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Diabetes and Diabetes and Nerve ProblemsNerve Problems
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What is Diabetes?
Diabetes is a condition in which there is too much sugar
(glucose) in the blood. Although sugar is needed to provide
energy for the body, when in excess, it causes problem.
Persons with diabetes have excess sugar because they lack or
have deficient supply of insulin.
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Diabetes
“Mild Disease”
Serious consequences
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Diabetes Mellitus A Serious Disease
Leading cause of newcases of blindness 25 times more prone to eye problems
6 times higher risk forParalysis (stroke)
5 times more prone toKidney failure
20 times more prone tolower limb amputationNerve damage causes loss of sensation
2-3 times higher risk forheart attack
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The Nervous System
The nerves in our body serve as a communication system.
The nervous system conveys messages from the brain to our
legs, hands, feet and other parts of the body (peripheral nervous system)
internal organs such as heart, stomach and bladder (autonomic nervous system)
The nervous system sends sensations to the brain so that appropriate actions can be taken in response
touch, pain, pressure, vibration and temperature smell, taste, sound, and sight
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Long periods of high blood sugar can damage nerve fibers,
impairing their ability to carry messages to and from the brain
Damaged nerve fibers relay signals (sensations) slowly or don’t
relay them at all
Restoration of the blood sugar level quickly to with-in target
range may allow damaged nerve fibers to heal and function
properly again
The Nervous System
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Cause of Nerve Damage
High blood sugar can harm nerve cells in two ways:
High sugar level in blood causes high amount of sugar to
enter the nerve cells. As the nerve cells cannot use all of it,
toxic substances accumulate and affect the nerves' ability to
transmit signals
High blood sugar also damages the small blood vessels that
carry oxygen and nutrients to the nerves
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Diabetes and Nerve Problems
Diabetic Neuropathy is a common complication of diabetes
It does not always cause obvious symptoms. When it does, you
may experience:
Loss of sensation in your feet and hands
Pain and other kind of discomfort
These symptoms are more likely to occur during periods of
poor blood sugar control
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Diabetes and Nerve Problems
Diabetic foot ulcers (common accompaniment to neuropathy)
are a common cause of prolonged hospitalizations
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Parts of the body most commonly affected by nerve problems in
people with diabetes: Leg, feet and hands
Genitals
Eye muscles
Heart
Stomach
Intestines
Bladder
Parts most often affectedDiabetes and Nerve Problems
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Symptoms of Diabetic NeuropathyFeet and Hands
Symptoms include various types of uncomfortable feelings
such as: Tingling, like a feeling of “ants crawling” or “pins and needles.”
Numbness and heaviness “feeling of walking on cotton”
Reduced ability to sense heat and cold
Stabbing or burning pain
A persistent “restlessness” in the feet and legs
Extreme sensitivity to touch, even light touch
Loss of balance and coordination
Dry skin susceptible to cracks and infections
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Most serious consequence of nerve problem is the loss of
protective sensation in the feet
Without an intact “pain-alarm-system,” minor injuries may occur
and go unnoticed until they develop into serious foot ulcers
Poorly fitted shoes can led to painless lesions that quickly
develop into ulcers
Symptoms of Diabetic NeuropathyFeet and Hands
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Serious burns or foreign body impaction (thorns; pebbles) may
occur without pain
Never walk barefoot. Sharp objects can cause injury at work or
home when you least expect them
Don’t underestimate the importance of daily foot inspection and
care – especially if you have nerve problems in your feet
Symptoms of Diabetic NeuropathyFeet and Hands
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Six pairs of eye muscles work together to turn both eyes in the
direction of your choice. These muscles are controlled by three
pairs of nerves.
If blood sugar control has been poor, one or more of these nerves
can be affected and can paralyse one or more eye muscles
causing double vision. This can occur suddenly without warning.
Severe unexplained pain behind the eye may also be due to
diabetic neuropathy
Symptoms of Diabetic NeuropathyEye Muscles
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Symptoms of Diabetic Autonomic Neuropathy
Stomach and Intestines Nausea, vomiting, feeling of bloating and lack of appetite, because of
delay in emptying of stomach
Difficulty in swallowing
Diarrhoea or constipation because stagnation due to poor bowel
movement
Weight loss
Urinary Tract and Genitals infection and incontinence of the bladder due to retention of urine
impotency and loss of libido (sexual response) in men and women
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Heart and blood vessels Sudden fall in blood pressure on standing and sitting suddenly
Silent heart attacks as the perception of pain of heart attack may be
affected
Abnormal heart beats and irregular pulse
Other Profuse sweating and inability of the body to control temperature as
the nerves to the sweat gland may get affected
Hypoglycaemia unawareness -the body's normal response to low
blood sugar is impaired, making it difficult for the person to
recognize the symptoms
Symptoms of Diabetic Autonomic Neuropathy
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You may also have serious nerve damage without any symptoms
Insist on your doctor examining your nervous system when you
are diagnosed or as soon as possible
See a neurologist (nerve specialist) regularly for examination if
and when advised by your doctor
Symptoms of Diabetic Neuropathy
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When to Check for Nerve Problems
The overall health of your nervous system should be checked as
part of your regular visits to the clinic
Children >10 years and adults < 30 years within 3-5 years of
diagnosis and thereafter once a year
Adults > 30 years at the time of diagnosis and thereafter once a
year
Those already diagnosed with abnormal findings need to be tested
more frequently as advised by their doctor
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Preventing Nerve Damage
Keep blood sugar levels as close to normal as possible to slow
the onset and progression of diabetic neuropathy
Avoid smoking as it worsens circulatory problem increasing the
risk of neuropathy
Reduce alcohol drinking as it can worsen neuropathy
Take Insulin, if advised
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Testing for Nerve Problems
Your doctor should ask you about: Vision problems
Any tingling, unusual pain or numbness
Any change in your ability to sweat
Heart palpitations
Bowel problems, such as constipation or diarrhea
Difficulty emptying your bladder
Problems with impotence
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Your doctor will examine you to check for sensations Pressure and deep sensation threshold test using a monofilament –
the doctor will apply a thin sharp plastic filament to the skin on the
feet and hands
Vibration perception threshold using a tuning fork – the doctor will
apply a vibrating tuning fork on bony prominences to check for
vibration sensation
Light touch sensation – using a cotton swap- doctor will lightly touch
the skin of the legs and hands to check presence of light touch
sensation
Testing for Nerve Problems
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Your doctor will examine you to check for sensations Thermal threshold to check for warm and cold sensation – using test
tubes filled with hot and cold water
Check reflexes – Strike parts of body with a small rubber hammer or
touch parts of body to examine for reflex reactions
Cold pressor test – doctor may ask you to dip your hands in ice cold
water and check for changes in your pulse or heart rate
Blood pressure response on standing – doctor will check BP in lying
down and while standing to see if blood pressure suddenly falls on
standing
Testing for Nerve Problems
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Other Tests Biothesiometry – to check for sensations. Biothesiometer is an
electrical device that varies the intensity of vibrations
Electromyography (EMG) - to check muscles response to electrical
impulses transmitted by nearby nerves. A slower or weaker response
suggests damage to the nerve or muscle
Nerve conduction studies – to check the flow of electrical current
through a nerve. Impulses that seem slower or weaker than usual
indicate possible damage to the nerve
ECG – to check regularity of heart rate
Ultrasound - to check functioning of the bladder and other parts of the
urinary tract
Testing for Nerve Problems
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Treatment For Neuropathy
To prevent further damage and reverse the changes of
neuropathy - bring the blood sugar levels under control Take Insulin, if advised
The aim of treatment is to relieve discomfort and reduce
pain Appropriate medication to help relieve pain; usual pain-killers may
not work well. Imipramine, Amitriptyline (anti depressants) are more
efficient in such cases
Insulin treatment improves painful neuropathy
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Treatment For Neuropathy
To reduce problems related to foot take special care of the
feet Follow the rules of foot care
To reduce muscle weakness Physiotherapy and physical exercise may be advised
Insulin treatment is also reported to improve weakness
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To reduce GI symptoms – such as indigestion, bloating, nausea and vomiting
Stop some types of anti diabetes medications Small frequent meals, with low intake of fat and fibre In severe cases medication may be prescribed
To reduce diarrhoea Stop some types of anti diabetes medications
Suitable medication for diarrhoea is prescribed
Treatment For Neuropathy
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To reduce dizziness and weakness related to postural
hypotension Sit or stand slowly from lying down position
Wear elastic stockings
Medication may be prescribed
Treatment For Neuropathy
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To reduce problems affecting the urinary tract Drink more fluids Pass urine regularly every 3-4 hours Antibiotics to treat urinary infections
To reduce sexual problems Counselling to help relieve stress Medication to help improve impotence in men Medication to reduce vaginal dryness and urinary tract infections in
women Suction devices or Surgery for men
Treatment For Neuropathy
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It has now been proven that prevention of nerve damage- like
prevention of other long term complication of diabetes- is best
achieved through tight blood sugar control
Take Insulin, if advised
Strive to keep your blood sugar with in your target < 120 mg/dl Fasting and < 180 mg/dl PP
You are in the best position to accomplish this goal through
regular blood sugar testing and appropriate adjustments in your
medication,diet and exercise
Conclusion
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