What is Diabetic Neuropathy?

Diabetic neuropathy is nerve damage caused by hyperglycemia (high blood glucose levels). The condition is divided into four subtypes: peripheral, focal, proximal, and autonomic. Each of these types affects organ systems differently, and more than one type may occur in the same patient concurrently, depending on the severity of the primary condition and the length of time since the patient originally presented with symptoms.

Peripheral Neuropathy Symptom Profile
Damage to the peripheral nervous system, which transmits information from the brain and spinal cord to other parts of the body, manifests in the extremities–the hands and feet. Consequently, patients experience numbness, tingling, burning, and generalized pain in the limbs. In severe cases, the condition necessitates partial or complete amputation of the hands, feet, arms, or legs, which can result in additional complications such as systemic infection.

Focal Neuropathy Symptom Profile
Focal neuropathy is limited in scope, affecting a single nerve in one area of the body. This may include a nerve in a limb or in one of the extremities, such as a wrist, foot, or thigh, or, alternatively, it may present as damage to one of the nerves associated with eye muscle movement. It is also seen in the nerves of the chest. Problems associated with vision and breathing may result, which may require the patient to seek additional care for secondary and tertiary ailments.

Proximal Neuropathy Symptom Profile
This type of neuropathy typically affects the proximal muscles of the lower limbs and extremities. Symptoms may be unilateral or bilateral and include pain in the legs, thighs, hips, and lower buttocks. Movement may be painful or restricted and result in the inability to exercise or even walk without difficulty, ultimately leading some patients to seek physical therapy to improve mobility issues.

Autonomic Neuropathy Symptom Profile
Autonomic neuropathy is one of the most severe forms of the condition due to the influence on the autonomic nerves, which control a variety of involuntary functions in the body. The nerves of the bladder, heart, and blood vessels are all under autonomic control, leading to problems with circulation and elimination. Digestion, temperature control, and sexual function may also be affected, resulting in metabolic imbalances, nutritional deficiencies, and detrimental effects on the overall quality of life.

Prevention of Diabetic Neuropathy
One of the best ways to prevent or delay the development of diabetic neuropathy is to come up with a treatment plan that will keep blood glucose levels in control at all times. It is vital that blood glucose measurements be taken several times a day. Daily monitoring must include fasting measurements (upon waking and before bed) and post-meal measurements (taken two hours after any meal, when blood glucose levels peak). Another tool that is pivotal in keeping diabetes under control is the A1C test, which measures average blood glucose for the past two to three months. This test is typically offered through a lab or physician. It is imperative that patients with neuropathy protect their feet with diabetic shoes and socks to enhance blood flow and to check for any open wounds on the extremities, as these can become infected, resulting in amputation.

Treatment of Diabetic Neuropathy
If diabetic neuropathy should develop despite measures to keep blood glucose levels under control, patients do have treatment options that can reduce and/or reverse the effects of the condition(s). Keeping A1C levels down sometimes requires increasing the dosage of insulin or oral medications, which helps some patients. Prescription drugs such as nerve pain medications, analgesics, narcotics, anesthetics, and anticonvulsants can treat the various symptoms and manifestations of each of the neuropathies. Patients may consider consulting specialists equipped to deal with their specific concerns to come up with more effective treatment plans. Seeing a neurologist, podiatrist, or endocrinologist who understands individual needs may be helpful in creating a positive outcome for the patient.

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