Diabetic Neuropathy

Diabetic neuropathy is a nerve disorder and its many complications that are caused by diabetes.

Diabetic neuropathy refers to several types of nerve damage associated with diabetes. The most common form is a slowly progressive degeneration of nerves in the arms and legs, in which the longest nerves (e.g., in the toes and feet) tend to be affected first and most severely. As nerve damage worsens, symptoms spread up the legs and begin in the hands. Neuropathy from diabetes can occur at any point, although typically it occurs in patients who have had diabetes for a longer period of time or in those who have had poorly controlled diabetes. This type of neuropathy from diabetes causes numbness, pain, weakness, and in severe circumstances can affect nerves that control basic bodily functions such as heart rate, digestion, sweating, blood pressure and others. Other types of diabetic neuropathy include isolated injury to one of the cranial nerves. Also, isolated nerves in the legs and arms may become acutely injured as a result of diabetes.

Scientists do not know how diabetic neuropathy occurs, although several factors interact together. High blood glucose causes chemical changes in nerves, impairing their ability to transmit nerve signals. High blood glucose also damages blood vessels that carry oxygen and nutrients to the nerves. Also, inherited factors probably unrelated to diabetes may make some people more susceptible to nerve disease than others.

Diabetic neuropathy appears to be more common in smokers, people over 40 years of age, and those who have had problems controlling the levels of glucose in their blood.

Types Of Diabetic Neuropathy

Doctors divide diabetic neuropathy into three main types:

Peripheral Neuropathy . The most common type of diabetic neuropathy, peripheral polyneuropathy affects nerves that transmit sensation, control muscle movement, and control bodily functions. Typically, symptoms start in the feet and spread up the legs. In more severe cases, hands and subsequently the face may become affected as well. Peripheral neuropathy usually involves nerves on both sides of the body. Some of the most common symptoms of this kind of neuropathy are:

• loss of coordination and balance
• extreme sensitivity to touch, even very light touch
• numbness or insensitivity to pain or temperature
• tingling, burning, or prickling
• sharp pains or cramps
• atrophy of muscles
• wounds that don't heal well and become easily infected

In more severe cases, the autonomic nerves (nerves that control bodily functions) are affected as well. Occasionally, these nerves may be the first nerves to be affected. Symptoms of autonomic nerve dysfunction include:>

• erectile or sexual dysfunction
• loss of bladder or bowel control
• abnormal sweating with inability to tolerate changes in temperature
• abnormal blood pressure control, causing lightheadedness when standing up
• trouble digesting food

Mononeuropathy (including "multiplex neuropathy") is isolated peripheral neuropathy, involving the distribution of only one or a few nerves. Occasionally, diabetic neuropathy appears suddenly and affects specific nerves, most often in the torso, leg or head. When mononeuropathy occurs, it may cause:

• double vision
• aching behind the eye
• inability to focus the eye
• pain in the front of the thigh
• paralysis on one side of the face (Bell's palsy)
• problems hearing
• severe pain in pelvis or lower back
• chest or abdominal pain sometimes mistaken for angina, heart attack, or appendicitis

This kind of neuropathy is unpredictable and occurs most often in older people who have mild diabetes. Although mononeuropathy can be very painful, it tends to improve by itself after a period of weeks or months without causing long-term damage.