What is Diabetic Neuropathy?
Diabetic neuropathy is a term used to describe one of the more common complications of diabetes in which nerves are damaged in various parts of the body. The most common form of neuropathy that occurs in a person with diabetes is called peripheral neuropathy, which commonly affects the arms, legs and feet, but it can also affect the body's internal organs. Roughly sixty to seventy percent of people with diabetes have some form of neuropathy varying from mild to severe, with the highest rates occurring in those that have had the disease for more than twenty five years. Neuropathy appears to occur most commonly in people that are over forty, those that have trouble keeping blood glucose levels under control, smokers and in those that are overweight/obese. Neuropathy can develop in someone with diabetes at any age, but the longer someone has diabetes the more at risk they become. Damage to nerves often leads to muscle weakness, the loss of reflexes, internal organs not functioning properly, and if left untreated long enough it can also lead to the total loss of feeling in the affected nerves and organ failure. It should be noted that some people with neuropathy can experience no symptoms at all, so for someone with diabetes it is extremely important to see a physician and receive testing for neuropathy.
Symptoms of Diabetic Neuropathy
Peripheral neuropathy can occur throughout the body because the peripheral nervous system, is divided into two subsystems, the somatic nervous system and the autonomic nervous system, so symptoms for each will depend on which nerves are affected and may be seen over a period of days, weeks, or even years.
Somatic Nervous System
Neuropathy in the somatic nervous system can affect nerves in the skin, muscles, and sensory organs such as the eyes, ears, nose and even your sense of balance. This is where most people with diabetes will commonly develop neuropathy, mainly in the legs, feet, arms and hands. The symptoms listed below are those most likely to occur in this portion of the peripheral nervous system and can often be worse at night disrupting sleep. These symptoms can also become temporarily worse once blood glucose levels have been brought under control after diagnosis and treatment.
• Insensitivity to temperature
• Sharp pains and muscle cramps or uncontrolled muscle twitching visible under the skin
• Numbness, burning, prickling or tingling sensations in the hands, feet and extremities
• Atrophy or wasting in the muscles of the hands or feet
• Feelings of extreme sensitivity to touch, where even the slightest touch can cause severe pain (allodynia)
• Insensitivity to pain
• Losing your sense of balance, coordination
• Pain, tingling or numbness in the fingers and toes
Autonomic Nervous System
Neuropathy in the autonomic nervous system can affect nerves in the body's internal organs and the nerves controlling automatic body functions. Nerves in the heart and blood vessels, lungs, digestive system, glandular tissues, the urinary tract, sexual organs, sweat glands and certain nerves in the eyes are most commonly affected. Some of the more common symptoms of neuropathy in the autonomic nervous system can be quite unpleasant and can include.
• In the digestive system - A form of neuropathy called "gastroparesis" can affect nerves in the stomach which interferes with its function and can cause digestion to be delayed (gastric stasis) or incomplete. If nerves in the throat and esophagus are affected it could make it difficult for a person to swallow. Nerves that control muscular contractions within the intestines, as well as nerves in the pancreas and gallbladder could also be affected. Any of this could lead to vomiting, nausea, bloating, constipation, incontinence or diarrhea and these symptoms can be persistent in the more severe cases.
• In the heart and blood vessels - Neuropathy can cause an irregular heartbeat, racing heart beat, or inconsistent blood pressure. Dizziness or faintness from sudden drops in blood pressure can occur after sitting or standing up (orthostatic hypotension). Neuropathy here can become life-threatening because in some cases sudden cardiac death can occur.
• In the eyes - If nerves in the eyes are affected it can interfere with the pupils ability to dilate and become less responsive to changes in light. This can result in a person being unable to see well in situations where the lighting changes frequently such as driving at night or a light being switched on in a dimly lit room.
• In the urinary tract - Neuropathy in the urinary tract can cause a loss in bladder control, an inability to empty the bladder completely or incontinence which can lead to a greater risk of urinary tract infections. Women have twice the risk of incontinence than men.
• The lungs - Neuropathy that affects the lungs can affect the ability of a person to breathe normally, making it difficult to take in lungs full of air, irregular breathing patterns or shortness of breath. This can become life-threatening in some of the more extreme cases.
• In the sexual organs - Neuropathy in the sexual organs can cause erectile dysfunction in men, excessive vaginal dryness in women and a marked decrease in sexual pleasure in both men and women.
• In glandular tissues - Symptoms of neuropathy in glandular tissues will depend on which glands are affected. The two most noticeable with will be sweat and salivary glands. If nerves in the salivary glands are affected a person can experience excessive dry mouth which can also affect digestion because saliva begins the digestive process. If nerves that control sweat glands are affected a person can experience profuse sweating even when cool, at night or while eating (gustatory sweating). It can also lead to an inability to sweat all together which could lead to an inability to properly regulate body temperature and cause heat intolerance.
Next: Focal neuropathy and Other complications
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