Diabetic neuropathy

Causes and Risks:
People with diabetes may develop temporary or permanent damage to nerve tissue during their illnesses. Injury to the nerves is caused by decreased blood flow and high blood-sugar levels . Neuropathies are more likely to develop if blood-glucose levels are poorly supervised. Some diabetics will not develop neuropathy, while others may develop this condition relatively early. On average, the onset of symptoms occurs 10 to 20 years after diabetes has been diagnosed.

Peripheral neuropathies may affect cranial nerves or nerves from the spinal column and their branches. This type of neuropathy tends to develop in stages. Early on, intermittent pain and tingling is noted in the extremities, particularly the feet. In later stages, the pain is more intense and constant. Finally, a painless neuropathy develops when pain sensation is lost to an area, which greatly increases the risk of severe tissue injury without pain as an indicator of injury.

Autonomic neuropathies affect the nerves that regulate involuntary vital functions including the heart muscle , smooth muscles, and glands. Low blood pressure , diarrhea , constipation , sexual impotence , and other symptoms result from autonomic neuropathies. Cranial neuropathies may affect vision and cause eye pain . Mononeuropathies affect a single nerve and are often reversible spontaneously. The incidence of diabetic neuropathy is 6 out of 10,000 people.

Prevention:
control of blood-glucose levels in people with diabetes may delay the onset or decrease the severity of neuropathies.

Symptoms:

Note: Symptoms vary depending on the nerve(s) affected and may include symptoms other than those listed. Symptoms usually develop gradually over years.

Signs and Tests:
Physical examination including neurological and sensory tests may reveal many neuropathies.

Treatment:
Treatment for diabetic neuropathy is symptomatic . Pain medication (not stronger than codeine because of the potential for addiction with long-term use) is usually prescribed. Dilantin and amitriptyline at bedtime have also provided relief of leg pain associated with neuropathy.

Prognosis:
The mechanisms of diabetic neuropathy are poorly understood. At present, treatment alleviates pain and can control some associated symptoms, but the process is generally progressive.

Complications:
There is an increased risk of injury because of loss of sensation and/or motor functioning.

Call Your Healthcare Provider:
Call for an appointment with your health care provider if signs and symptoms of diabetic neuropathy develop.