Diabetic neuropathy is a form of nerve damage in individuals with diabetes resulting from consistently high blood sugar levels. This condition primarily affects nerves in the legs and feet but can also impact other body areas. Symptoms of diabetic neuropathy range from mild to severe and may include pain, numbness in the limbs, and issues with the digestive system, urinary tract, blood vessels, and heart. Affecting up to 50% of people with diabetes, this severe complication can be prevented, or its progression slowed through diligent blood sugar management and maintaining a healthy lifestyle.
Different Types of Diabetic Neuropathy
- Peripheral Neuropathy: This affects the nerves in the arms, legs, hands, and feet. It can cause tingling, numbness, and pain in these areas, leading to losing sensation over time.
- Autonomic Neuropathy: This affects the nerves that control involuntary bodily functions like digestion, heart rate, blood pressure, and bladder control. Symptoms can include gastrointestinal problems, sexual dysfunction, urinary issues, and cardiovascular disturbances.
- Proximal Neuropathy: This mainly affects the nerves in the hips, buttocks, and thighs. It causes pain, weakness, and muscle atrophy or muscle wasting (refers to the loss of muscle mass and strength) in those areas, usually on one side of the body.
- Focal Neuropathy: This involves damage to specific nerves, leading to sudden pain or weakness in a particular area, such as the wrist, leg, or face. It can cause conditions like carpal tunnel syndrome or facial paralysis.
Causes & Risk Factors
The exact causes of diabetic neuropathy are not fully understood. However, researchers believe prolonged exposure to high blood sugar levels significantly damages the nerves and disrupts their ability to transmit signals effectively. Additionally, elevated blood sugar levels can weaken the walls of the small blood vessels (capillaries) that supply oxygen and nutrients to the nerves, further contributing to neuropathy development.
Several risk factors increase the likelihood of developing diabetic neuropathy:
- Poor Blood Sugar Control: Failure to maintain optimal blood sugar levels increases the risk of various complications associated with diabetes, including nerve damage.
- Duration of Diabetes: The longer a person has diabetes, mainly if blood sugar levels are poorly controlled, the higher the risk of developing diabetic neuropathy. It underscores the importance of early diagnosis and effective management of diabetes.
- Kidney Disease: Diabetes-related kidney damage can lead to the release of toxins into the bloodstream, which can contribute to nerve damage.
- Excess Weight: Being overweight, typically defined as having a body mass index (BMI) of 25 or higher, can increase the risk of developing diabetic neuropathy.
- Smoking: Smoking has detrimental effects on the circulatory system, causing narrowing and hardening of arteries. This diminishes blood flow to the legs and feet, making it more challenging for wounds to heal and causing damage to the peripheral nerves.
Diagnosing Diabetic Neuropathy
Autonomic testing plays a crucial role in diagnosing diabetic neuropathy by evaluating the function of the autonomic nervous system (ANS). Since diabetic neuropathy often affects the autonomic nerves, these tests help assess the extent and severity of autonomic dysfunction.
Some standard autonomic tests used in diagnosing diabetic neuropathy include:
- Tilt Table Test: This test measures changes in blood pressure and heart rate as the patient’s posture is altered from lying flat to an almost standing position. It helps identify orthostatic hypotension, a common symptom of autonomic neuropathy.
- Quantitative Sudomotor Axon Reflex Test (QSART): QSART evaluates the function of the nerves that control sweating. Measuring the sweat response to electrical stimulation helps identify abnormalities in sweat gland function, which can indicate autonomic nerve damage.
- Thermoregulatory Sweat Test (TST): TST measures how well the body sweats in a warm environment. It assesses the ability of the sweat glands to respond appropriately to temperature changes, providing valuable information about autonomic function.
- Bladder Ultrasound: This test examines the bladder after urination to assess residual urine volume. Since autonomic neuropathy can affect bladder control, an ultrasound helps identify any issues in bladder emptying.
By evaluating specific functions of the autonomic nervous system, these tests aid in confirming the diagnosis and guiding appropriate treatment strategies.
It is essential to consult with a healthcare professional for a comprehensive assessment and interpretation of autonomic testing results. The findings from these tests, along with other diagnostic tools and clinical evaluation, help establish a tailored management plan for diabetic neuropathy.
When to Go to the ER
Diabetic Neuropathy doesn’t normally come on without warning. When to go to the ER depends on th individual symptoms. However, any sudden or unusual symptoms that are causing discomfort should be evaluated by a doctor as soon as possible. These could include sharp shooting pains, numbness and tingling of extremities, shortness of breath, dizziness, fatigue and an increase in heart rate. If these symptoms worsen or become persistent they should not be ignored and medical attention must be sought.
It’s also important to seek medical help if there is an infection, which is a common complication of diabetic neuropathy. If the skin around your feet or hands looks red and inflamed, it could be infected. Other signs include fever, swelling, warmth in the area and severe pain. Seek immediate medical attention if these are your symptoms.
WebMD. “Diabetic Neuropathy: Types, Symptoms, Prevention, Treatment.” WebMD, www.webmd.com/diabetes/diabetes-neuropathy.
Mayo Clinic. “Diabetic Neuropathy.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 29 Apr. 2022, www.mayoclinic.org/diseases-conditions/diabetic-neuropathy/symptoms-causes/syc-20371580.
MedlinePlus. “Autonomic Testing: Medlineplus Medical Test.” MedlinePlus, U.S. National Library of Medicine, medlineplus.gov/lab-tests/autonomic-testing/.