Nerve Damage Due to Diabetes

What Is Diabetes?

Diabetes is a metabolic condition that occurs when the body does not create enough insulin or use the insulin produced effectively. Insulin is a hormone produced by the pancreas. Hyperglycemia (high blood sugar levels) is a defining feature of diabetes. Numerous symptoms of diabetes include polyuria (frequent urination), polydipsia (increased thirst), polyphagia (increased appetite), etc. Along with multiple metabolic problems, diabetes causes nerve damage (neuropathies) and microvascular complications. Diabetes is categorized into type 1 and type 2. In type 1 diabetes, the pancreas fails to produce an adequate amount of insulin due to the loss of beta cells of the pancreatic islet. In type 2 diabetes, the body's cells fail to respond to the insulin the pancreas produces. In the United States, diabetes affects 10 % of the population overall, and between 1980 and 2012, the incidence of the disease increased dramatically. One of the main causes of the rapidly rising number of diabetes cases is unhealthy eating habits, sedentary lifestyles, and obesity.

What Is Diabetic Nerve Damage?

Diabetic nerve damage, also known as diabetic neuropathy, is a type of nerve damage commonly seen in people with diabetes. It occurs when an individual has hyperglycemia (increased blood sugar levels) for a long period. Diabetic nerve damage can be prevented or slowed down by checking the blood sugar level and maintaining it within the normal range, eating a healthy diet, and maintaining an active lifestyle. The most common body parts that are affected by diabetic nerve damage are the legs and feet. The nerves are damaged by high blood sugar, so they may cease sending messages to various body parts. Nerve damage can result in health issues ranging from numbness to pain, making it difficult to perform daily tasks. The symptoms of diabetic nerve damage develop and progress slowly; therefore, it is crucial to notice these symptoms early and take measures to prevent them from worsening.

What Are the Types of Diabetic Nerve Damage?

Various types of diabetic nerve damage are:

1. Peripheral Nerve Damage: Peripheral nerve damage due to diabetes usually affects the legs and feet, and sometimes it can also affect the hands and arms. Peripheral nerve damage is also called distal symmetric peripheral neuropathy. This is the most prevalent type of diabetic nerve damage. The signs and symptoms of peripheral nerve damage usually aggravate at night.

2. Autonomic Nerve Damage: Autonomic nerve damage refers to the damage noticed in the autonomic nervous system by long-standing diabetes. The autonomic nervous system affects the heart, digestive function, urinary function, sweating, sexual desires, eyes, etc.

3. Proximal Nerve Damage: Proximal nerve damage or diabetic polyradiculopathy is a type of nerve damage that affects thighs, hips, legs, shoulders, buttocks, etc. Symptoms typically only affect one side of the body, although they occasionally spread to the other. Additionally, the chest and abdomen may be impacted.

4. Mononeuropathy (Focal Nerve Damage): Mononeuropathy or focal nerve damage is a type of diabetic nerve damage that affects only a single or specific nerve. The affected areas include the torso, face, arms, or legs.

Who Is Likely to Develop Diabetic Nerve Damage?

• Individuals suffering from diabetes for a long time are prone to developing diabetic nerve damage.

• Presence of other comorbidities along with diabetes like; hypertension (high blood pressure), high body mass index (BMI), high cholesterol, renal diseases, etc.

How Common Is a Diabetic Nerve Damage?

• Approximately 50 % of all diabetes patients develop diabetic nerve damage.

• Some types of diabetic nerve damage are more common compared to others.

• One in every two individuals has peripheral nerve damage.

• One in every three individuals has autonomic nerve damage.

• One in every four people develops carpal tunnel syndrome, a common mononeuropathy.

What Causes Diabetic Nerve Damage?

Each type of diabetic nerve injury has an unknown underlying cause. According to research, diabetic neuropathy develops due to nerve damage and interference caused by chronically elevated blood sugar levels. The walls of the tiny blood vessels that carry oxygen and nutrients to the nerves are also weakened by high blood sugar. Moreover, several risk factors increase the probability of developing diabetic nerve damage. These risk factors include:

• Uncontrolled Diabetes: Poor blood sugar control is the most crucial risk factor that increases the chances of diabetic nerve damage and other diabetes-related complications.

• Diabetes History: The longer a person has diabetes, the higher their chance of developing diabetic nerve damage.

• Kidney Disease: Kidney disease is a risk for diabetes. Toxins enter the bloodstream when the kidneys are damaged, which can cause nerve damage.

• Being Overweight: A BMI (body mass index) of 25 or higher is associated with an increased risk of diabetic nerve damage.

• Smoking: Smoking causes the arteries to constrict and harden, which reduces blood flow to the legs and feet. This harms the peripheral nerves and makes healing more difficult for wounds.

What Are the Symptoms of Diabetic Nerve Damage?

The type of nerve injury and the afflicted nerves determine the symptoms of diabetic nerve damage. The symptoms of different types of nerve damage are as follows:

Peripheral Nerve Damage:

• Numbness.

• Reduced sensation to feel temperature changes.

• Increased pain sensitivity.

• Tingling sensation.

• Muscle weakness.

• Foot ulcers and infections.

• Pain in bone and joints.

Autonomic Nerve Damage:

• Being unaware of increased blood sugar levels.

• Orthostatic hypotension (blood pressure drops when standing, sitting, or lying).

• Bladder problems.

• Bowel problems.

• Slow emptying of the stomach causes nausea and vomiting.

• Loss of appetite and difficulty in swallowing.

• Reduced or increased sweating.

• Vaginal dryness in women.

• Erectile dysfunction in men.

• Changes in the eyes' ability to shift from bright to dark or from distance to close.

Proximal Nerve Damage:

• Pain in hips, thighs, and buttocks.

• Weak thigh muscles.

• Difficulty in rising from a sitting position.

• Chest wall pain.

• Abdominal wall pain.

Focal Nerve Damage:

• Double vision (seeing two images of an object).

• One side of the face may get paralyzed.

• Tingling in hands and feet.

• Weakness in hands or feet.

• Pain in the shin area.

• Pain in the feet.

• Foot drop (difficulty in raising the front part of the foot).

How Is Diabetic Nerve Damage Diagnosed?

The diagnosis is made in the following ways:

• A foot exam is typically used to diagnose nerve damage caused by diabetes. The doctor examines the feet for wounds, blisters, or other ailments. The healthcare professional could also touch the feet using special tools to check for decreased sensations.

• One might get an electromyogram (EMG) if the healthcare professional detects nerve injury. This examination examines nerve responsiveness or electrical activity.

• The healthcare provider will also check the overall muscle strength, tone, tendon reflexes, sensitivity to touch, perception of pain, and sensitivity to vibrations.

• Other tests like filament testing, sensory testing, nerve conducting testing, and autonomic testing may also be done.

• During filament testing, skin regions are brushed with a smooth nylon fiber (monofilament) to assess their sensitivity to touch.

• In autonomic testing, specific tests may be performed to see how the patient's blood pressure changes in different positions and whether their perspiration falls within the normal range.

How Is Diabetic Nerve Damage Treated?

• The most crucial step in preventing further nerve damage is controlling diabetes. Treatment for diabetes-related nerve injury involves cautious blood sugar control. Blood sugar levels can be maintained within the normal range by eating a healthy diet, exercising regularly, and taking the prescribed medications.

• Individual blood sugar levels must be monitored. However, for most diabetics, the American Diabetes Association (ADA) suggests the following target blood sugar levels: between 80 mg/dL to 130 mg/dL before a meal and less than 180 mg/dL after two hours of eating a meal.

• Numerous prescription drugs can treat nerve pain caused by diabetes, but not everyone benefits. Talking to the doctor about medications' advantages and potential negative effects is crucial to determine which drug will work best. Drugs that might help with diabetic nerve damage include antidepressants, antiseizure drugs, painkillers, etc.

Can Diabetic Nerve Damage Be Reversed?

It is not clear whether diabetic nerve damage can be reversed or not. However, in most cases, the damage is irreversible; it can only be prevented from worsening. With very good blood glucose control, one can prevent diabetes-related neuropathy from worsening and may even reverse the nerve damage somewhat, but the procedure is very slow.

How Can Diabetic Nerve Damage Be Prevented?

The best method to lower the risk of or delay the onset of nerve damage is to maintain the blood sugar levels as close to the goal range as possible. Steps that can help in preventing diabetic nerve damage are:

• Keeping blood sugar levels within the normal range.

• Exercising regularly.

• Maintaining Blood pressure within the normal range.

• Losing weight if one is obese or overweight.

• Limiting alcohol intake.

• Stopping smoking.

• Eating a healthy diet every day.

• Taking the prescribed medicines.

Conclusion:

Diabetic nerve damage is a prevalent complication of chronic diabetes. Along with systemic metabolic complications, uncontrolled blood sugar levels can cause nerve damage in several body parts. Nerve damage associated with diabetes can be of four types, and symptoms of each type vary accordingly. Diabetic nerve damage cannot be reversed; however, the condition can be prevented or slowed down by taking certain precautions like maintaining blood sugar levels, keeping blood pressure in check, eating a healthy diet, exercising regularly, etc. The balance may be affected by nerve damage. It may be difficult to walk or sit still comfortably if one has nerve pain. An individual with nerve damage might not notice a foot injury immediately. People with diabetes must treat cuts on their feet and legs immediately. Diabetes can contribute to or exacerbate peripheral artery disease (PAD). If left untreated, PAD might result in amputations.