropathy, and the worse it will be.

While reasonable control is essential in both types of diabetes, its effect on neuropathies may change if you have type 2 diabetes. In type 1, the person is usually insulin-deficient when the pancreas stops making insulin. In type 2 diabetes, you are insulin resistant, so your body reacts by pumping out more and more insulin; however, your muscles and fat cells can't take in sufficient fats and glucose.

"Clearly in type 1 people, the DN is more closely correlated to glucose control," said Dr. Feldman. "Well-controlled studies are noting that if you control glucose in type 1 people, you are less prone to have neuropathies and even improve any preexisting impairment. In type 2 diabetes, even with good control, the nerve damage can extend over time."

In type 2, there may be a condition getting the correct combustible into the nerve cells. Think of nerve cells as small power plants. It would help if you got something to generate power while also excluding waste products. If you decide to use diesel fuel when the plant is set up for regular gasoline, your plant won't work efficiently, and sludge will begin to build up that ultimately shuts the plant down.

Data indicate that controlling glucose in type 1 diabetes can reduce diabetic neuropathy incidence by 60% and frequently slow progression. On the other hand, among those who have type 2, at least 50% will show indications of diabetic neuropathies even with reasonable control.

"With type 2 diabetes, the medicine of nerve damage is probably more multifactorial," stated Feldman. "In addition to glucose, lipids, high blood pressure, and obesity run parallel with this type of diabetes. You want to treat dyslipidemia, control weight, and work with hypertension to see a beneficial impact on type 2 diabetes."

While most specialists and guidelines set HbA1c goals of 6.5% to 7.5%, that is not always the case. Indeed, some forms of diabetic neuropathy may make that goal critical to certain people.

One of the body's normal defenses against hypoglycemia, or low blood sugar, is the adrenaline release from the adrenal gland. If diabetic neuropathy has attacked the nerve that assists this gland, the hormone isn't released.

"This hypoglycemic unawareness, or failure to sense low blood sugars, may indicate you have to tolerate high glucose levels to avoid frequent episodes of low blood sugar," declared Lyle Mitzner, MD, a staff doctor at the Joslin Diabetes Center in Boston. "The body is wired for a particular response in the state of low blood sugars. If nerve damage indicates that it doesn't work, the glucose will proceed to drop, and we need to avoid that."

An ounce of prevention

The best method to avoid diabetic neuropathies is never to get diabetes.

"From the viewpoint of prevention, diabetes doesn't occur overnight," said Quan. "There is a stage of prediabetes or impaired glucose metabolism, which is a transition between frank diabetes and healthy blood sugar levels. In that twilight region, there is a chance to avoid type 2 diabetes in the first place."

Early symptoms of diabetic neuropathy include:-

• burning sensation in the fingers or toes 

 • tingling

 • electric-shock feelings

 • pricking pain

 • hypersensitivity to touch

 • muscle weakness

 • loss of reflexes

 • loss of coordination and balance 

As the neuropathy gets more critical, you may lose sensation in your extremities. It can be the most severe part of the process.

"When you have nerve harm to the point you can't feel your feet, you are at high risk for catching ulcerations," says Dr. Mitzner. "If you don't feel a scratch or cut on your foot, you don't understand to treat it. This can cause ulcerations, infections, and maybe even amputation of the toes or foot."

This is the reason your diabetes health care team stresses examining your feet often. The injuries can be challenging to see, but further problems can be prevented when caught early.

Diabetes-related nerve damage diagnosis often occurs in the diabetologist's office. An essential part of the assessment is a physical examination or good history. After all of this, just because you with diabetes doesn't suggest you can't have another neurological problem.

Your healthcare provider will frequently use a tuning fork to test for sensitivity to fluctuations and a safety pin to see pain perception deficits. He/she may have you force against his or her hands or grip his or her fingers to evaluate your strength and whether it is the equivalent on both your left and right sides. In some cases, nerve conduction researches might be used to see if the nerve messages are going through.

"I study what my patient is telling me regarding their symptoms and observe if they are consistent with what we notice in diabetic neuropathies," stated Mitzner. "Not everyone will require to see a neurologist unless I notice something indicating some other potential medical concern."

Treatment of diabetic neuropathy pain

There are no magic tablets or treatments that will reverse any damage already happen to the nerves. If the symptoms are mainly things such as tingling or electric shock, little can be done. When there is pain, medicines can help.

Recently, only two medications have been approved by the U.S. Food and Drug Administration (FDA) to treat neuropathic pain in diabetes. These contain the anti-seizure medication pregabalin (Lyrica) and the antidepressant duloxetine (Cymbalta).

Although they have not gone through getting official FDA approval for such use, many other types of medications have been displayed in comprehensive research to help with pain relief. It is so-called "off-label" use is accepted by many doctors and should not alarm you if prescribed. Many of these have cheap generic versions available.

These groups hold other anti-seizure medicines such as carbamazepine and gabapentin, and tricyclic antidepressants like amitriptyline, imipramine, anddesipramine.

If these do not reduce the pain, more potent medicines may be used. Opioid narcotics are possible if the pain is refractory after other drugs have been used.

"We can help to treat pain if the symptoms affect your ability to function or restrict your quality of life," stated Mitzner. "Medicines have side effects that can be more troublesome than the symptoms themselves. In other terms, people are already on a lot of medicines and don't want to have another one. Treatment of pain is very individualized."

The important message from all three specialists is don't wait until you have diabetic neuropathy. The quicker you think about it, the better off you will be.

"From my viewpoint, the minute you are diagnosed with diabetes, you should be talking with your physician about what you require to do to prevent or lessen conditions for yourself in the long run," tell Quan.