Sunday, 25 November 2007

Diabetic neuropathy

Diabetes: Neuropathy
Introduction to diabetic neuropathy
Peripheral neuropathy
Autonomic neuropathy
A common complication of diabetes is damage to the nerves that allow you to feel sensations such as pain. This is called neuropathy. There are a number of ways that diabetes damages the nerves, but they all seem related to blood glucose being too high for a long period of time.
Diabetes-related nerve damage can be painful, but it isn't severe pain in most cases.
There are four types of neuropathy: peripheral, autonomic, proximal and focal.
Peripheral Neuropathy The areas of the body most commonly affected by peripheral neuropathy are the feet and legs. Nerve damage in the feet can result in a loss of foot sensation, increasing your risk of foot problems. Injuries and sores on the feet may go unrecognized due to lack of sensation. Therefore, you should practice proper skin and foot care. Rarely, other areas of the body such as the arms, abdomen, and back may be affected.
Numbness (severe or long-term numbness can become permanent)
In most cases, early symptoms will become less when blood glucose is under control. Medications can be taken to help control the discomfort if needed.
To prevent peripheral neuropathy:
Work with your doctor to keep your blood glucose under tight control
To help prevent the complications of peripheral neuropathy:
Examine your feet and legs daily
Apply lotion if your feet are dry
Care for your nails regularly. (Go to a podiatrist, if necessary)
Wear properly fitting footwear and wear them all the time to prevent foot injury
Autonomic Neuropathy Autonomic neuropathy most often affects the digestive system, especially the stomach, blood vessels, urinary system, and sex organs. To prevent autonomic neuropathy, continuously keep your blood glucose levels well controlled.
Symptoms of neuropathy of the digestive system may include:
Feeling full after small meals Treatments may include:
Eat smaller meals
Symptoms of neuropathy of the blood vessels may include:
Blacking out when you stand up quickly
Increased heart rate
Low blood pressureTreatments may include:
Avoid standing up too quickly
Wearing special stockings
Symptoms of neuropathy of the male sex organs may include:
Unable to have or maintain an erection (erectile dysfunction)*
"Dry" or reduced ejaculations *Note: Impotence needs to be evaluated by your doctor. It may be caused by your medicines or factors other than diabetes.
Treatments include:
Penile implant
Vacuum erection device
Penile injections
Medicine Symptoms of neuropathy of the female sex organs may include:
Decrease in vaginal lubrication
Decrease in number of orgasms or lack of orgasmTreatments include:
Vaginal estrogen creams, suppositories and rings
LubricantsSymptoms of neuropathy of the urinary system may include:
Unable to completely empty bladder
Incontinence (leaking urine)
Increased urination at night Treatments include:
Self-catheterization (inserting a catheter into the bladder to release urine)
Proximal Neuropathy
Proximal neuropathy causes pain (usually on one side) in the thighs, hips, or buttocks. It can also lead to weakness in the legs. Treatment for weakness or pain is usually needed and may include medication and physical therapy. The recovery varies, depending on the type of nerve damage. Prevention consists of keeping blood glucose under tight control.
Focal Neuropathy
Diabetic neuropathy can also appear suddenly and affect specific nerves, most often in the head, torso, or leg, causing muscle weakness or pain. This is known as focal neuropathy. Symptoms may include:
double vision
eye pain
paralysis on one side of the face (Bell's palsy)
severe pain in a certain area, such as the lower back or leg(s)
chest or abdominal pain that is sometimes mistaken for another condition such as heart attack or appendicitis
Focal neuropathy is painful and unpredictable, however, it tends to improve by itself over weeks or months and does not tend to cause long-term damage.
Other Nerve Conditions Seen With Diabetes
People with diabetes can also develop other nerve-related conditions, such as nerve compressions (entrapment syndromes).
Carpal tunnel syndrome is a very common type of entrapment syndrome and causes numbness and tingling of the hand and sometimes muscle weakness or pain.
Prevention of Diabetic Neuropathy
Keeping tight control of your blood sugar levels will help prevent many of these diabetes-related nerve conditions. Talk to your doctor about optimizing your individual diabetes treatment plan

Reviewed by Certified Diabetes Educators in the Department of Patient Education and Health Information and by physicians in the Department of Endocrinology at The Cleveland Clinic. Edited by Cynthia Haines, MD, WebMD, September 2005. Portions of this page copyright © The Cleveland Clinic 2000-2005

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