When Does Diabetes cause Neuropathy
Diabetes-induced neuropathy is a common disorder and is defined as symptoms of peripheral nerve dysfunction in a patient with diabetes mellitus in whom other causes of neuropathy have been excluded. 75 % of diabetic neuropathy is asymmetrical which may involve primarily cranial nerves and limb nerves. Cranial nerves are the combination of 12 nerves that function to transmit various types of information to and from the body through the spine. Some of the nerves are motor nerves that move muscles. Others are sensory nerves; they carry information from the body to the brain so we can feel the touch. Some cranial nerves are a combination of motor and sensory nerves. Cranial mononeuropathy III is the most common cranial nerve disorder in people with diabetes This disorder affects the third cranial nerve in the skull. This is one of the cranial nerves that are responsible for controlling eye movement.
According to doctors, over time, uncontrolled high blood sugar damages nerves and interferes with their ability to send signals effectively, leading to diabetic neuropathy. High blood sugar also weakens the walls of the small blood vessels (capillaries) that supply the nerves with oxygen and nutrients. Different types of nerve damage cause different symptoms. Symptoms can range from pain and numbness in your feet to problems with the functions of your internal organs, such as your heart and bladder. Researchers are still trying to find how exactly diabetes harms and destroys the nerves cells. the conventional theory is- high blood sugar is the cause, but there are other factors that you should be aware of, which are likely to contribute to an increased risk of developing peripheral nerve damage, and its progression, including:
- Overweight and obesity
- Cigarette smoking
- High total blood cholesterol
- High blood pressure
- High triglycerides
Types of neuropathy in diabetes
Distal Symmetric Neuropathy(DSN)
DSN is the most common condition among patients with DN. this condition is length-dependent called distal symmetric polyneuropathy, patients with frequent numbness in fingers and toes, tingling sensations, and pain that starts with tips and spreads to other parts of the body. For accurate diagnosis patients without a known cause should undergo a complete blood cell count, comprehensive metabolic panel, vitamin B12 measurement, serum protein electrophoresis with immunofixation, fasting glucose measurement, and glucose tolerance test. Up to 50% of older type 2 diabetic patients are having symptoms of distal neuropathy. These neuropathies are characterized by a progressive loss of nerve fibers affecting both the autonomic and somatic divisions of the nervous system. The clinical features of diabetic neuropathies vary immensely, and only a minority are associated with pain.
The Start of DSN is commonly gradual or insidious and is heralded by sensory symptoms that start in the toe tips and then progress proximally to involve the feet and legs in a stocking distribution. When the disease is well developed in the lower limbs in more severe cases, there is upper limb involvement, with a similar progression proximally starting in the fingers. As the disease advances further, motor skill manifestations, such as wasting of the small muscles of the hands and limb weakness, become apparent. In some cases, there may be sensory loss that the patient may not be aware of, and the first presentation may be a foot ulcer. Approximately 50% of patients with DSPN experience neuropathic symptoms in the lower limbs including constantly occurring uncomfortable tingling (dysesthesia), pain (burning; shooting or “electric-shock like”; lancinating or “knife-like”; “crawling”, or aching, etc., in character), evoked pain (allodynia, hyperesthesia), or unusual sensations (such as a feeling of swelling of the feet or severe coldness of the legs when clearly the lower limbs look and feel fine, odd sensations on walking likened to “walking on pebbles” or “walking on hot sand,” etc.). There may be marked pain in walking that may limit exercise.
Painful Diabetic Neuropathy
Painful diabetic neuropathy is pain arising as a direct consequence of abnormalities of the somatosensory system in diabetic patients and predominantly affects the feet and legs. DN pain is typically getting worse at night and can be described as constant burning, pins and needles, shooting, aching, jabbing, sharp, cramping, tingling, cold, or allodynia. Some patients develop predominantly small fiber neuropathy manifesting with pain and paresthesia early in the course of diabetes that may be associated with insulin therapy in less than six months duration, symptoms are aggravated at night, and manifest more in feet than hands. this condition then gets turned into chronic painful neuropathy. Chronic painful DN refers to painful neuropathy occurring over more than six months. These patients may develop tolerance to drugs and even get addicted. Chronic painful Neuropathy can develop even before the onset of clinically diagnosable diabetes mellitus, which is known as “impaired glucose tolerance neuropathy”.
Diabetic Autonomic Neuropathy
Diabetic autonomic neuropathy (DAN) is one of the least recognized and understood complications of diabetes despite its significant negative impact on survival and quality of life in people with diabetes. This is the condition when diabetic autonomic neuropathy starts affecting various organs of the body resulting in cardiovascular, gastrointestinal, excessive sweating, pupil dilation, and metabolic disturbances.DAN is also associated with genitourinary tract disturbances including bladder and sexual dysfunction. Evaluation of bladder dysfunction should be performed for individuals with diabetes who have recurrent urinary tract infections, pyelonephritis, incontinence, or a palpable bladder. Disruption of microvascular skin blood flow and sudomotor function may be among the earliest manifestations of DAN and lead to dry skin, loss of sweating, and the development of fissures and cracks that allow microorganisms to enter. These changes ultimately contribute to the development of ulcers, gangrene, and limb loss.
Diagnosis of Diabetic neuropathy
When you start feeling tingling sensations, your doctor or nurse will check your feet periodically. If you are diabetic and have symptoms of diabetic neuropathy, your doctor will take a complete health history and perform a physical exam. If you have never been diagnosed with diabetes, your doctor may order a blood test first. Nerve function tests are used to diagnose diabetic neuropathy. Nerve function tests will measure your response to electrical signals, sensitivity to touch, and changes in temperature.
Along with the nerve exam, your doctor may also perform or order specific tests to help accurate diagnostics of diabetic neuropathy, such as
- Muscle response testing. Called electromyography, this test is often done with nerve conduction studies. It measures electrical discharges produced in your muscles.
- Nerve conduction testing. This test measures how quickly the nerves in your arms and legs conduct electrical signals. It’s often used to diagnose carpal tunnel syndrome.
- Filament test. Your doctor will brush a soft nylon fiber (monofilament) over areas of your skin to test your sensitivity to touch.
- Autonomic testing. Special tests may be done to determine how your blood pressure changes while you are in different positions, and whether you sweat normally.
Treatment of diabetic neuropathy
The only treatment of Diabetic neuropathy is to focus on preventing the progression of neuropathy and providing symptomatic relief. so what can you do at home?
Rub it off with oils
Popular for their healing powers for thousands of years, essential oils are known for their magical pain vanishing properties. They’re said to help soothe the mind and body, and they may treat a number of conditions. Because of this, they’re often seen as a natural alternative to medication. The regeneration of nerves can be a slow process, but treatments of oil massage can be a great alternative method to aid in this process. essential oils are known to have especially pain-relieving and anti-inflammatory effects. They are said to achieve this by increasing circulation within the body. And all this is non-invasive, and found naturally in plant extracts! Some of the most effective essential oils for nerve pain relief include:
- Eucalyptus: Eucalyptus oil works well as an anti-inflammatory. It also suppresses muscle spasms and helps pain relief. It is said to help stimulate blood circulation in several nerve conditions, including neuralgia and sciatica.
- Peppermint: Peppermint oil is known for its fresh, awakening scent and multiple health benefits. Among these benefits are effects that may help treat peripheral neuropathy. Peppermint oil is an especially helpful essential oil for the treatment of nerve damage. It induces pain relief, as well as exhibits anti-inflammatory properties. Peppermint is a stimulant and should not be used before bedtime. It works well combined with other oils, making it even more potent.
- Lavender: famous for the scent of calmness, Lavender is also an essential oil that provides anti-inflammatory benefits, which can help relieve pain in neuropathy patients. it helps with the reduction of anxiety, stress, and depression. It also fights inflammation and promotes blood flow in the body. This oil can help in the treatment of sciatica, muscle aches, neuralgia, and muscle spasms.
- Frankincense: This oil also acts as a sedative that fights inflammation in arthritis and rheumatoid arthritis. Studies have shown that frankincense can help prevent cartilage tissue from breaking down, which is the major cause of these conditions.
There are several ways you can administer these oils. You can mix them in with your lotions. Or you can add a few drops into the water when you take a bath. Taking an essential oil bath can be doubly healing due to the warm water in the bath. Warm water is said to increase blood circulation throughout the body, which can lessen the pain.
Capsaicin is can be used as a topical ointment for those who cannot tolerate medications, or want to avoid them. The initial treatment of the ointment may burn, but eventually, you will experience a reduction in sensations. You can also incorporate cayenne pepper into your diet, as well as take it in supplement form. Capsaicin often works well for people, with very few people experiencing systemic side effects. Some negative aspects of the chemical compound include lack of efficacy when used at low doses, high cost, as well as the need to often reapply. Talk to your doctor before you undergo this treatment method. And before using, be sure to test on a small area for any irritation.
Taking supplements depends on your comfort level, the state of your condition, and the go-ahead from your doctor. Make sure to only take the recommended amounts your doctor suggests. Vitamin and mineral deficiencies are one of the primary risk factors for peripheral neuropathy. There are many supplements you can take to help ease your symptoms, some significant ones are listed here. Do your research on the variety of vitamins and supplements that you can also take. Here are the recommendations:
A deficiency in B vitamins can lead to extensive nerve damage. You can get vitamin B from food, but the supplement offers it in a much more concentrated form. Follow doctors’ orders for the recommended dose to avoid the worsening systems and to prevent toxicity. Vitamin B-12 assists in the formation of red blood cells and DNA. B-12 and B-6 both play a key role in the maintenance of the myelin sheath which encloses the nerve fibers and makes sure the messages your nerves are conveying are traveling through your body. This helps reduce the pain from nerve damage. Vitamin B-6 also assists in the formation of chemicals that implement communication between nerves. Vitamin B-7, also known as biotin, in combination with a chromium supplement can help with blood glucose levels to fight diabetes and diabetes-induced neuropathy. Biotin is said to help control the pancreas’ output of insulin, while chromium is said to improve insulin sensitivity.
Food rich in B vitamins include:
- Meat, poultry, and fish
- Low-fat dairy foods
- Fortified cereals
Alpha-lipoic acid: This is a potent antioxidant that is made in our bodies which eliminates free radicals. You can also find it in spinach and broccoli, though only in small amounts. Taking alpha-lipoic acid has been proven to reduce numbness, tingling, and burning symptoms. It helps the leveling of blood sugar and can help maintain healthy blood vessels that are connected to the nerves.
Omega-3 fatty acids: Omega-3s have anti-inflammatory properties and can decrease numbness, burning, and tingling.
Immobility is a big problem with peripheral-neuropathy patients. It can result in muscular atrophy (shrinkage) and tightening (loss of flexibility), as well as decreased metabolism, which means less energy and high risk for gaining fat,” the general benefits of aerobic and flexibility exercises are well-known, increasing movement and heart-rate are particularly important for people suffering from peripheral neuropathy. Physical activity can improve blood circulation, which strengthens nerve tissues by increasing the flow of oxygen. Aerobic exercise also improves not only physical functioning but helps fight depression, maintain ideal body weight, and improve pain tolerance. Aerobic exercise also helps to control blood glucose in diabetics and may lower insulin requirements.