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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:

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.

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Lone Star Neurology
4.4
Based on 634 reviews
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Edward Medina
Edward Medina
15:34 30 Jun 22
Just such an amazing staff that makes you feel like part of their family. I’ve been going there for over 5 years now... and each visit I get the very best care and treatments that I have ever received in the 20+ years that I’ve been dealing with severe debilitating migraines. Since i started seeing them the number of my migraines has dropped from 15-20 a month to 2-3 every 3 month. I highly recommend them …they will change your life!read more
Daneisha Johnson
Daneisha Johnson
22:20 19 May 22
Dr. Askari was very kind and explained everything so I could understand. The other staff were nice as well. I would... have gave 5 stars but I was a little taken aback when I checked in and had to pay 600.00 upfront. I think that should have been discussed in a appointment confirmation call or email just so I could have been prepared.read more
Jean Cooper
Jean Cooper
16:54 29 Apr 22
I love the office staff they are friendly and very helpful. Dr. JODIE is very caring and understanding to your needs... and wants to help you. I will go back. would recommend Dr. Dr. Jodie to other Patients in a heart beat. The team works well together.read more
Linda M
Linda M
19:40 02 Apr 22
I was obviously stressed, needing to see a neurologist. The staff was so patient and Dr. Ansari was so kind. At one... point he told me to relax, we have time, when I was relaying my history of my condition. That helped ease my stress. I have seen 3 other neurologists and he was the only one who performed any assessment tests on my cognitive and physical skills. At one point I couldn't complete two assessments and got upset and cried. I was told, it's OK. That's why you're here. I was truly impressed, and super pleased with the whole experience!read more
Leslie Durham
Leslie Durham
15:05 01 Apr 22
I've been coming here for about 5 years. The staff are ALWAYS friendly and knowledgeable. The Doctors are the absolute... best!! Jodie Moore is always in such a great mood which is a plus when you are already stressed. Highly recommendedread more
Monica Del Bosque
Monica Del Bosque
14:13 25 Mar 22
Since my first post my thoughts have changed here. It's unfortunate. My doctor and PA were great, but the office staff... is horrible. They never call you back when they say they will, they misinform you, they cause you too much stress wondering what's going on, they don't keep you posted. They never answer the phone. At this point I've left four messages in the last week, and I have sent three messages. Twice from their portal and one direct email. No response. My appointment is on Monday morning at 8:30am, no confirmation on my insurance and what's going on. What the heck is going on, this is ridiculous!I've given up... the stress her office staff has put me through is just not worth it. You can do so much better, please clean house, either change out your office staff, or find a way for them to be more efficient please. You have to do something. This is not how you want to run your practice. It leaves a very bad impression on your business.read more
Ron Buckholz
Ron Buckholz
23:32 23 Mar 22
I was actually pleasantly surprised with this visit! It took me a long time to get the appointment scheduled because no... one answers your phones EVER! After a month, I finally got in, and your staff was warm, friendly, and I was totally impressed! I feel like you will take care of my needs!read more
Steve Nabavi
Steve Nabavi
16:28 16 Mar 22
It was a nice visit. Happy staff doing all they can do to comfort the patients in a very calming environment. You ask... me they are earned a big gold star on the fridge. My only complaint they didn't give me any cookies.read more
Katie Lewis
Katie Lewis
16:10 10 Feb 22
Had very positive appointments with Jodie and Dr. Sheth for my migraine care. Jodie was so fast with the injections and... has so much valuable info. I started to feel light headed during checkout and the staff was SO helpful—giving me a chair, water, and taking me into a private room until I felt better. Highly recommend this practice for migraine patients, they know what they’re doing!!read more
Joshua Martinez
Joshua Martinez
16:02 10 Dec 21
I was scheduled to be checked and just want to say that the staff was fantastic. They were kind and helpful. I was... asked many questions related to what was going on and not once did I feel as though I was being brushed off. The front desk staff was especially great in assisting me. I'm scheduled to go back for a mri and am glad that I'll be going there.read more
Isabel Ivy
Isabel Ivy
21:42 03 Nov 21
I had such a good experience with Lone Star Neurology, Brent my MRI Tech was so awesome and made sure I was very... comfortable during the appointment. He gave me ear plugs, a pillow, leg support and blanket, easiest MRI ever lol 🤣 My 72 hour EEG nurse Amanda was also so awesome. She made sure I was take care of over the 3 days and took her time with the electrodes to make sure it was comfortable for me! Paige was also a huge help in answering all my questions when it came to my test results, and letting me know her honest opinions about how I should go forth with my treatment.read more
Leslie Luce
Leslie Luce
17:37 20 Oct 21
The professionalism and want to help attitude of this office was present from the moment I contacted them. The follow... up and follow through as well as their willingness to find a way to schedule my dad was above and beyond. We visited two offices in the same day with the same experience. I am appreciative of this—we spend a lot of time with doctors and this was top notch start to finish.read more
robert Parker
robert Parker
16:38 16 Apr 21
I love going to this office. The staff is friendly and helpful. The doctor is great. I am getting the best... neurological tests and treatment I have ever had. The only reason I did not give them a 5 star rating is because it is impossible to reach a live person at the office to reschedule appointments. Every time I have tried to get through to the office it says all people are busy and I am sent to a voicemail. If they could get their phone answering fixed, I would give them a strong 5 stars.read more
MaryAnn Hornbaker
MaryAnn Hornbaker
00:26 25 Feb 21
Dr. Harney is an excellent Dr. I found him friendly , personable and thorough. I evidently am an unusual case. ... Therefore he spent a Hugh amount of time educating me. He even gave me literature to further explain my condition and how to follow up. This is something you rarely get from your doctors. So I am more than please with my doctor and his staff.read more
Roger Arguello
Roger Arguello
03:05 29 Jan 21
Always courteous, professional. The staff is very friendly and always work with you to find the best appointment time.... The care team has been great. Always taking the time to listen to your concerns and to find the best treatment.read more
Margaret Rowland
Margaret Rowland
01:12 27 Jan 21
I have been a patient at Lone Star Neurology for several years. Now both my adult daughters also are patients there. I... love Jodie. She is always so prompt whether it is a teleamed call are a visit in the office. She takes the time to explain everything to me and answers all my questions. I am so blessed to have Jodie as my doctor.read more
Susan Miller
Susan Miller
03:01 13 Jan 21
My husband had an accident 5 years ago and Lone Star Neurology has been such a blessing to us with my husbands care.... Jodie Moore is his provider and she is amazing! Jodie is very knowledgeable, caring, and thorough. She takes her time with you, making sure your needs are met and she is happy to answer any questions you may have. Lone Star Neurology’s patients are very lucky to have Jodie providing their care. Thank you Lone Star Neurology and especially Jodie for everything you have done for us. Jodie, you are the best!read more
Windalyn C
Windalyn C
01:32 09 Jan 21
Jodie is wonderful. She is very caring and knowledgeable. I have been to over a dozen neurologists, and none were able... to help me as much as they have here. Thanks!read more
Katie Kordel
Katie Kordel
00:40 09 Jan 21
Jodi Moore, nurse practitioner, is amazing. I have suffered from frequent, debilitating headaches for almost 20 years.... She has provided the best proactive and responsive care I have ever received. My quality of life has been greatly improved by her caring approach and tenacity in finding solutions.read more
Ellie Natsis
Ellie Natsis
15:41 07 Jan 21
I have had the best experience at this neurologist's office! For over a year I have been receiving iv treatments here... each month and my nurse, Bobbie is beyond wonderful!! She's so attentive, knowledgeable, caring, and detail oriented. She makes an otherwise uncomfortable experience much more pleasant and definitely puts me at ease! She also helps me with my insurance,ordering this specialty medication and dealing with the ordering process which is no easy feat.Needless to say, she goes above a beyond in every way and I'm so grateful to this office and to Bobbie for all they do for me!read more
Matt Morris
Matt Morris
15:39 07 Jan 21
Let me start by saying that I have been coming here for years. Due to my autoimmune disease, I am in this office... once every three weeks for multiple hours at a time. The office is very clean and the staff very friendly. My only complaint would be there communication via phone. They aren't the best at responding if you leave a voicemail and expect a call back. I understand that this is prob just due to the sheer number of alls they receive daily. What I can say I like the best about the office are the people. Bobby who handles my infusions is great. I never have any issues with her setting up my infusions. She is very quick to reply to messages sent via text and if she were to leave then my whole opinion of the office may change. I also enjoy people like Matt, Lauren, and Jodi. I appreciate all that they do for me and without this team I'm not sure I would be as happy as I am to visit the office as frequently as I have to. Please ensure that these folks are recognized as they are what makes my visit to this office so tolerable :).read more
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