Diabetes can be accompanied by damage to nerve function as an additional disease (complication), in other words, neuropathy. Damage may occur in both normal voluntary peripheral nerves and involuntary autonomic nerves that regulate visceral function. Diabetic nerve damage is found in about half of diabetics. It is more common in type 2 than in type 1 diabetes. The elderly are the most affected than the young.
In type 1 diabetes, neuropathy develops slowly over the years and can begin 10 to 15 years after the onset of the disease. After twenty years, about half show at least mild symptoms of neuropathy.
In type 2 diabetes, one-fifth of patients already show some signs of neuropathy at the time the disease is diagnosed, because diabetes may have been latent for years before it was diagnosed. In most cases, neuropathy does not develop until years of illness. After 10 years of type 2 diabetes, neuropathy is diagnosed in about half of the patients.
Causes of neuropathy
Diabetic neuropathy is strongly associated with excessive blood sugar, as reflected by sugar hemoglobin, or “sugar percentage” (see B-Hemoglobin-A1c (B-HbA1c) ). Excessive blood sugar levels that have persisted for years greatly increase the risk of neuropathy. Similarly, neuropathy can be avoided by maintaining a healthy sugar balance.
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Elevated blood sugar (glucose) can affect the nerves in a number of different ways. When glucose accumulates in the nerves, it is converted into a different type of sugar, sorbitol. The body is unable to use sorbitol to the same extent as glucose, which is why it interferes with the normal functioning of nerves. Another mechanism is that the small blood vessels in the nerves are damaged due to elevated blood sugar. Nerve proteins can also change their structure as a result of years of elevated blood sugar.
Various nerve disorders
The most typical nerve disorder in diabetes is a bilateral peripheral nerve disease or polyneuropathy. It occurs mainly in the extremities of the lower limbs, mostly in the feet. Disorders initially occur in the sensory nerves, but the motor nerves that regulate muscle function can also be damaged over time.
Diabetes can be associated with disorders of an individual nerve or group of nerves (mononeuropathy). These usually manifest as local pain or minor symptoms of paralysis in different parts of the body. The most typical areas are the calf, the other side of the chest, the thigh, and the hand, but the symptoms can be almost anywhere on the body.
Its own group is diabetes-related involuntary nervous system damage, i.e., autonomic neuropathy. This part of the nervous system regulates, among other things, gastrointestinal function, vascular tendency, bladder emptying, and penile erection, all of which may present with symptoms.
Symptoms of neuropathy
Lower limb symptoms. Typical symptoms include tingling, numbness, and pain in the foot area. Excessive skin sensitization may occur at first, making the contact feel uncomfortably strong. As the injury progresses, the sensation of the feet decreases. As a result, the foot does not feel the abrasions caused by unsuitable shoes, which can cause damage and inflammation before the matter can be addressed. If neuropathy is diagnosed, regular monitoring and careful treatment of the condition of the feet is necessary (see Diabetic Foot Problems and Prevention).). As neuropathy progresses, symptoms may appear higher in the leg and thigh area. At the same time, muscle function may be disrupted, resulting in, for example, difficulty in squatting or a change in the position of the toes and foot.
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Single nerve disorders. The most common of the nerve disorders (mononeuropathies) is paralysis of the basal nerve (see Peripheral nerve diseases ). This is when the foot hangs and cannot be raised when walking upwards. Other sites of mononeuropathy include painful femoral nerve palsy and carpal tunnel syndrome (see Peripheral Nerve Diseases ).
Cardiovascular symptoms. The disorder of the autonomic nervous system causes the heart rate to rise, which means that the heart rate can be at rest for more than 100 minutes. Another manifestation is a drop in blood pressure when standing up because the walls of the arteries do not have time to tend to fast enough due to weak nerve regulation. One consequence of an autonomic nervous system disorder is a kind of “numbness” in the heart, in which the heart does not normally sense pain. In this case, the pain symptoms associated with coronary artery disease are mild or non-existent.
Stomach and intestinal disorders. Not to move food normally the autonomous neuropathy can impair the function of the intestinal and stomach muscles. The condition is called "gastric stroke," the professional term for gastroparesis. In this case, after eating, the upper abdomen feels uncomfortably full, and sometimes you have to vomit after food. These symptoms are usually intermittent, last for a few days, and sometimes have an asymptomatic period of weeks or months. Gastroparesis can be alleviated with the following dietary guidelines: Six small meals a day, reducing dietary fat (up to 40 g per day), avoiding fiber preparations, chewing well, and eating chopped foods.
Intestinal dysfunction can also manifest as diarrhea, which also occurs at night. Some patients experience constipation. The tendency to diarrhea and constipation are otherwise common ailments (see Irritable Bowel Syndrome (IBS) and Bleeding Disorders ), so it is not always possible to say whether they are due to diabetes or some other cause.
Urinary and erection problems. Symptoms may include bladder emptying disorders. In spite of being bladder full, the diabetic won't have the urge to urinate. When urinating, the bladder may only partially empty. Impotence manifests as erectile dysfunction of the penis, in which case the penis does not stiffen as before during sexual arousal.
Sweating problems. The autonomic nervous system regulates the function of the sweat glands. Disorders can reduce or increase sweat secretion in certain situations. In lower limb neuropathy, the skin is often dry due to impaired sweat production. Excessive sweating most often manifests as sweats in the upper body or head, which often occur at night. In some diabetics, this kind of sweating occurs especially when eating.
Self-care
The most essential factor in the treatment of all types of neuropathy is maintaining the best diabetes sugar balance possible. The aim is to bring the equilibrium glucose hemoglobin value (see B -Hemoglobin-A1c (B-HbA1c) ) to 42-53 mmol/ml (6-7%) or as close as possible. With a hemoglobin value of 42 to 53, the risk of further disease is low. From a value of 53 (7%) upwards, the risk increases sharply, so that at a value of 75 (9%) it is already ten times higher than the normal value (see figure ). Good sugar balance always slows the progression of neuropathy. Mild neuropathic changes may be corrected if no permanent changes in the nerves have yet occurred.
Relationship between hemoglobin concentration in diabetes and organ changes in diabetes. Relationship between glycemic hemoglobin levels and organ changes in diabetes (see Diabetes ). The risk associated with an upper limit of 6.0% (42 mmol/mol) of the hemoglobin reference value (normal value) is indicated in section 1.0. The risk increases sharply as the hemoglobin value of the sugar rises. At 9% (75 mmol / mol) hemoglobin, the risk is tenfold and at 12% (108 mmol / mol) fifty-fold.
There are not many other self-care options available for lower limb pain and tingling symptoms. Gymnastics and massage may help. Vitamin B supplements are commonly used for neuropathy, but should not be used because studies have shown them to be ineffective. Regular monitoring of the feet, selection of suitable shoes, and other care are very important to prevent foot infections (see Diabetes Foot Problems and Prevention ).
Gastric emptying disorders are often affected by the quality of the food, for example, some patients get more symptoms from high-fiber foods. However, no universally valid dietary guidelines can be given because individual differences in the effects of different dishes are significant. Conventional antidiarrheal drugs, such as loperamide, can be used to control diarrhea.
The effects of the fall in blood pressure associated with autonomic neuropathy are alleviated when you first lie down to sit for a minute and wait to stand up a moment before you set off.
Care
Also, the most important goal in treatment by a doctor and diabetes nurse is to get the most out of your blood sugar through insulin, other medications, and dieting.
Neuropathic pain symptoms are primarily treated with so-called tricyclic antidepressants and some antiepileptic drugs (pregabalin, gabapentin), which affect chronic pain. If they don’t help, you can try painkillers that affect the central nervous system or newer antidepressants. Thus, these drugs have an independent effect on the nerves.
For disorders caused by autonomic neuropathy, it is possible to try drugs that relieve various symptoms. The same medications used to treat erectile dysfunction caused by neuropathy in diabetes are the same as for impotence in general.
Birth control
Large studies have shown that if the therapeutic balance of diabetes is good, the development of neuropathy (and other co-morbidities of diabetes) is low or completely prevented. On the other hand, it is known that there are no curative treatments available for the treatment of neuropathy in advanced diabetes, and symptomatic treatment is not very effective. The prevention of neuropathy with a good treatment of diabetes is vital
The development of diabetic neuropathy can be reduced by avoiding heavy alcohol consumption and smoking. Excessive alcohol consumption causes nerve dysfunction and therefore increases the risk of diabetic neuropathy. Regular smokers develop neuropathy faster than non-smokers.
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