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Neuropathy


Neuropathy is a common complication of both type 1 and type 2 diabetes.


According to the American Diabetes Association, 50% of people with diabetes experience some form of nerve damage in their lifetime. In fact, a fairly large percentage of diabetics show signs of neuropathy at diagnosis indicating that early glucose impairment, such as in prediabetes, is associated with neuropathy. It is more common , however, in people who have had diabetes for many years and/or diabetics who maintain poor glycemic control.


Diabetic neuropathy is primarily caused by damage to the body’s nerves due to elevated blood glucose levels over prolonged periods. It is classified as peripheral neuropathy, autonomic neuropathy, and other. I will focus on peripheral and autonomic neuropathy here.


Peripheral neuropathy is most common and typically begins in the feet. It is almost always bilateral (occurring on both feet) and is known as “stocking glove” neuropathy because of the way it progresses. Think of it like putting on a neuropathy sock; it starts at the toes and ascends. Peripheral neuropathy can also occur in the hands. Symptoms are usually worse at night and can range from mild discomfort to completely debilitating.


These symptoms include; numbness and tingling, loss of sensation, burning sensations, muscle cramps, muscle weakness, increased touch sensation (for some even the weight of a bed sheet can be insufferable), decreased balance and coordination (increased falling), loss of reflexes, and the development of foot ulcers.


Frequent foot exams are a must for people with diabetes especially if they have developed neuropathy. I encourage all my patients or their loved ones to check the bottom of their feet daily. If someone has developed neuropathy, they may not be aware of trauma to their feet. Because of the slow healing that comes with diabetes, a small laceration, a splinter, or an ingrown toenail can easily lead to an infection. If that is unfelt by the diabetic, it may be left untreated which can then lead to diabetic ulcers and possibly amputation. Prevention is key!


Your autonomic nervous system is the system that controls your digestive system, your heart and lungs, your bladder, your sex organs, and your eyes. Nerve damage to these areas can be very dangerous. Symptoms can include; vision changes, hypoglycemia unawareness (inability to feel hypoglycemia), constipation, diarrhea, urinary incontinence or retention (leading to bladder infections), erectile dysfunction, inability for your body to adjust blood pressure and heart rate, difficulty regulating body temperature, and increased resting heart rate. Gastroparesis is one of the more commonly known autonomic neuropathies and is caused by nerve damage in the GI tract. This leads to nausea, vomiting (of undigested food), bloating, and loss of appetite.


So, what can we do to avoid this? Control our blood sugars!!! BG control is the best prevention AND treatment of neuropathy. That being said, there are some really amazing and helpful drugs out there to help with painful neuropathy. If you have been experiencing these symptoms, ask your clinician for help! Remember, we’re on your team!

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