Types of Diabetic Neuropathy

Diabetic neuropathies are in the family of nerve disorders caused by diabetes. People with this disease can develop damage to nerves throughout the body. Neuropathies lead to numbness and sometimes pain and weakness in the hands, arms, feet or legs. Problems may also occur in every organ system. Patients reported problems in the digestive tract, heart and sex organs. People with diabetes can develop nerve problems at any time, but the longer a person has diabetes, the greater the risk of developing some. Since 50 percent of those with diabetes have some form of neuropathy, we must know there are different types of diabetic neuropathy and we should learn more about it.

Diabetic neuropathy is damage to nerves throughout the body with people who have diabetes. Most people reported some kind of numbness, pain and weakness, but not all with neuropathy have symptoms. The highest rates of neuropathy are among people who have had the disease for at least 25 years of their life. Diabetic neuropathy also appears to be more common in people who have had problems controlling their blood glucose levels. It would be more common in those with high levels of blood fat and blood pressure, in overweight people, and in people over the age of 40. The most common type is peripheral neuropathy, also called distal symmetric neuropathy, which affects the arms and legs, but actually, there are three types of diabetic neuropathy. Those are peripheral, autonomic and focal neuropathies.

The causes why neuropathy occurs are probably different for different varieties of diabetic neuropathy. Researchers are studying the effect of glucose on nerves to find out exactly how prolonged exposure to high glucose causes this problem. Nerve damage is likely due to a combination of metabolic factors, abnormal blood fat levels, neurovascular factors, autoimmune factors, mechanical injury to nerves, or lifestyle factors such as smoking or alcohol use.

Symptoms depend on the type of neuropathy at first, but it also depends of which nerves are affected. Some people have no symptoms at all, while for others, numbness, tingling, or pain in the feet is often the first sign. A person can experience both pain and numbness, although symptoms are minor at first. Since most nerve damage occurs over several years, mild cases may go unnoticed for a long time. Symptoms may involve the sensory or motor nervous system, as well as the involuntary, or autonomic, nervous system. In some people, mainly those with focal neuropathy, the onset of pain may be sudden and severe according to type of their neuropathy. Symptoms may include numbness, tingling, or pain in the toes, feet, legs, hands, arms, and fingers. Patient could also experience wasting of the muscles of the feet or hands, indigestion, nausea, or vomiting, diarrhea or constipation, and dizziness or faintness due to a drop in postural blood pressure. Some people reported also problems with urination, erectile dysfunction or vaginal dryness, and weakness.

For some researchers, we could classify diabetic neuropathies as peripheral, autonomic, proximal, and focal. Each affects different parts of the body in different ways, where peripheral neuropathy causes either pain or loss of feeling in the toes, feet, legs, hands, and arms. Autonomic neuropathy causes changes in digestion, bowel and bladder function, sexual response, and perspiration, as well as nerves that serve the heart and control blood pressure. Proximal neuropathy causes pain in the thighs, hips, or buttocks and leads to weakness in the legs, while focal neuropathy results in the sudden weakness of one nerve, or a group of nerves, causing muscle weakness or pain. Neuropathy affects nerves throughout the body depending of the type.

The best way to prevent neuropathy is to keep blood glucose levels as close to the normal range as possible. Maintaining safe blood glucose levels protects nerves throughout the body.

You will get diagnosis of diabetic neuropathy based on symptoms and a physical exam. During the exam, the doctor may check blood pressure and heart rate, muscle strength, reflexes, and sensitivity to position, vibration, temperature, or a light touch and the way you will experience it will help to the doctor. The doctor may also do other tests to help determine the type and extent of nerve damage and determine which type of diabetic neuropathy you might have. A comprehensive foot exam assesses skin, circulation, and sensation, and this test is possible to have during a routine office visit. To assess protective sensation or feeling in the foot, the doctor will attach nylon monofilament to a wand, and then touch the foot. Those who cannot sense pressure from the monofilament have lost protective sensation. Those people are at risk for developing foot sores that may not heal properly. Other tests include checking reflexes and assessing vibration perception. These diagnosing methods are more sensitive than touch pressure. Nerve conduction studies check the transmission of electrical current through nerve. With this test, an image of the nerve conducting an electrical signal projects onto a screen. Nerve impulses that seem slower or weaker than usual indicate possible damage or neuropathy. This test allows the doctor to assess the condition of all the nerves in the arms and legs, depending from case to case. Electromyography is common diagnostic method, which shows how well respond to nerve signals muscles show. The electrical activity of the muscle displays on a screen. A response that is slower or weaker than usual suggests damage to the nerve or muscle, which might determine if you have some type of diabetic neuropathy. Quantitative sensory testing uses the response to stimuli, such as pressure, vibration, and temperature, to check for neuropathy. A check of heart rate variability shows how the heart responds to deep breathing and to changes in blood pressure and posture, which might also change due to diabetic neuropathy. Ultrasound uses sound waves to produce an image of internal organs, where the ultrasound of the bladder for example can show how this organ preserves a normal structure and whether the bladder empties completely after urination. Nerve or skin biopsy involves removing a sample of nerve or skin tissue for examination by microscope to diagnose neuropathy.

Treatment of diabetic neuropathy

The first step is to bring blood glucose levels within the normal range. This is extremely important, in order to prevent further nerve damage. Blood glucose monitoring, meal planning, exercise, and oral drugs or insulin injections patients need to control their blood glucose levels. Although symptoms may get worse when blood glucose is under control at the beginning, over time, maintaining lower blood glucose levels helps lessen symptoms of diabetic neuropathy. Importantly, good blood glucose control may also help prevent or delay the onset of further problems patients might also have. Additional treatment depends on the type of nerve problem and symptom. However, if you want to get appropriate treatment you must first talk to your doctor to determine exact type for your diabetic neuropathy. Until that time, just remember that diabetic neuropathies are nerve disorders caused by many of the abnormalities common to diabetes, such as high blood glucose. Neuropathy can affect nerves throughout the body, causing numbness and sometimes pain in the hands, arms, feet, or legs, and problems with the digestive tract, heart, and sex organs so everything you might experience is normal for this disease. Treatment first involves bringing blood glucose levels within the normal range, which you could do on your own for the start. Good blood glucose control may help prevent or delay the onset of further problems so until your doctor find right treatment, try to stick to tips you already know about controlling blood sugar. Foot care is another important part of treatment because people with neuropathy need to inspect their feet daily for any injuries, but your doctor is going to explain all this to you. Untreated injuries increase the risk of infected foot sores and amputation that you surely wish to avoid. Treatment also includes pain relief and other medications as needed, depending on the type of nerve damage you have. You have to know that smoking significantly increases the risk of foot problems and amputation, so if you smoke, ask your health care provider for help in quitting.