If you have neuropathy related problems, it can make your life painful. Do not loose faith. It will take 3 to 6 months to get rid of symptoms if managed properly.
Symptoms of neuropahty:
i. Unusual burning, tingling weakness or pain in your hands or feet
ii. Dizziness
iii. Markedly increased or decreased sweating
iv. Changes in your digestion, urination or sexual function
Diabetic neuropathy is a peripheral nerve disorder caused by diabetes or poor blood sugar control. The most common types of diabetic neuropathy result in problems with sensation in the feet. It can develop slowly after many years of diabetes or may occur early in the disease.
The symptoms are numbness, pain, or tingling in the feet or lower legs. The pain can be intense and require treatment to relieve the discomfort. The loss of sensation in the feet may also increase the possibility that foot injuries will go unnoticed and develop into ulcers or lesions that become infected. In some cases, diabetic neuropathy can be associated with difficulty walking and some weakness in the foot muscles.
There are other types of diabetic-related neuropathies that affect specific parts of the body. For example, diabetic amyotrophy causes pain, weakness and wasting of the thigh muscles, or cranial nerve infarcts that may result in double vision, a drooping eyelid, or dizziness. Diabetes can also affect the autonomic nerves that control blood pressure, the digestive tract, bladder function, and sexual organs. Problems with the autonomic nerves may cause lightheadedness, indigestion, diarrhea or constipation, difficulty with bladder control, and impotence.
There are four main types of diabetic neuropathy. You may have just one type or symptoms of several types. Most develop gradually, and you may not notice problems until considerable damage has occurred. For some people, symptoms of neuropathy develop before diabetes is ever diagnosed.
Causes of diabetic neuropathy
High blood sugar a factor
Prolonged exposure to high blood sugar (glucose) can damage delicate nerve fibers, but exactly why this happens isn’t completely clear. It’s likely that a combination of factors plays a role, including the complex interaction between nerves and blood vessels. High blood glucose interferes with the ability of the nerves to transmit signals. It also weakens the walls of the small blood vessels (capillaries) that supply the nerves with oxygen and nutrients.
Other factors
Other factors that may contribute to diabetic neuropathy include:
i. Protein glycation. This occurs when sugars in your body react with proteins, altering the nature of the proteins. Glycated proteins have been linkedto aging and to complications of diabetes, including diabetic neuropathy.
ii. Inflammation in the nerves caused by an autoimmune response. This occurs when your immune system mistakenly attacks part of your body as if it were a foreign organism.
iii. Genetic factors unrelated to diabetes that make some people more susceptible to nerve damage.
iv. Smoking and alcohol abuse, which damage both nerves and blood vessels and significantly
The signs and symptoms of diabetic neuropathy vary, depending on the type of neuropathy and which nerves are affected:
Symptoms of autonomic neuropathy
The autonomic nervous system controls your heart, bladder, lungs, stomach, intestines, sex organs and eyes. Diabetes can affect the nerves in any of these areas, causing:
i. Bladder problems, including frequent urinary tract infections or urinary incontinence
ii. Digestive problems, such as bloating, belching and abdominal pain
iii. Constipation, uncontrolled diarrhea or a combination of the two
iv. Slow stomach emptying (gastroparesis), leading to nausea, vomiting and loss of appetite
v. Erectile dysfunction, which affects more than half the men with diabetes who are age 60 or older
vi. Vaginal dryness and other sexual difficulties in women
vii. Increased or decreased sweating
viii. Inability of your body to adjust blood pressure and heart rate, leading to sharp drops in blood pressure after sitting or standing (orthostatic hypotension)
ix. Problems regulating your body temperature
x. Changes in the way your eyes adjust from light to dark
Autonomic neuropathy is most likely to occur in people who have had poorly-controlled diabetes for many years.
Tests and diagnosis
Diabetic neuropathy is usually diagnosed based on your symptoms, your medical history and a physical exam. During the exam, your doctor is likely to check your muscle strength and tone, tendon reflexes, and sensitivity to touch, temperature and vibration.
Filament test
Sensitivity to touch is often tested using a soft nylon monofilament. If you’re unable to feel the filament on your feet, it’s a sign that you’ve lost sensation in those nerves.
Other tests
In some cases, other tests may be needed, including:
i. Nerve conduction studies. This test measures how quickly the nerves in your arms and legs conduct electrical signals. It’s often used to diagnose carpal tunnel syndrome.
ii. Electromyography (EMG). Often performed along with nerve conduction studies, electromyography measures the electrical discharges produced in your muscles.
iii. Quantitative sensory testing. This noninvasive test is used to assess how your nerves respond to vibration and changes in temperature.
Diabetic neuropathy has no known cure. Treatment for diabetic neuropathy focuses on:
i. Slowing progression of the disease
ii. Relieving pain
iii. Managing complications
iv. Restoring function
Slowing disease progression
Consistently keeping blood sugar within a narrow target range can help delay the progression of peripheral neuropathy and may even cause an improvement in symptoms you already have. In some people, intense glucose control may reduce the overall risk of diabetic neuropathy by more than 60 percent.
For intense blood sugar control, your goals will likely be:
i. Blood sugar level before meals — 90 to 130 mg/dL (5 to 7 mmol/L)
ii. Blood sugar level two hours after meals — less than 180 mg/dL (10 mmol/L)
iii. Hemoglobin A1C, an indicator of your blood sugar control for the past few months — less than 7 percent
A1C is the amount of sugar that has bound to hemoglobin — the substance that carries oxygen inside red blood cells — in your blood. The higher your average blood sugar level for the past two or three months, the higher your A1C number will be. People who don’t have diabetes have an A1C between 4 percent and 6 percent.
To help slow nerve damage:
i. Follow your doctor’s recommendations for good foot care
ii. Keep your blood pressure under control
iii. Follow a healthy eating plan
iv. Get plenty of physical activity
v. Maintain a healthy weight
vi. Stop smoking
vii. Avoid alcohol entirely or, if drinking is allowed, have no more than one drink a day if you’re a woman and no more than two drinks a day if you’re a man.
Relieving pain
Providing effective pain relief is one of the most difficult parts of managing diabetic neuropathy. Several medications are used to relieve nerve pain, but they don’t work for everyone and most have side effects that must be weighed against the benefits they offer.
Among the medications that may be tried are the following:
i. Anti-seizure medications: Drugs such as gabapentin, pregabalin and carbamazepine were originally developed to treat seizure disorders (epilepsy), but they’re also prescribed for nerve pain. Side effects may include drowsiness and dizziness.
ii. Tricyclic antidepressants: Antidepressant medications, such as amitriptyline, nortriptyline , desipramine and imipramine may provide relief for mild to moderate symptoms by interfering with chemical processes in your brain that cause you to feel pain, but they also cause a number of side effects. Selective serotonin reuptake inhibitors (SSRIs), such as paroxetine and fluoxetine hydrochloride have fewer side effects but work less well for pain. Newer antidepressants called serotonin and norepinephrine reuptake inhibitors (SNRIs) are often a better choice, relieving pain with few side effects.
iii. Lidocaine patch: This patch contains the topical anesthetic lidocaine. You apply it to the area where your pain is most severe. It has almost no side effects, although it may cause a rash in some people.
iv. Capsaicin: This is the chemical that gives hot peppers their bite. When applied to the skin, capsaicin creams can reduce pain sensations in some people.
v. Other medications: Opioid analgesics, such as codeine or oxycodone may be used to relieve pain. But this class of medications may produce serious side effects, including addiction, that make long-term use of them undesirable.
Other types of therapy
Several drug-free therapies and techniques also may help with pain relief. Doctors frequently use them in conjunction with medications, but some may be effective on their own. They include:
i. Alpha-lipoic acid (ALA): One of the most interesting developments in pain research is the discovery that alpha-lipoic acid, a powerful antioxidant found in food, may be effective at relieving the symptoms of peripheral neuropathy. Studies used an intravenous form of ALA, which isn’t yet available, however, and researchers caution that it’s not known whether over-the-counter supplements have the same effect.
ii. Transcutaneous electrical nerve stimulation (TENS): Your doctor may prescribe this therapy, which can help prevent pain signals from reaching your brain. TENS delivers tiny electrical impulses to specific nerve pathways through small electrodes placed on your skin. Although safe and painless, TENS doesn’t work for everyone or for all types of pain.
iii. Biofeedback: This therapy uses a special machine to teach you how to control certain body responses that reduce pain. You then learn how to control these same responses yourself. Biofeedback techniques are often taught in medical centers and hospitals.
iv. Acupuncture: The National Institutes of Health has found that acupuncture can be an effective treatment for chronic pain, possibly including the pain of neuropathy. Keep in mind that you may not get immediate relief with acupuncture and will likely require more than one session.
v. Hypnosis: Many adults can be hypnotized by a trained professional, but for hypnosis to be most effective, you also have to be a willing and motivated participant. During hypnosis, you’ll typically receive suggestions intended to decrease your perception of pain.
vi. Relaxation techniques: Designed to help reduce the muscle tension that makes pain worse, relaxation techniques range from deep-breathing exercises to visualization (imagining yourself floating in a tropical ocean, for example), yoga and meditation. You might want to take classes in one or more of these techniques, or you can learn them yourself using books or tapes.
Managing complications
Specific treatments exist for many of the complications of neuropathy, including:
i. Urinary tract problems: Antispasmodic medications (anticholinergics), behavioral techniques such as timed urination, and devices such as pessaries — rings inserted into the vagina to prevent urine leakage — may be helpful in treating loss of bladder control. Often, a combination of therapies may be most effective.
ii. Digestive problems: Gastroparesis can usually be helped by eating smaller, more frequent meals, reducing fiber and fat in the diet, and, for many people, eating soups and pureed foods. Diarrhea, constipation and nausea may be helped with dietary changes and medications.
iii. Low blood pressure on standing (orthostatic hypertension): This is often helped with simple lifestyle measures, such as avoiding alcohol, drinking plenty of water and standing up slowly. Several medications, either alone or together, also may be used to treat orthostatic hypotension. For example, the drug fludrocortisone helps boost your blood volume, which in turn raises blood pressure.
iv. Sexual dysfunction: Sildenafil (Viagra), tadalafil and vardenafil can improve sexual function in some men, but these medications aren’t effective or safe for everyone. When medications don’t work, many men turn to vacuum devices, or, if these fail, to penile implants. Women may be helped with vaginal lubricants and estrogen creams.
Lifestyle choices
These measures also can help reduce your risk of diabetic neuropathy:
i. Keep your blood pressure under control. People with diabetes are about twice as likely to have high blood pressure as people who don’t have diabetes. Having both high blood pressure and diabetes greatly increases your risk of complications because both damage your blood vessels and reduce blood flow. Try to keep your blood pressure in the range your healthcare provider recommends, and be sure to have it checked at every office visit. Also consider checking it regularly at home.
ii. Make healthy food choices. Eat a balanced diet that includes a variety of healthy foods —especially fruits, vegetables and whole grains — and limit portion sizes to help achieve or maintain a healthy weight.
iii. Be active every day. In addition to helping you achieve a healthy weight, daily activity protects your heart and improves blood flow. It also plays a major role in keeping your blood sugar and blood pressure under control.
iv. Stop smoking. If you have diabetes and use tobacco in any form, you’re more than twice as likely as nonsmokers with diabetes to die of heart attack and stroke. And you’re more likely to develop circulation problems as well.
Prevent foot problems from diabetic neuropathy
Keep your feet healthy by following these tips:
i. Check your feet every day.You may need to use a mirror to to check the bottoms of your feet. Call your doctor at the very first sign of redness, swelling, infection, pain, numbness or tingling in any part of your foot.
ii. Check inside your shoes every day for things like gravel or a torn lining. These things could hurt your feet.
iii. Have your doctor look at your feet during every office visit (at least once a year) or whenever you notice anything that seems wrong.
iv. Choose the right shoes. The most common cause of foot sores is shoes that are new or don’t fit properly. Buy shoes that fit properly and have good arch support. Choose shoes made of soft leather. They should not fit tightly anywhere. To get the best fit, try on shoes at the end of the day when your feet are a little swollen. If you’ve had problems before with shoes that didn’t fit well, you may want to be fitted for a custom-molded shoe with plenty of room for your toes.
v. Break in new shoes slowly. Wear the shoes for 1 to 2 hours. Then check your feet for red spots. If you have red spots, do not wear the shoes again until the red spots are gone. Slowly break in new shoes by wearing them one hour longer each day every 3 days.
vi. Wear white socks and check when you take them off to see if there is any blood or fluid from a sore on them.
v. Wash your feet daily in lukewarm water. Dry them well, especially between the toes. Use a soft towel and blot gently; don’t rub. Keep the skin of your feet smooth by applying a cream or lanolin lotion, especially on your heels. If your feet sweat easily, keep them dry by dusting them with nonmedicated powder before putting on your socks, nylons and shoes.
vi. Avoid things that are bad for your feet. Do not walk barefoot. Do not wear stretch socks, nylon socks, socks with inside seams, or socks with an elastic band or garter at the top. Do not put hot water, electric blankets, or heating pads on your feet. Do not use hydrogen peroxide, iodine, or astringents (such as rubbing alcohol or witch hazel) on your feet.