Diabetic Neuropathy

Diabetic neuropathy is a type of nerve damage that can occur in people with diabetes. It is caused by high blood sugar levels over time, which can damage the blood vessels that supply the nerves. There are several types of diabetic neuropathy, each affecting different body parts. Symptoms of diabetic neuropathy can include numbness and tingling in the hands and feet, pain, weakness, and difficulty with balance and coordination. In advanced cases, it can lead to the loss of sensation in the limbs and increase the risk of foot ulcers and amputations.

Types of diabetic neuropathy

Several types of diabetic neuropathy^{[1][2] affect} different body parts. The most common styles include:

1. Peripheral neuropathy: This type affects the nerves in the hands and feet and can cause numbness, tingling, pain, and weakness. It can also make it challenging to sense temperature changes or pain in the affected areas, increasing the risk of injury.
2. Autonomic neuropathy: This type affects the nerves controlling internal organs, such as the heart, blood vessels, bladder, and intestines. Symptoms can include changes in blood pressure, heart rate, digestion, and bladder function.
3. Proximal neuropathy: This type affects the nerves in the legs, hips, buttocks, or thighs and can cause pain, weakness, and loss of muscle mass.
4. Focal neuropathy: This type affects a single nerve or a group of nerves in specific areas of the body, such as the face, torso, or leg. Symptoms can include sudden, severe pain or weakness in the affected area.
5. Diabetic Amyotrophy: This type affects the nerves in the thigh and hip, causing weakness and pain in the affected area.

Risk factors for diabetic neuropathy

There are several risk factors^[3][4] for diabetic neuropathy, including:

1. Duration of diabetes: The longer a person has diabetes, the greater their risk of developing neuropathy.
2. High blood pressure: High blood pressure can damage the blood vessels that supply the nerves, increasing the risk of neuropathy.
3. High cholesterol levels can increase the risk of neuropathy by contributing to plaque formation in the blood vessels that supply the nerves.
4. Smoking: Smoking can damage blood vessels, including the ones that supply the nerves, increasing the risk of neuropathy.
5. Obesity: Being overweight or obese can increase the risk of neuropathy, as it increases the strain on the blood vessels that supply the nerves.

Symptoms for diabetic neuropathy

Symptoms^[5][6] of diabetic neuropathy can vary depending on the type and severity of the nerve damage. Some common symptoms include:

1. Numbness and tingling in the hands and feet: This is often one of the first symptoms of peripheral neuropathy.
2. Pain: People with diabetic neuropathy may experience burning, shooting, or stabbing pain in the affected areas.
3. Weakness: Weakness in the muscles, especially in the legs and feet, can make it difficult to walk or stand for long periods.
4. Loss of sensation: Neuropathy can cause a loss of success in the affected areas, making it challenging to sense temperature changes, pain, or injuries.
5. Difficulty with balance and coordination: Peripheral neuropathy can affect the nerves that control balance and coordination, making it difficult to walk or stand.

Diagnosis process of diabetic neuropathy

The diagnosis of diabetic neuropathy^[7][8] typically involves a combination of a physical examination, nerve function tests, and other diagnostic tests. The process may include the following steps:

1. Medical history and physical examination: The healthcare provider will take a detailed medical history and conduct a physical exam to check for signs of nerve damage, such as loss of sensation, muscle weakness, and reflex changes.
2. Blood tests: Blood tests will be done to check blood sugar levels, cholesterol levels, and other indicators of diabetes and overall health.
3. Nerve function tests: These tests can include nerve conduction studies, which measure the speed of nerve signals, and electromyography, which measures the electrical activity of muscles.
4. Imaging tests: Imaging tests such as MRI or ultrasound may be done to check for nerve damage or other underlying conditions.
5. Skin biopsy: A skin biopsy can be done to check for nerve damage in tiny fibers.

Complications of diabetic neuropathy patient

Diabetic neuropathy can lead to several complication^[2][4]s, including:

1. Foot injuries: Loss of sensation in the feet can make it difficult for people with diabetic neuropathy to sense injuries, blisters, or other foot problems. This can increase the risk of foot ulcers, leading to infection and, in some cases, amputation.
2. Cardiovascular disease: Autonomic neuropathy can also affect the nerves that control the heart and blood vessels, increasing the risk of cardiovascular disease.
3. Charcot foot: This condition occurs when nerve damage causes the bones in the foot to become weakened, leading to fractures and dislocations.
4. Diabetic retinopathy: It can also affect the nerves in the eyes. This serious eye condition can cause blindness.
5. Diabetic gastroparesis is when the stomach muscles don’t work correctly, making it hard to digest food.

Who are the most vulnerable to diabetic neuropathy

People with diabetes are most vulnerable to developing diabetic neuropathy^[6][8]. Specifically, those who are more vulnerable include:

1. People with poorly controlled diabetes: People with uncontrolled blood sugar levels are at a higher risk for developing diabetic neuropathy.
2. People with type 1 diabetes: People with type 1 diabetes are more likely to develop neuropathy than those with type 2 diabetes, although both types of diabetes can cause neuropathy.
3. People who have had diabetes for a long time: The longer a person has diabetes, the greater their risk of developing neuropathy.
4. Older people: Older adults with diabetes are at a higher risk of developing neuropathy than younger adults.
5. People who smoke: Smoking can damage blood vessels, including the ones that supply the nerves, increasing the risk of neuropathy.

Prevention process of diabetic neuropathy

The best way to prevent diabetic neuropathy^[1][3] is to tightly control blood sugar levels through lifestyle changes and medication. The following steps can help prevent diabetic neuropathy:

1. Maintaining reasonable blood sugar control: Keeping blood sugar levels as close to normal as possible can help prevent nerve damage. This can be done through a combination of healthy eating, regular physical activity, and medication if prescribed by a doctor.
2. Regular check-ups with a healthcare provider: Regular check-ups with a healthcare provider can help detect nerve damage early and allow for prompt treatment.
3. Maintaining a healthy diet: Eating a healthy diet that is low in fat and cholesterol can help prevent nerve damage.
4. Regular physical activity: Regular physical activity can help keep blood sugar levels under control and improve overall health.
5. Quit smoking: Smoking can damage blood vessels, including the ones that supply the nerves, increasing the risk of neuropathy.

The treatment plan for the diabetic neuropathy patient

Treatment for diabetic neuropathy^[5][7] typically involves a combination of approaches, including managing blood sugar levels, relieving pain, and preventing further nerve damage. A treatment plan may include the following:

1. Managing blood sugar levels: Tightly controlling blood sugar levels is the most effective way to slow the progression of diabetic neuropathy. This can be done through a combination of healthy eating, regular physical activity, and medication if prescribed by a doctor.
2. Medications to relieve pain: Medications such as anticonvulsants, antidepressants, and painkillers can be used to alleviate the pain and discomfort caused by diabetic neuropathy.
3. Topical creams or patches: Topical creams or patches containing capsaicin, a compound found in chilli peppers, can be applied to the skin to relieve pain.
4. Physical therapy: Physical therapy can help improve muscle strength and coordination and reduce the risk of falls.
5. Surgery: In some cases, surgery may be necessary to relieve pain or improve mobility.

Home treatment can take a diabetic neuropathic patient on own

There are several home treatment options that a diabetic neuropathy patient can take on their own to help manage symptoms and prevent further nerve damage. These include:

1. Maintaining reasonable blood sugar control: Keeping blood sugar levels as close to normal as possible can help prevent nerve damage. This can be done by combining healthy eating, regular physical activity, and medication as prescribed.
2. Regular physical activity: Regular physical activity can help improve blood flow and nerve function and reduce the risk of falls.
3. Proper foot care: Diabetic neuropathy can cause a loss of sensation in the feet, increasing the risk of foot injuries. Good foot care, including regular check-ups with a foot specialist, can help prevent injuries.
4. Maintaining a healthy diet: Eating a healthy diet that is low in fat and cholesterol can help prevent nerve damage.
5. Quitting smoking: Smoking can damage blood vessels, including the ones that supply the nerves, increasing the risk of neuropathy.

When a diabetic neuropathy patient needs to visit a doctor

Diabetic neuropathy patients need to visit a doctor if they are experiencing symptoms such as numbness, tingling, pain, or weakness in the hands or feet. 

Additionally, diabetic patients need to schedule regular check-ups with a healthcare provider to monitor for the development of neuropathy, even if they are not experiencing symptoms. This is because diabetic neuropathy can occur without symptoms, and early detection and treatment can prevent further nerve damage.

Diabetic neuropathy is a common complication of diabetes that occurs when high blood sugar levels damage the nerves over time. It can cause various symptoms, including numbness, tingling, pain, and weakness in the hands and feet. It can lead to severe complications if left untreated. The best way to prevent diabetic neuropathy is to control blood sugar levels through lifestyle changes and medication tightly. Early detection and treatment are vital to preventing further nerve damage and managing symptoms. 

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Dr. M Shahadat Hossain

Physiotherapy Specialist at ASPC Manipulation Therapy Centre

BSPT (DU), MSc PT(DU), PhD-fellow (JU), Dip. in-Manipulation Therapy (Certified ETOMG-Belgium), McKenzie (A&B), Mulligan and dry Needling (India) Faculty Member of Bangladesh Health profession Institute (CRP), Savar.
Assistant professor, Dhaka College of Physiotherapy
Chief Consultant(Ex): Popular Medical college Hospital, Dhanmondi- 2.
Chairman and Chief Consultant: ASPC Manipulation Therapy Centre, Nurjahan Road, Mohammadpur.
Founder and conceptual inventor: Structural Diagnosis and Management (SDM) concept.
Secretary: Centre for the Rehabilitation of Autism and Person with Disabilities (CARD).
Secretary-General: Bangladesh Physiotherapy Association (BPA).
Phone +88 01712-867364
Email aspc.dhaka@gmail.com
Website https://aspc.com.bd

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