When you have diabetes mellitus, which is referred to as diabetes, your blood glucose level is consistently high. Untreated, a high sugar level damages your nerves. Blood vessels that take oxygen to your nerves are also damaged. Damaged nerves send messages slowly or at the wrong times, and nerves eventually stop sending messages to the brain. This damage is called diabetic neuropathy.
Diabetic neuropathy can occur in both Type 1 and Type 2 diabetes. In Type 1 diabetes, the body does not produce insulin. Insulin is needed to convert glucose into energy that the body needs. Type 2 diabetes is more common. In Type 2 diabetes, the body does not use insulin properly, which is called insulin resistance. The body begins to make extra insulin. Over time, the body cannot make enough insulin to keep the glucose level normal.
Neuropathy is a serious complication of diabetes, and it affects up to 70 percent of people with diabetes. Neuropathies can occur in any part of the body, including the eyes, heart, lungs and feet.
Peripheral neuropathy is the most common type and occurs slowly. Initially, it affects the foot. Peripheral neuropathy eventually spreads to the ankle and leg. Because nerves have been damaged, patients do not feel pain. Patients may be unaware of foot injuries, which can lead to open sores. If these sores don't heal or they become infected, they result in more complications. In severe cases, toes or the foot need to be amputated. Foot ulcers account for 85 percent of toe or foot amputations. Approximately 50 percent of amputees die within five years.
Neuropathy also results in muscle loss. This makes standing or walking difficult. People with neuropathy may become depressed and socially isolated. Neuropathy also decreases quality of life.
Symptoms of peripheral neuropathy
If any of the following statements apply to you, contact your doctor. Tests will be ordered to confirm whether you have diabetic neuropathy:
• My feet tingle.
• I feel "pins and needles" in my feet.
• I have burning or shooting pains in my feet.
• My feet are sensitive to touch.
• My feet hurt at night.
• My feet are numb and feel dead.
• I don't feel pain in my feet.
• I can't feel my feet when I'm walking.
• I'm unsteady when I walk or stand.
• My feet and hands get very cold or very hot.
• I have open sores on my feet and legs that heal slowly.
• It feels like the muscles and bones in my feet have changed.
What factors increase my chances of getting diabetic neuropathy?
People with diabetes can develop nerve problems at any time. The risk increases with age. The highest rates of nerve problems are among people who have had diabetes for at least 25 years.
Neuropathies are more common in people who are overweight and have high cholesterol levels. The risk increases when control of their blood glucose level is inadequate. Other risk factors include smoking, heavy alcohol use and being tall. Having both diabetes and high blood pressure greatly increases the risk for serious complications.
What is the treatment?
There is no cure for neuropathy. Nerve damage cannot be reversed. Treatment focuses on three goals. The first is to slow the progression of neuropathy. The second is to relieve pain. The third is to treat complications such as infections. To slow the progression, it is critical to bring blood glucose to a normal level. Glucose monitoring, meal planning, physical activity and medication help control the glucose level. Good glucose control prevents or delays the onset of future problems.
For patients with diabetic neuropathy, commonly used medications include antidepressants, anticonvulsants, prescription pain medication and topical agents. Many of these medications are approved for treating other conditions. They are used because of their positive effects. Antidepressants and anticonvulsants are generally used first. Depending on the medication, side effects may include constipation, dizziness, headache, nausea, dry mouth, fatigue, diarrhea, weight gain and insomnia.