Diabetes mellites is an epidemic of modern civilization. With the modern technology, comfort and convenience has come, but the well-being and health is taken away. Increase in the sedentary lifestyle has led to increased incidence of many diseases. Diabetes is one of them.
Diabetes is not just a disease of high sugar levels as perceived conventionally. Many metabolic and vascular complications are occurring independent of the sugar levels.
Neuropathy means damage to the nerves. Neuropathy is a common complication of type 1 and type 2 diabetes. It is seen in 26 percent of people with type 2 diabetes at the diagnosis of diabetes itself.
The most common symptoms of diabetic neuropathy include pain, burning, tingling, or numbness in the toes or feet, and extreme sensitivity to light touch. The pain may be worst at rest and improve with activity, such as walking. Some people initially have intensely painful feet while others have few or no symptoms.
Diabetic neuropathy usually affects both sides of the body. Symptoms are usually noticed first in the toes. If the disease progresses, symptoms may gradually move up the legs; if the mid-legs are affected, symptoms may develop in the hands. Over time, the ability to sense pain may be lost, which greatly increases the risk of ulcers.
The neuropathy in diabetes can take various forms.
- Large fiber neuropathy: The most common form is tingling-numbness of feet, legs and hands in a glove and stocking distribution
- Small fiber neuropathy: In this type, there is burning of feet or any other areas.
- Proximal motor neuropathy: This type causes weakness in muscle of shoulder and hip girdle.
- Acute mononeuropathies- This type can involve the truck, head affecting the individual nerves than a bunch of nerves.
- Pressure palsies: Diabetics are more prone to pressure palsies. The most common being the median nerve at wrist (Carpal tunnel syndrome).
In people with type 1 or type 2 diabetes, the biggest risk factor for developing diabetic neuropathy are
- High sugar levels
- Heart disease
- High cholesterol
- High blood pressure
As the patient loses the ability to sense pain or hot and cold, the risk of painless injury increases. Injuries that would normally cause the pain will not necessarily cause it if you have neuropathy. Unless you inspect your feet daily, A small injury has the potential to develop into a large ulcer. Hence, it is important to inspect the foot daily. One of the most serious complications of foot ulcers is the need for amputation of a toe, or in extreme cases, the foot itself.
Diabetic neuropathy is diagnosed based upon a medical history and physical examination of the feet. During an examination, there may be signs of nerve injury, including:
- Loss of the ability to sense vibration and movement in the toes or feet.
- Loss of the ability to sense pain, light touch and temperature in the toes or feet
More patients usually need nerve conduction studies to diagnose, decide the type and prognosticate the neuropathy.
*Reference: Eva L.Feldman MD. Patient education: Diabetic neuropathy. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc.
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