Diabetic Neuropathy - Its type, its cause, symptoms, treatment

Diabetic neuropathy is a well-known complication of type II diabetes, that is, diabetes mellitus. Diabetic neuropathy can be classified into four types, out of which, peripheral diabetic neuropathy is the most common in India. The cases of peripheral neuropathy widely range from 9.6% to 78% in different sections of India. With such an alarming rise in cases, it is very important to inform the public about this disease and how it is caused.

Therefore, in this article let's talk about what is diabetic neuropathy, its different forms, and their symptoms, causes, risk factors, and treatment.

What are the types of Diabetic Neuropathy?

Diabetic neuropathy refers to a condition wherein your nerves get damaged due to diabetes. This can happen due to the high levels of blood sugar and fats like triglycerides present in your blood. Diabetic neuropathy can be of different types depending upon which nerve is damaged. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), diabetic neuropathy is of the following four types:

Peripheral Neuropathy

• It is a very common type of neuropathy
• It is characterised by the damage to the nerves that affect your legs, feet, arms, and hands.
• Peripheral neuropathy is diagnosed in around one-third to half of the people having diabetes.
• The symptoms of peripheral neuropathy include:
  • Reduced sensation to feel temperature changes or pain
  • Burning or tingling feeling
  • Weakened muscles
  • Extremely sensitive to touch, that is, holding a simple bed sheet can also give you pain
  • Joint or bone damage
  • Infection or ulcers in foot

Autonomic Neuropathy

• This neuropathy is caused by damage to the nerves that control the functioning of your internal organs like your blood pressure, heart rate, urinary bladder, digestive system, sweat glands, sex organs, and eyes.
• The damage to these nerves can also be a cause of hypoglycemia unawareness.
• The symptoms of autonomic neuropathy include:
  • Bowel or bladder related problems
  • Hypoglycemia unawareness, that is, you are not aware that sugar levels in your blood are low.
  • Orthostatic hypertension, that is, you feel dizziness when standing up from sitting or lying position due to decreased blood pressure
  • Gastroparesis, that is, it takes time for the stomach to get empty leading to loss of appetite and sensation of fullness
  • Vomiting
  • Nausea
  • Difficulty in swallowing
  • Difficulty in adjusting eyes from far to near or light to dark
  • Excessive or diminished sweating
  • Vaginal dryness in females
  • Erectile dysfunction in males

Focal Neuropathy

• Focal neuropathy is also known as mononeuropathy.
• Focal neuropathies are characterised by damage in the single nerves of the head, hand, leg, or torso.
• Entrapment syndromes like carpal tunnel syndrome are the most common form of focal neuropathy.
• The symptoms of focal neuropathy include:
  • Double vision or difficulty in focussing
  • One side of the face being paralysed
  • Severe pain in foot, shin, or the front area of the thigh
  • Foot drop, that is, an intense weakness that makes lifting the front part of the foot difficult
  • Tingling or numbness in the fingers or hand
  • Dropping things because of weakness in the hand

Proximal Neuropathy

• Proximal neuropathy is also known as diabetic polyradiculopathy.
• This is a rare form of diabetic neuropathy.
• Proximal neuropathies are characterised by damage to the nerves of the buttocks, hip, or thighs.
• This neuropathy usually affects only one side of the body and seldom spreads to the other side.
• The symptoms of this neuropathy may improve steadily over some time. These symptoms may involve:
  • Intense pain in the thigh, hip, or buttock region
  • Having difficulties in rising from a sitting position
  • Thigh muscles getting weakened or shrinking
  • Chest pain
  • Pain in the abdominal wall

What are the causes of Diabetic Neuropathy?

The main cause of diabetic neuropathy is the uncontrolled levels of high blood sugar that interferes with the ability of the nerves to send signals by damaging the nerve connections. The walls of the capillaries (small blood vessels) also get weakened due to high levels of sugar in the blood. The exact cause for different types of diabetic neuropathy is still not known. However, a certain group of people are at a higher risk of developing diabetic neuropathy. These risk factors that make you more prone to diabetic neuropathy include:

• Reduced control of blood sugar levels (uncontrolled levels of blood sugar)
• Having a history of diabetes for a long time, especially if it is uncontrolled diabetes
• Kidney disease or damage that causes the toxins to circulate in the blood leading to nerve damage
• Smoking can cause the arteries to narrow and harden that reduces the flow of blood to the legs and feet due to which the wounds don't heal and peripheral nerves get damaged.
• Obesity, that is, having a body mass index (BMI) greater than 25 can also increase your risk to diabetic neuropathy.

How can Diabetic Neuropathy be treated?

Diabetic neuropathy is an incurable health condition, therefore, the treatment of diabetic neuropathy is designed with an objective to delay the progression of the disease, relieve pain, restore the function of the affected nerves, and manage the future complications that may arise due to diabetic neuropathy.

Delay the progression of the disease

Delaying the progression of diabetic neuropathy is very important to prevent the disease from worsening and to avoid the future complications that may arise due to the disease. Certain ways by which you can delay the progression of disease includes:

• The key method to delay the progression of disease includes keeping the blood sugar levels at check. According to the American Diabetes Association (ADA), the recommended blood sugar levels for people diagnosed with diabetes is between 80 mg/dL (4.4 mmol/L) to 130 mg/dL (7.2 mmol/L) before meals and less than 180 mg/dL (10.0 mmol/L) two hours after your meal. The HbA1C should be less than 7.0%. 
• Keep your blood pressure at check
• Maintain a healthy and normal weight
• Ensure regular physical exercise

Relieving Pain

The nerve pain caused due to diabetes is very common. Your doctor might prescribe you certain medicines that will help in relieving your pain. The Prescription for relieving pain may include:

• Anti-seizure drugs: Nerve pain can be relieved by medications that are used to treat seizure disorders like epilepsy. The anti-seizure drugs that might be recommended to you include lyrica (pregabalin) and gralise (gabapentin or neurontin). These drugs are generally safe but may have certain side effects like drowsiness, swelling in the hands and feet, and dizziness.
• Antidepressants: These drugs are not only prescribed to people who are depressed but also help in relieving nerve pain. 
  • Tricyclic antidepressants like nortriptyline (pamelor), amitriptyline, and desipramine (norpramin) are used to treat mild to moderate nerve pain. The side effects of using these drugs include constipation, dry mouth, difficulty in concentrating, drowsiness, and orthostatic hypotension (that is difficulty in changing postures). 
  • The alternative of tricyclic antidepressants with fewer side effects are the serotonin and norepinephrine reuptake inhibitors (SNRIs) that includes ADA approved drugs like duloxetine (Drizalma Sprinkle, Cymbalta) and venlafaxine (effexor XR). The side effects that these drugs can have include sleepiness, nausea, dizziness, constipation, and decreased appetite.

A combination of antidepressants and anti-seizure drugs can also be used to relieve pain. These drugs are over-the-counter medicines, that is, they are available without prescription. These include ibuprofen (Motrin IB, Advil), acetaminophen (Tylenol), and a skin patch with numbing substances like lidocaine.

Managing Complications

Diabetic neuropathy can give rise to various health complications. Different complications are managed differently. 

Urinary Tract Problems

Issues with the urinary tract may arise as a side effect of certain medicines. Therefore, if you feel that your urinary tract is not functioning properly or there are changes in your urination pattern, you must get a consultation from an expert. Your doctor might suggest you one of the following:

• Stopping the medicines that are causing urinary tract problems and suggesting an alternative for that drug.
• Following a strict urination schedule, that is, going for urination after every few hours, by applying a gentle pressure on the bladder area.
• Self-catheterization is recommended in severe cases where it becomes difficult to remove urine from a nerve damaged bladder.

Digestive Problems

You may experience certain signs of gastroparesis, that includes indigestion, nausea, bleaching, and vomiting. These problems can be handled by:

• Eating smaller portions of meal more frequently
• Making modifications in your diet
• Medicines can also be prescribed to provide relief from constipation, diarrhoea, and nausea.

Low Blood Pressure (Orthostatic Hypotension)

Orthostatic hypotension is the condition wherein you face problems when standing up after sitting or lying down. The ways by which you can manage orthostatic hypotension includes:

• Limit alcohol consumption
• Keep yourself hydrated
• Changing positions gradually, that is, don’t stand up suddenly from a sitting or lying position
• Keep your head raised to 4-6 inches at night to prevent high blood pressure
• You may also require compression support by using abdominal binder and compression shorts
• Certain medicines can also be prescribed for the treatment of orthostatic hypotension.

Sexual dysfunction

Sexual dysfunction, that is, erectile dysfunction in males and vaginal dryness in females can also occur. Certain ways by which sexual dysfunction can be managed includes:

• Oral medicines or injections can be prescribed. However, this is not a very effective treatment approach.
• The flow of blood in penis can be increased by the use of mechanical vacuum devices
• Vaginal lubricants can be used by females to ease dryness in the vaginal area.

Takeaway

Diabetes neuropathy is a severe condition that may arise due to diabetes. Therefore, it is very crucial to keep your blood sugar levels at check. Now that you know all about diabetic neuropathy, its types, symptoms, causes, and treatment, you better know how to manage your health in order to prevent the future complications of diabetic neuropathy.

Frequently Asked Questions (FAQs)

1. What is the latest treatment for diabetic neuropathy?

   The latest FDA approved drugs used for the treatment of diabetic neuropathy include neurontin (gabapentin), cymbalta (duloxetine), and lyrica (pregabalin).

2. What are the warning signs of diabetic neuropathy?

   The initial warning signs of diabetic neuropathy include observing the effect on your legs, feet, arms, and hands, and numbness to pain and temperature.

3. Where does diabetic neuropathy usually start?

   The first part of the body affected by diabetic neuropathy is your feet and legs.