What Is Diabetic Neuropathy?

What is neuropathy in diabetes? It is a condition that occurs as a result of untreated or late-diagnosed diabetes mellitus, which manifests itself in a degenerative lesion of all elements of the nervous system. This disease often occurs 15-25 years after the onset of diabetes in a person. This pathological condition is characterized by damage to the peripheral nerves in the absence of other causes of neurological disorders other than diabetes. It is manifested by motor, respiratory, and cardiac activity disorders and dysfunction of the endocrine glands.

Both the somatic nervous system, which innervates the skeletal muscles, bones, joints, skin, and the autonomous nervous system, which regulates the functioning of internal organs, are affected. The disease complicates the course of diabetes mellitus in more than 30% of patients. It is the main risk factor for a leg amputation. 

Symptoms

The most common symptoms of diabetic neuropathy are:

• Pain in the legs and arms;
• Sensation of numbness of the limbs;
• Causeless heat on the palms and feet;
• Rapid fatigue;
• Muscle weakness.

The most common form of the disease is chronic sensorimotor neuropathy. Polyneuropathy of the lower extremities begins at the end of the legs and spreads towards the trunk. 

Thin sensory fibers are the first to suffer, and this is manifested by: 

• Pain;
• Unpleasant burning sensation;
• Tingling;
• Numbness. 

Other diabetic neuropathy symptoms, especially neuropathic pain, can appear suddenly and be quite pronounced. They reduce patients’ quality of life, create difficulties with movement, and cause bad moods and social maladjustment.

Movement disorders such as weakness or thinning of the feet muscles and diabetic nerve pain in the legs manifest in the later stages of the disease.

People with damage to thick myelin fibers have complaints of: 

• Numbness;
• Tingling; 
• Pain;
• Unsteady gait. 

An unsteady gait is a common symptom, especially in the dark or when walking on uneven surfaces. Individuals with this type of polyneuropathy are at high risk of developing ulcerative lesions, which eventually lead to amputation.

In a minority of patients with this disease, thin myelin fibers are predominantly affected. Clinically, this is manifested by decreased temperature and pain sensitivity with a relatively intact vibrational and muscle sensation. Patients often describe neuropathic pains as burning or nagging, like “needles.”

Autonomic polyneuropathy and its symptoms

Another form of the disease is autonomic polyneuropathy. Diabetic neuropathy signs are disorders of the autonomic nervous system which occur quite often, and present under various clinical types.

Complaints vary depending on which organ system is affected:

1. Cardiovascular – dizziness, fainting;
2. Gastrointestinal – swallowing disorder, nausea, vomiting, constipation/diarrhea, bedwetting;
3. Genitourinary – the need to wake up several times at night to urinate, a feeling of incomplete emptying of the bladder, erectile dysfunction, vaginal dryness;
4. Also, autonomic polyneuropathy is characterized by a disorder of sweating (absence or sweat during meals). It may also be the adaptation of the pupil to light and silent myocardial ischemia.

Disturbance of pupillary reactions is expressed in a paradoxical decrease in pupil diameter during adaptation to darkness in the early stages. It may also be an absence or very slow and incomplete expansion of the pupil in the future. The difficulty of driving at night manifests this feature.

There is evidence that a patient may pose a threat to himself and others when driving a vehicle. The inhibitory reaction is slowed down in people with neuropathy of the lower extremities. And it increases the probability of an accident. 

Causes of Diabetic Neuropathy

Causes of diabetic neuropathy can include:

1. Diabetes disease
2. Damage to sensory nerves
3. Damage to small nerve fibers
4. Damage to large nerve fibers
5. Damage to motor nerves

Now let’s look at the causes of diabetic neuropathy in more detail:

Diabetes. Pain in neuropathy sometimes occurs at the beginning of diabetes treatment. When blood sugar returns to normal, the pain usually disappears. Although other neuropathy symptoms may persist for a longer time. If the sugar is still high and the pain disappears, this indicates the progression of neuropathy.

Damages to sensory nerves. When sensory nerves are damaged, there is a complete or partial loss of sensation in the limbs. 

• With extensive damage to the sensory nerves, patients may feel cold extremities. If small fibers are affected, a person may no longer distinguish between cold and hot, which increases the risk of frostbite and burns.
• A person does not experience pain with cuts, wounds, or burns. As a result, ulcers may develop. If these ulcers become infected, disease and gangrene can occur. In this case, the only way is to amputate part of the affected limb. 

Pay attention! It is very important to do routine checks for the feet with such diabetic neuropathy symptoms. It is also necessary to inspect the lateral parts of the feet as well as the heels and the spaces between the fingers. If you notice that the skin on your legs has lost its sensitivity, you should immediately consult a professional neurologist.

Damage to small nerve fibers. With the deterioration of small nerve fibers, patients often experience pain in the extremities of a different nature. They can be aching, dull, tingling, and twitching. The pain gets worse at night. 

The damage to large nerve fibers. With the defeat of large nerve fibers, a person does not feel the movements of the fingers and touch. In addition, balance problems can occur, which are often described as “not being able to tell where my feet are when I’m walking.” The most serious difficulties arise when moving in the dark.

Motor nerves are affected. If the motor nerves are affected, the muscles of the limbs get thin and weaken, but such symptoms do not occur immediately.

Diagnostics

Diabetic neuropathy is detected during neurological examinations, which should be carried out annually in all patients with diabetes mellitus.

The following tests are performed to assess different types of neuropathy in diabetes:

• Graduated tuning fork test;
• Touching hot and cold objects;
• Monofilament touching the plantar surface of the feet;
• Passive flexion of the toes while the patient’s eyes are closed;
• Diagnostics of tendon reflexes.

According to the indications, the state of the vegetative system is examined. Rhythm variability during breathing is assessed, as well as an orthostatic test and a Valsalva test are performed to study the innervation of the heart.

In the presence of relevant complaints, an examination of the stomach and genitourinary system is carried out.

Treatment of diabetic neuropathy

Treatment of diabetic neuropathy includes specific therapy (insulin, etc.), constant blood sugar monitoring, physiotherapy, diet, rational physical activity, and special foot hygiene. 

Maintaining an optimal glucose level in the blood allows you to slow down or stop degenerative neuropathic processes. It should be remembered that untreated diabetic neuropathy is one of the main risk factors in the pathogenesis of arrhythmias, myocardial infarction, and life-threatening lesions of the lower extremities. Its early diagnosis largely ensures a favorable prognosis for peripheral or autonomic diabetic neuropathology.

Treatment options include the following:

• A prerequisite for the effective treatment of diabetic neuropathy is optimizing glucose levels in the patient’s body. For this purpose, specific therapy (insulin, etc.) and constant blood sugar monitoring are prescribed.
• The therapeutic strategy usually includes B vitamins, vitamin E, other antioxidants, and trace elements (zinc, magnesium). If diabetic neuropathy is accompanied by pain, analgesics are prescribed.
• Drug treatment of diabetic neuropathy is combined with physiotherapy, diet, and rational physical activity; special foot hygiene is necessary (therapeutic baths, pedicures, moisturizing).

Complications

In the absence of treatment for diabetic neuropathy, the patient loses limbs. And his vital activity is completely disrupted. However, if the disease is detected early, the prognosis for preserving of limbs and normal life activity is favorable in most cases.

Bottom Line 

Diabetes mellitus and its complications (diabetic polyneuropathy and angiopathy, diabetic foot syndrome, retinopathy – damage to the retina) are considered the most dangerous diseases. They can not only reduce the quality of life but also pose a direct threat to it. With the help of modern drugs and methods of non-drug correction, you can achieve good results, control the disease and avoid serious consequences.

Our Lone Star Neurology clinic deals with the treatment of neurological diseases. Among the diseases treated by our highly qualified specialists are the following:

• Diabetic neuropathy;
• Parkinson’s disease;
• Alzheimer’s disease;
• Epilepsy;
• Migraine;
• Stroke;
• Multiple sclerosis;
• Memory loss.

Go to our website and view the complete list of diseases that are within our clinical practice. Also, you can read our interesting and useful articles about different kinds of diseases and their treatment. Contact our experts if you need help.

FAQs 

• How do people with diabetes get neuropathy?

Diabetic neuropathy is a condition that occurs as a result of untreated or late-diagnosed diabetes mellitus, which manifests itself in a degenerative lesion of all elements of the nervous system.

• Where does diabetic neuropathy usually start?

The initial stages of diabetic neuropathy go invisible by the patient himself. Only an experienced neurologist can determine both a decrease in reflexes in certain areas and a violation of sensitivity in the feet and palms.

• What are the 5 main symptoms of diabetic neuropathy?

• Pain in the legs and arms;
• Feelings of numbness of the limbs;
• Causeless heat on the palms and feet;
• Rapid fatigue;
• Muscle weakness.

• What is the most common diabetic neuropathy found?

Peripheral neuropathy, also called sensorimotor neuropathy, is the most common diabetic neuropathy. It is a complication of diabetes mellitus, the essence of which is manifested in damage to the patient’s nervous system.

• What are the stages of neuropathy?

Neuropathy manifests itself in several stages:

1. Numbness and Pain
2. Regular and Persistent Symptoms
3. Debilitating Pain
4. Constant Numbness
5. Complete Loss of Sensation.