What is Diabetic Neuropathy

May 19 '17
Nerve damage is a frequent consequence of diabetes. These can, for example, interfere with pain perception. The therapy aims to prevent progress as far as possible and to alleviate the symptoms

Nerve damage is one of the most common consequences of diabetes

What is a diabetic neuropathy?
What patients themselves can do

1. What is diabetic Neuropathy?

First of all we should some have some knowledge about Diabetes in Depth.
Diabetes can also attack the nerves. In diabetic Neuropathy the nerves are damaged as a result of permanently elevated blood glucose levels. It is one of the most common complications of diabetes - with approximately every third patient suffering from the disease is suffering from neuropathy. On the one hand, the peripheral nerves can be affected, which include the sensory sensory nerves as well as the motor nervous nerves. Often, however, the vegetative (also autonomous) nervous system, which can not be consciously influenced and controls the manifold functions in the body, for example the activity of internal organs or the formation of perspiration.

The range of complaints is very large with diabetic nerve damage. Peripheral neuropathy can lead to disturbances of pain, touch or temperature, but also to chronic pain, dyslexia and paralysis. Autonomic neuropathy can, for example, result in gastric paralysis or cardiac arrhythmia, but can also lead to bladder weakness or erectile problems.

In addition, diabetic neuropathy is an important cause of the so-called diabetic foot syndrome : because the pain sensation is diminished, injuries to the feet often remain unnoticed for a long time. This can lead to poorly healing wounds, which ignite and spread into the depth of the tissue - usually favored by simultaneous circulatory disturbances. Diabetic foot syndrome is one of the main causes of amputations in Germany.

2. Symptoms

Neuropathy in diabetes may be noticeable with various indications. Typical symptoms of disturbed senso-motor nerves are:

Burning, boring pain
Tingling, ants running, furry feeling
Reduced sensitivity to temperature or pain
There are also connections to the so-called restless legs syndrome. Its symptoms include uncomfortable tension or pressure of the legs at rest, often in the evening, at night, or while sitting still, as well as symptoms such as tingling or convulsive pain. As movement aggravates the discomforts, those affected often feel a strong urge to move.

In the case of sensomotor neuropathy, symptoms usually extend from the toes, feet and lower limbs. Typically, the discomfort in the bed worsens and improves when walking. If the nerves responsible for the leg muscles are affected, this can lead to gait uncertainties as well as increased stumbling-up.

If the autonomic nervous system affected hang the complaints from the affected organ. Nerve damage to the cardiovascular system can manifest itself with pulse changes, such as an increased resting pulse, or disturbances of the blood pressure. In the gastrointestinal tract, swallowing, heartburn, bloating or nausea are possible effects. In addition, for example, a bladder weakness can occur and the sexual feeling can be disturbed.

A central neuropathic problem in diabetes is the absence of counter-regulation when the blood sugar decreases. Affected persons are therefore less likely to experience hypo-glycaemia. You should also know the symptoms of diabetes.

3. Causes

Various factors influence the likelihood of developing a neuropathy. In principle, there is no significant difference in risk between type 1 and type 2 diabetes . The mechanisms that cause diabetes to damage the nerves have not been clarified so far. Numerous factors play a role, among which increased blood glucose values ​​occupy a central place.

On the one hand, a high sugar level damages the blood vessels leading to the nerves. The latter then only receive insufficient oxygen. On the other hand, the excess of blood sugar causes complicated metabolic processes, which affect the nerves themselves.

4. Diagnosis

Damaged nerves do not always manifest themselves with perceptible signs. Even if they do not have any complaints, people with diabetes should therefore have their nerves examined once a year by a family doctor or diabetologist: in the case of type 1 diabetes from the fifth year of onset, in type 2 diabetes immediately after the diagnosis For a long time undoubtedly elevated sugar values.

With simple examination methods it is possible to test whether there is possibly damage to the sens-omotor nerves. The physician checks, among other things:

The pain sensation
The touch sensitivity
The temperature sensitivity
The feeling of vibration
Achilles and knee-joint reflex
Pressure and touch at certain points of the foot

In addition, the doctor asks the patient, when he introduces himself for the first time, to his / her medical history (anamnesis) and according to previously used drugs. In the case of control examinations, he will concentrate on current developments in the patient. If the suspicion of nerve damage is suspected, the physician can use various technical procedures to examine whether a diabetic neuropathy is actually present or the symptoms are due to other causes. I have also watched a program against diabetes disease which is working well. You can check it here.

More difficult to determine: damage to the autonomic nerves

In the event of a damage to the autonomic nerves, the patient`s details may also be evident to the physician. Depending on the complaint, further investigations will follow.

Indications for a heart ache suffer from various cardiac examinations. Thus, an ECG or 24-hour ECG may show a quietly increased pulse beat or a decrease in the natural fluctuations of the heart rhythm. A tendency to fall in blood pressure, for example after standing up from the bed (subject heading: neurogenic orthostatic hypotonia), can be traced, for example, by means of blood pressure measurements during lying and standing, a so-called Schellong or orthostasis test.

Autonomic neuropathy of the gastric nerves, which control the muscles of the stomach wall, is difficult to determine. Complications such as nausea, bloating or swallowing may also be due to other causes. A reference to a diabetic nerve damage can however be a poorly adjusted blood glucose level as well as unlikely explainable blood glucose fluctuations with inclination to hypoglycemia as well as a disturbance of the welding formation. The latter can become noticeable with dry feet.

Further diagnostic measures such as an ultrasound examination, a gastro response and the measurement of the gastric emptying rate can be useful, as well as different laboratory values.

In the case of complaints such as bladder weakness, erectile dysfunction and other sexual problems, it is also possible to investigate suspected diabetic nerve damage by means of special examination methods.

5. Therapy

The treatment of diabetes-induced neuropathy is about different goals. On the one hand, it is necessary to stabilize nerve damage and prevent further deterioration. Pain therapy is also intended to alleviate the symptoms and help the patient to achieve a higher quality of life. The specific objectives and measures in the individual case are clarified by the treating physician.

Further development of the Neuropathy stop

Affected persons should quit smoking and, if possible, dispense with alcohol. This will help prevent nerve damage from progressing. Alcohol is a nerve poison and attacks the nerves directly. Smoking damages above all the blood vessels and can thereby indirectly affect the nerve pathways.

In addition, a good adjustment of the blood glucose level as well as the blood fat and blood pressure values ​​is important. Over-weighting helps sustainability. All measures together serve to counteract a worsening of the neuropathy. Sometimes an improvement may even occur.

Pain therapy: relieve discomfort

In the treatment of neuropathy, the responsible doctors - neurologists, pain therapists, diabetologists and family physicians - are generally close to each other.

Medicines play an important role in alleviating the pain that occurs as a result of diabetic neuropathy. Patients should not have to resort to non-prescription painkillers, but should consult with their doctor to determine which treatment is advisable in their case. The exact diagnosis is decisive. If, for example, an independent restless leg syndrome (RLS) is found as the cause of the symptoms, the physician will align the therapy accordingly.

At the same time, it is also important to make a drug which is possibly responsible for the complaints as such and to adjust the treatment if possible. Only the doctor can make this medication change. This can be relevant, for example, in an RLS-like complaint, but also, for example, in a bladder disorder.

For patients, it is worthwhile not to take a neuropathy lightly. The longer a targeted therapy is postponed, the more likely the pain becomes chronic.

Often it takes time to find out which drugs are effective in the individual case. In the case of neuropathy, some remedies which also help against depression or epilepsy, as well as opiate pain relievers. The choice of the medication always depends on the individual characteristics and possible risk factors of the patient.

These include physiotherapy, cold-heat treatments or various electro-therapeutic procedures, including electric nerve stimulation (TENS) or high-tone therapy. In these patients, the patient is glued to the skin. These emit light current pulses with different frequencies, which inhibit the transmission of the pain sensations in the nerves or, as in the case of high-tone therapy, influence the metabolism of the cells and are thereby pain-relieving. However, these methods are not proven to be effective.

Since the psyche also plays a role in coping with pain, those affected can benefit from a psychotherapy or pain management training to alleviate the discomfort. Even horror also impact on our health.

6. What patients can do yourself

There is no absolute protection from a diabetic nerve damage. However, people with diabetes can do something to protect themselves. The best way to do this is to consult the doctor.

Look for good blood glucose and blood pressure. The therapy goals are discussed with the doctor
If you are overweight, take off
Do not smoke
Do not drink or drink very little alcohol    
Go to the prevention department and have yourself examined at least once a year by the doctor for signs of nerve damage
Check your feet daily, even if there is already a nerve damage.

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