What is Diabetic Neuropathy?
Diabetic Neuropathy is a very common chronic complication in people with Diabetes who don’t exercise adequate control over their blood glucose levels for a prolonged time which affects their nervous system.
The nervous system is composed of the central nervous system (which consists of the cerebrum, cerebellum and spinal cord), and the peripheral nervous system (which connects the spinal cord with the rest of the body). Peripheral nerves, which are connected to the spinal cord, are responsible for sending electrical signals with information from the brain to all of the body’s organs and from there, back to the brain.
Diabetic Neuropathy is damage of one or more peripheral nerves, including motor (which send signals with information from the brain to the organs), sensory (which send signals with information from the organs to the brain) and autonomous nerves (those we can’t consciously control). Due to the large amount of peripheral nerves that exist in our bodies, there are several kinds of neuropathy, among which we can mention, peripheral, autonomic, focal and proximal neuropathy.
Peripheral or Distal Neuropathy: Neuropathy affects the nerves that go to the limbs, both upper (arms and hands) and lower (legs and feet). The longest peripheral nerves are those which go from the lumbar area of the spinal cord (lower back) to the tip of the toes. Toes, along with fingers, are those which present the most damage, and this occurs because these are the ones which are furthest or at the end of the nerve. As a result, this can cause pain in the joints and bones, infections, ulcers, foot deformities (Charcot foot), and in its most severe stages may require amputation. Symptoms often worsen at night.
Peripheral Neuropathy can affect one or more nerves. Mononeuropathy presents damage in a single nerve; when there’s alteration of two or more nerves in different areas this is known as Multiple Mononeuropathy and when there’s deterioration of several nerves, it’s called Polyneuropathy.
Autonomic Neuropathy: This is the Neuropathy that affects the body’s autonomic nerves, that is, those we can’t consciously control. The autonomic nervous system controls those nerves which are responsible for normal functioning (homeostasis) of all organs of the circulatory, digestive, respiratory, urinary, reproductive, etc. systems of the body. When these nerves are damaged, this can cause imbalance in the autonomic system, disrupting proper functioning of those organs.
The autonomic nervous system controls the eyes, bladder, lungs, heart, stomach, intestines and sexual organs. Poorly controlled diabetes can damage the nerves of any of these organs, which can produce, among other things: inability to perceive hypoglycemia or low blood sugar symptoms (hypoglycemia unawareness), incontinence, urine infections, constipation, diarrhea, nausea, vomiting, loss of appetite, difficulty to swallow, erectile dysfunction or impotence, vaginal dryness, increased or decreased sweating, inability of the body to adjust blood pressure and heart rate, lightheadedness or fainting, irregular thermal body sensation, inability of the iris to allow entry of light into the eye and increased heart rate when at rest.
Focal Neuropathy or Mononeuropathy: This may appear suddenly and affect the a specific nerves in the torso, legs and head (especially the eyes), causing pain and muscle weakness in a particular area, unlike Proximal Neuropathy which causes generalized pain and muscle weakness in several parts. Among some of these symptoms we can include paralysis on one side of the face (Bell’s palsy), double vision, difficulty focusing, eye pain, severe pain in a defined area of the abdomen, lower back or chest.
Proximal Neuropathy or Radiculoplexus: Also known as Diabetic Amyotrophy or Radiculopathy, this is the second most common kind of Neuropathy in people with type 2 Diabetes and the elderly. It is a form of neuropathy that causes muscle weakness in the buttocks, hips and may involve nerve pain in the lower back and upper legs. Its most common symptoms include abdominal bloating, weight loss, weak and atrophied thigh muscles, severe pain in the buttocks, hips and thighs and eventual difficulty with rising from a sitting position.
Damage to the peripheral and autonomic nerves occurs when blood sugar levels (glucose) and Hemoglobin A1c remain high for several years. Excess blood glucose affects the production of nitric oxide in the blood vessels, which is why these become compressed and clog, obstructing normal blood flow which carries oxygen and nutrients to the various peripheral nerves of the organism. This decreases the nerve’s ability to transmit electrical signals.
Too much blood glucose also lowers myelin, which is the protective layer of the peripheral nerves, leaving many nerve areas exposed and unprotected, which causes those shock, burning, itching, stinging or tingling sensations, leading this affected area to even become numbed. Myelin is a substance that covers and protects the axons of some nerve cells, whose main function is to increase the transmission speed of nerve impulses.
It is estimated that 60% of people who’ve had Diabetes for 10 years, have had some degree of neuropathy and the progression rate of neuropathic damage will depend on their control of their blood glucose levels over time, as well as other factors which can accelerate these damages such as high blood pressure, age, sex and consumption of alcoholic beverages and cigarettes. People who maintain poor control of their diabetes, at some point present a painful distal diabetic polyneuropathy (neuropathic pain).
Fortunately, the onset and progression of this damage can be minimized, if we maintain good control over our blood glucose levels and Glycated Hemoglobin or A1c at all times.
At Diabetes Up to Date we have a strong commitment to offer all the necessary knowledge in order to be able to prevent the dreaded chronic complications associated with poorly controlled diabetes so you can enjoy a healthy, productive and happy life.