Diabetic Neuropathy (weakness of nerves)

Diabetes brings with it myriad of problems. The complications associated with diabetes affect various organs ranging from eyes, kidneys to nervous system disorders like neuropathy. Neuropathy literally means pathological involvement of the nerves or in a layman’s language weakness of the nerves. There are basically two types of nerves in our body viz. motor that brings out the signal from the brain to the muscles in the periphery to bring out the movements. The other type of nerves are sensory nerves that take care of taking the peripheral sensation to the brain. There are another type of nerve fibers that involve controlling the body internal homeostasis or maintaining the internal organ balance like maintaining the heart rate, blood pressure, bowel movements, urinary control, pupillary responses and sweating response to changes occurring inside the body. Diabetes can affect all the types of nerves in the body.  So in short, diabetes can cause :

  • Sensory Neuropathy affecting sensation perception like touch and temperature.
  • Motor Neuropathy affecting muscle movement.
  • Autonomic Neuropathy affectingdigestive system or heart rate.

Who is at risk?

Those diabetics, not strictly controlling their glucose control, are at a higher risk for developing the neuropathic changes. Incidence of neuropathy are more common in patients with poor control, obese, have higher levels of blood fat and blood pressure, and are over the age of 40. Apart form these factors duration of diabetes remains another non modifiable risk factor in diabetics and it is independent of the other risk factors.  Overall prevalence of neuropathy may be up to 50% in people with diabetes.

Symptoms of neuropathy will often first manifest as numbness or pain in the hands, feet, arms or legs (distal symmetric neuropathy). Apart from above symptoms, they may also affect the organs like blood vessel, heart, sex organs and also gastrointestinal system.

What causes neuropathy in diabetes?

Prolonged exposure to high glucose levels is the most important factor. But there other factors that also contribute, like….

  • Lifestyle: like exercise, smoking and alcohol use
  • Metabolic: high BP, Low insulin levels, abnormal blood fat concentration
  • Neurovascular: Damage of the blood vessels carrying oxygen and nutrients to the nerves
  •                Inherited: Preconditions that increase possibility of developing theneuropathy

Symptoms of diabetic neuropathy?

The symptoms depend on the form of neuropathy present, and type of nerves being affected. There might be some people who develop no symptoms leading to subclinical neuropathy.

Common symptoms might include:

  • Numbness
  • Tingling
  • Pain
  • Wasting of muscles in feet or hands
  • Indigestion, nausea and vomiting,
  • Diarrhoea/constipation
  • Urinary problems
  • Impotence or vaginal dryness
  • Faintness or dizziness
  • Weakness of the limbs

How is neuropathy diagnosed?

Diagnosis will occur on the basis of person’s individual symptoms and a detailed physical examination. The doctor may test blood pressure, heart rate, strength, reflexes and sensitivity. Foot examinations are recommended for all diabetics. Few other tests may be required.

  • Nerve conduction studies
  • EMG (electromyography) and
  • QSART (quantitative sensory testing)

How frequently should a doctor evaluate diabetics for neuropathy?

Foot examination should be done regularly during the clinic visits.

Detailed nerve examination should be done at least once a year.

Author: Dr. Rajiv Singla

A leading endocrinologist and diabetologist from New Delhi. An alumnus of University College of Medical Sciences, Dr. Singla completed his MD (Medicine) from Maulana Azad Medical College (MAMC). He went on to pursue DM (Endocrinology & Diabetes) from reputed AIIMS, Delhi.

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