What You Should Know About Diabetic Neuropathy

	Aremmia Tanious, MD

The Three Types
“There are three types of neuropathy that occur in people with diabetes,” says Dr. Aremmia Tanious, a neurologist with Jefferson Medical Associates.

• Peripheral neuropathy reduces your ability to sense pain, touch, temperature, and vibration in certain parts of the body and may sometimes affect movement and muscle strength. It most often affects the feet and lower legs and may contribute to serious foot problems. It is the most common form of diabetic neuropathy.
• Autonomic neuropathy is caused by damage to the nerves that control the involuntary functions of your body, such as heartbeat, blood pressure, sweating, digestion, urination, and some aspects of sexual function. It is also common in people with diabetes.
• Focal neuropathy is far less common and usually develops suddenly. It affects a single nerve, most often in the wrist, thigh, or foot. It also may affect the nerves of the back and chest, as well as those that control the eye muscles.

Symptoms of Neuropathy
The damage caused by diabetic neuropathy can upset the normal flow of nerve impulses through the legs, arms, and other parts of the body. This may limit your ability to feel pain, which is one of the ways the body protects itself against injury. Neuropathy can affect internal organs and body systems, such as the following:

• Digestive system—frequent bloating, belching, constipation, nausea and vomiting, diarrhea, and abdominal pain
• Temperature regulation—profuse sweating at night or while eating certain food
• Urinary system—difficulty sensing when the bladder is full or difficulty emptying the bladder completely
• Reproductive system
• Cardiovascular system—poor circulation or low blood pressure causing dizziness, weakness, or fainting when you stand or sit up from a reclining position
• Blood sugar levels—difficulty knowing when blood sugar is low

What Causes the Disease?
“The exact cause of diabetic neuropathy is not known,” Dr. Tanious continues, “but it may reflect the effect of blood sugar on the arteries rather than the nerves. The higher your blood sugar level, the greater your risk for developing neuropathy. The risk of nerve damage also increases the longer you have diabetes. Excessive alcohol consumption may further increase the risk.”

Prevent Severe Neuropathy
Severe neuropathy often can be avoided:

• If you have developed nerve damage, keep your blood sugar levels within a safe range.
• If you already have nerve damage, detecting it early and then maintaining a safe blood sugar level may help prevent severe neuropathy and may reduce your risk of complications.

Diagnosis and Treatment
Diagnosis of diabetic neuropathy is based on your medical history—largely your symptoms—and physical exam. If these indicate peripheral neuropathy, an electromyography (EMG) and nerve conduction studies may be done.

Treatment focuses on preventing occurrence and slowing progression of the disease by consistently keeping your blood sugar levels within a safe range. You can keep your blood sugar levels within a safe range by taking your insulin or oral diabetes medication as prescribed, checking your blood sugar level often, following your diet for diabetes, exercising, and seeing your health professional regularly.

If you have peripheral neuropathy, treatment depends on the symptoms. Treatment to relieve pain such as medications and physical therapy may be used. Treatment for autonomic neuropathy depends on the organ or system affected and may include medications for digestive system problems, elastic stockings and medications for blood vessel problems, devices to improve erections, or lubricating creams for vaginal dryness. If focal neuropathy is present, treatment may include a splint or brace. If the nerve is being compressed, surgery may be necessary.

For additional information about diabetic neuropathy, contact Jefferson Medical Associates at 649-2863.

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