Diabetic Neuropathy

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Diabetes — Characterized by high blood sugar (hypoglycemia) and the body’s inability to regulate blood sugar levels. There are an estimated 20.8 million people in the U.S. with diabetes mellitus, approximately 7% of the national population. (American Diabetes Association)

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PancreasThere are two different types of diabetes:

Insulin is a hormone in the body secreted by the pancreas that helps to open cells to allow sugar (glucose) to enter and fuel them. Without enough insulin, the body does not use the molecular energy it intakes from food, causing frequent hunger, thirst, fatigue, blurred vision and other symptoms. Basically, insulin allows our food to fuel our body’s cells. A lack of effective insulin makes it impossible for the cells to extract energy from our food so that we have energy during our daily lives.

There is no certain cause of type II diabetes, diets high in sugar and fat, lack of exercise, and a family history of diabetes are related to the development of Type II Diabetes. Type I is usually diagnosed early in life and is caused by a defect in the pancreas that stops it from producing insulin.

Diabetes can cause nerve death. Approximately half of people with diabetes have some form of nerve damage. This nerve damage in diabetics is called diabetic neuropathy. Nerves are located throughout our bodies and their principle function is to let the brain know about what is going on in the environment around us andthrough this information, allowing us to control how we use our bodies in our environment.Nervous System

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For example, we have nerves that send messages from our fingertips to our brain, informing us of heat changes, smoothness and roughness of surfaces (think sandpaper), pressure, vibration, wetness, and pain. Without these nerves, we lose the ability to gain certain information about our environment (think of holding your finger on a stove burner and not feeling the hot, burning sensation).

We also lose the ability to rely on many unconscious bodily functions that rely on the nervous system for information (our heart rate relies upon the nervous system for information, and damage to the nerves that control heart rate can cause the heart to beat at a constant high rate instead of rising and falling in response to varying bodily functions and exercise).

In diabetics, neuropathy is most likely caused by prolonged periods of high blood sugar (glucose) and damage to blood vessels in the circulatory system caused by obesity (damage to the blood vessels lowers the amount of oxygen received by nerves, thus causing them damage or death). Overexposure to high amounts of sugar in the blood has been shown to damage nerve cells, but researchers are still trying to understand how this happens.

To examine your risk to developing Diabetes, you may either take a short diabetes risk test or a more interactive and in-depth test at the following sites:

The Types of Neuropathy

There are several different types of neuropathy, each affecting different areas of the body. The most common four types are peripheral neuropathy, autonomic neuropathy, proximal neuropathy, and focal neuropathy. Here are details on these types of neuropathy including symptoms caused by each:

Peripheral Neuropathy

Peripheral Neuropathy

Peripheral neuropathy is the most common type of neuropathy amongst diabetics. With peripheral neuropathy, the nerves that are damaged are referred to as the peripheral nerves (see image). Its symptoms include tingling, pain, increased sensitivity, numbness, and feelings of weakness in the hands and feet. If untreated, the symptoms may progressFoot w/ Neuropathy up the arms and legs.

Diabetics with peripheral neuropathy typically complain of having intense pains in their feet. The sensations that they experience are described as a feeling of burning in conjunction with stabbing or shooting pain. Sometimes most of a hand or foot will become numb while the areas that are unaffected will become supersensitive causing people to feel great pain at the slightest touch. This sensation of numbness that individuals with diabetic neuropathy feel is often described as feeling as though one is wearing a sock or glove. The danger of this numbness is that oftentimes, it can lead people to overlook what would normally be painful cuts, sores, blisters, or other injuries they have on their feet. When even small injuries to the extremities go unnoticed, infections may develop and spread to the bone, thus requiring amputation. For this reason, it is important for diabetics to pay attention to the sensations, or lack thereof, they experience in their feet and routinely check for foot injuries that could lead to more serious issues.

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Autonomic Neuropathy

Autonomic neuropathy describes damage to nerves that control various body systems. This includes the nerves that control heart rate, regulate blood pressure, and control the level of sugar in the blood stream. Additionally, autonomic neuropathy can have negative affects on the digestive system, urinary tract, eyes, sex organs, respiration, and sweat glands. Here are details on each system affected:Autonomic Neuropathy

Proximal Neuropathy

Proximal neuropathy is more common in type II diabetics and older diabetics. Nerve damage is found in the hips, thighs, buttocks, and legs usually specific to one side of the body. The nerve damage in this situation causes pain and weakness in these areas. Walking may be difficult for individuals with proximal neuropathy, and they may need assistance transitioning from a seated to a standing position.

Focal Neuropathy

Focal neuropathy describes the incidence of neuropathy that occurs in a specific point in the body rather than a nerve circuit, which is characteristic of peripheral, autonomic, and proximal neuropathies. Focal neuropathy has a sudden onset, and it typically occurs in the head, torso, or legs. In addition to its rapid development, focal neuropathy is characterized by pain, and it is more likely to occur in older rather than younger people. Here are some specific examples of focal neuropathy:

Suggestions on how to live with diabetic neuropathy:Symptoms

The best advice any individual with diabetes can receive is that it is imperative to try to keep your blood sugar (glucose) levels within your target range. To do this, monitor your blood glucose levels throughout daily life. Decisions regarding what to eat, the amount of physical activity to undertake, and the amount of medications to take (if prescribed) can help you control your blood sugar levels as well. A helpful tool that is useful in keeping tabs on your blood sugar levels is the blood glucose meter. These can help you maintain your blood sugar levels in the range of 90-110 mg/dL.

To learn about blood sugar meters, visit the FDA's website:

Buy a blood sugar meter:

Getting an A1C test from a doctor at least twice a year is also very helfpul. This test will inform you of your average blood glucose levels during the past two to three months. This will allow you to better understand your blood glucose levels so that, in the future, you can make more informed decisions regarding lifestyle choices. As discussed in the peripheral neuropathy section of this website, foot care is extremely important in self-care for diabetics. The occurrence of neuropathy can lead one to not notice sensations of pain or injury in the feet and allow an infection to develop and spread to the bone. Because of this it is essential for a diabetic to check their feet every day, especially if sensations of numbness have been experienced. Additionally, it is important to be careful with exercise, as autonomic neuropathy may make it difficult to transition between states of low activity to high activity.

To complete a symptom checklist that evaluates diabetic neuropathy, click here.

Drug Treatment for Pain Associated with Diabetic Neuropathy:
Pain is one of the most problematic symptoms of diabetic neuropathy. Gabapentin has been prescribed as an effective drug treatment for pain and sleep loss due to pain in diabetic neuropathy. Additionally, the drugs Amitriptyline and Cymbalta have been found to relieve the pain associated with diabetic neuropathy. (Backonja, 1998) (Max, 1987)




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