Diabetic neuropathy is a disease of the nerves that can develop as part of long-term diabetes mellitus. Symptoms typically begin first in the feet and may present with loss of sensitivity and tingling, as well as paralysis.
What is diabetic neuropathy?
Neuropathy is a disease of the nerves (more specifically, the peripheral nerves, that is, all the nerves of the body except the brain and spinal cord), which can have various causes. Diabetic neuropathy is the typical nerve damage that can occur as a result of diabetes mellitus. Diabetic neuropathy occurs in about 30% of diabetics during their lifetime. This nerve damage can lead to a variety of symptoms. Diabetic neuropathy typically manifests as peripheral polyneuropathy, in which many nerves are affected uniformly, and autonomic neuropathy, which is disease of the nerves of the involuntary nervous system.
Causes
The exact factors in the development of diabetic neuropathy are not well understood to date. Undoubtedly, elevated blood glucose levels play a crucial role in the development of diabetic neuropathy. Thus, on average, neuropathy develops much more rapidly in diabetics with poor glycemic control than in well-controlled patients. One factor thought to be responsible for the destruction of nerve cells in diabetic neuropathy is the formation of sugar-protein compounds, which can be formed at high blood glucose concentrations and can have a direct damaging effect on nerve cells.
Symptoms, complaints, and signs
Diabetic neuropathy is initially manifested by nonspecific leg pain and sensory disturbances in the limbs. Increasing tingling is typical, often associated with sensory disturbances and numbness. In diabetic neuropathy, the legs react more sensitively to touch stimuli. As a result, there is often a strange sensation when putting on socks or pantyhose, which usually starts at the toes and radiates from there to the lower legs. Also characteristic are the small, usually barely visible wounds on the foot, which can enlarge in the course of the disease and cause irreversible damage. Furthermore, the disease can manifest itself through a feeling of malaise. The typical feeling of sickness occurs mainly in the case of chronic complaints. It is manifested by pale skin, regular sweating and cardiovascular complaints. The areas of skin affected by neuropathy also feel cold and often have a noticeable discoloration. If diabetic neuropathy is not treated, serious secondary diseases can develop. First of all, there is a risk of vascular damage and embolisms. There may be an undersupply of various organs, which can lead to further complications. In addition, there is an increased risk of infection in the affected areas on the leg, which can result in abscesses and ulcers.
Diagnosis and course
Often, the diagnosis of diabetic neuropathy is not made until the patient experiences symptoms such as tingling in the feet. However, the diagnosis can be made earlier when patients with diabetes are specifically looked for symptoms of diabetic neuropathy. Peripheral polyneuropathy often first manifests as decreased sensitivity and temperature sensitivity, typically initially affecting the toes, feet, and lower legs in a stocking-like fashion. One way to make an early diagnosis is to use a tuning fork to check for vibration sensation in these areas. Temperature sensation can also be checked by touching the foot with warm or cold objects. By examining the reflexes with a reflex hammer, the function of the nerves can also be checked in more detail. A more detailed examination of the nerves is possible using electroneurography (ENG) and electromyography (EMG). As part of the autonomic neuropathy, dysregulation of the cardiovascular system occurs in diabetic neuropathy, which can be seen, for example, in the long-term ECG and in the so-called Schellong test, which consists of blood pressure measurements while lying down and after standing up.
Complications
Diabetic neuropathy develops in the context of diabetes. Due to the fact that the concentration of sugar in the blood is continuously greatly increased, a wide variety of complications occur. Sugar molecules can bind with proteins, which as a result can clog the smallest vessels, leading to a lack of supply to various organs. One example of this is nerves (diabetic neuropathy), which can lead to sensory disturbances and paralysis. This is particularly the case in the foot. The affected person usually does not notice that there are minor wounds on the foot and does not pay attention to them. The wounds can increase in size as they progress and cause irreversible damage, as there are also wound healing problems due to diabetes. There is also an increased risk of infection. As a result, the foot can die and, in the worst case, must be amputated (diabetic foot). Furthermore, vessels in the retina become clogged, which can lead to disturbances in vision. In the worst cases, this can even lead to blindness (diabetic retinopathy). Typically, diabetes leads to a disturbance of the kidney function, which can lead to complete failure (diabetic nephropathy). There is a severe reduction in quality of life and dialysis may need to be intervened or even kidney transplantation.
When should you see a doctor?
If the affected person suffers from disturbances in sensitivity, numbness or a tingling sensation on the skin, this is considered unusual. If the symptoms persist or increase in intensity and extent, a doctor must be consulted. If symptoms of paralysis occur, a doctor should be consulted as soon as possible. If legs are painful or locomotion is impaired, it is advisable to have a check-up. If there is hypersensitivity to the touch of another person or clothing on the skin, there is reason for concern. A doctor should be consulted so that the cause of the discomfort can be found. If an altered perception to temperature influences develops in the toes, feet and lower legs, a visit to the doctor is necessary. If there is a general feeling of discomfort or a diffuse feeling that discomfort is present, a doctor should be consulted. Symptoms can appear all over the body, but the legs and feet are primarily affected. Therefore, a doctor should be consulted as soon as possible, especially if there are irregularities in the limbs. If there is a sensation of running ants on the skin or if there is a probing and burning pain, an examination should be made as medical attention is needed. Some sufferers report feeling furry, which is considered an indication to see a doctor.
Treatment and therapy
A key factor in the treatment of diabetic neuropathy is the consistent adjustment of blood glucose levels to curb the progression of the disease. Depending on the severity and type of diabetes, this can be done by weight reduction, tablets (known as oral antidiabetics), or insulin injections. Pain that can occur in the context of polyneuropathy can be treated symptomatically with painkillers. Here, so-called co-analgesics that influence pain perception, such as antidepressants or antiepileptics, also play an important role. Other therapeutic options include the administration of B vitamins (vitamins B1, B6, and B12) and fatty acids such as alpha-lipoic acid and gamma-linolenic acid. Some consequences of autonomic neuropathy can be treated specifically. For example, diabetic neuropathy can lead to impotence, digestive problems, and an increase in blood pressure, each of which can be treated with specific medications.
Outlook and prognosis
Although diabetes is not curable, the prognosis of diabetic neuropathy is considered favorable in patients who have had diabetes for a short time. In long-term patients, the prognosis worsens. Lifespan is greatly reduced, especially in patients who have had diabetes for several years, with additional diabetic neuropathy. There is an increased incidence of renal dysfunction and blindness may occur. The quality of life is reduced and the risk of developing a mental disorder is increased.Patients diagnosed with diabetes only a few months ago have a good chance of alleviating their symptoms if they make consistent lifestyle changes and receive good medical treatment. The goal of treatment is to prevent the disease from progressing. With today’s medical possibilities, this can be achieved in almost all cases. If the blood glucose level is optimally adjusted and the patient lives a healthy life, there is an improvement in health. In addition to sufficient exercise and maintaining a normal weight, overexertion should be avoided. Reducing stress and using relaxation techniques to balance the daily challenges, additionally help to cope with the disease. If the recommendations are followed, the patient can prevent the occurrence of further symptoms.
Prevention
The best prevention of diabetic neuropathy is good management of diabetes mellitus. For this, early detection of diabetes also plays a role in minimizing the time during which the patient has uncontrolled high blood glucose levels. In addition, alcohol should be avoided, especially when signs of neuropathy are beginning, as it can lead to additional damage to the nerves. A feared complication of diabetic neuropathy is diabetic foot syndrome: Due to the reduced sensitivity, small wounds on the foot occur more frequently, which heal more poorly due to the diabetes. Often, amputation is necessary in the end. To prevent this, the feet should be examined daily, for example with a mirror, and a doctor should be consulted quickly if problems arise.
Aftercare
Due to the chronic course of a diabetic disease, the patient should come regularly for check-ups with the family doctor as well as with the appropriate specialists. Because diabetes mellitus often affects the nerves, the patient should see a neurologist to check the function of the nerves and initiate treatment if necessary. The nerves are damaged to the extent that numbness or muscle weakness develops. Because of this, the primary care physician should look at the foot during office hours, as injuries are often overlooked by the patient due to nerve damage. In case of extensive damage to the foot (diabetic foot), amputation may be considered in the worst case. In addition, the sugar should also be checked in order to control the setting of the medication and possibly initiate a change. In case of a newly discovered diabetes mellitus, the patient should be adjusted with medication and trained, as the intake can be very complex. Besides the nerves, other organs are often affected by diabetes mellitus. The patient should therefore also be checked annually by an ophthalmologist, who can detect changes in the retina by means of ophthalmoscopy, which can lead to blindness. Furthermore, a nephrologist should also be consulted regularly, since damage to the kidney is not uncommon and can lead to kidney failure if diabetes mellitus is unadjusted.
What you can do yourself
Diabetic neuropathy generally requires medical treatment. However, diabetics can also take action themselves to protect themselves from the consequences of the nerve disorder. One of the most important measures is to measure blood glucose. This should be done in consultation with the doctor and at clearly defined times. It is also important to check blood fat, body mass index (BMI), blood pressure and waist circumference. In addition, diabetics are advised to take good care of their nerves and avoid stress as much as possible. It is also advisable to avoid factors that damage the nerves, such as nicotine and alcohol. If the diabetic suffers from excess weight, it is recommended that this be reduced. A balanced diet and sufficient exercise will help. Anyone who wants to do sports despite diabetic neuropathy is well advised to talk to their doctor in advance to clarify the individual restrictions and possibilities. For example, the feet are not stressed to the same extent by every type of sport. The use of diabetic-friendly footwear or insoles also plays an important role. It is equally important to check and care for the feet daily. In addition, it makes sense for diabetics to undergo regular preventive examinations and to have their feet checked once a year for possible nerve damage.The focus here is primarily on the feet. Which measures are ultimately best suited to the individual should be discussed with the attending physician.
