Neuropathy

Nerve Damage and Diabetes

Nerves send messages to and from your brain about pain, temperature, and touch. They tell your muscles when and how to move. They also control body systems that digest food and pass urine. About half of all people with diabetes have some form of nerve damage. It is more common in those who have had the disease for a number of years.Nerve damage from diabetes is called diabetic neuropathy. It can lead to many kinds of problems.


If you keep your blood glucose levels on target, you may help prevent or delay nerve damage. There are treatments that can help as well.


The two common types are:


Peripheral Neuropathy


This can cause tingling, pain, numbness and weakness in your feet and hands.


SYMPTOMS

This is the most common form of nerve damage. It can affect your hands, arms, feet, and legs. Look at the list below. Place a check mark next to any symptom you have and bring this list to your next office visit.


Tingling


    My feet tingle.
     I feel “pins and needles” in my feet.

Pain or increased sensitivity


    I have burning, stabbing or shooting pains in my feet.
     My feet are very sensitive to touch. For example, sometimes it hurts to have the bed covers touch my feet.
    Sometimes I feel like I have socks or gloves on when I don’t.
     My feet hurt at night.
     My feet and hands get very cold or very hot.

Numbness or weakness


    My feet are numb and feel dead.
     I don’t feel pain in my feet, even when I have blisters or injuries.
    I can’t feel my feet when I’m walking.
     The muscles in my feet and legs are weak.
     I’m unsteady when I stand or walk.
     I have trouble feeling heat or cold in my feet or hands.

Other


    It seems like the muscles and bones in my feet have changed shape
    I have open sores (or ulcers) on my feet and legs. These sores heal very slowly.

DIAGNOSIS

Foot exams. Your health care provider should look at your feet at each office visit to check for injuries, sores, blisters, or other problems. As a reminder, take off your shoes and socks when you’re in the exam room.


Have a complete foot exam once a year. If you already have foot problems, have your feet checked more often. A complete foot exam includes a check of the skin on your feet, your foot muscles and bones, and your blood flow. Your provider will also check for numbness in your feet by touching your foot with a monofilament. It looks like a stiff piece of nylon fishing line or a bristle in a hairbrush.


Other ways to check your nerves include using a tuning fork. It may be touched to your foot to see if you can feel it moving.



At Fusion Health Care Biothesiometer Testing is Done to Check for Neuropathy.


Nerve conduction studies and electromyography (EMG). If the doctor thinks you might have nerve damage, you may have tests that look at how well the nerves in your arms and legs are working. Nerve conduction studies check the speed with which nerves send messages. An EMG checks how your nerves and muscles work together.


TREATMENT

To treat nerve damage, you will need to keep your blood glucose levels in your target range, manage your pain, and protect your feet. Many people get depressed when they have nerve damage and may need medication for depression as well as counseling.

Medications

Medications to relieve pain and reduce burning, numbness, and tingling are available. Some of these are known for their use in other conditions but they still seem to help those with nerve damage. In addition to over-the-counter pain relievers there are other medications your doctor may prescribe for painful peripheral neuropathy.


Other treatments for pain

There are a number of other ways to help with the pain.



    Capsaicin (cap-SAY-sin) cream made from hot peppers can be rubbed on the skin
    A TENS unit blocks pain signals
    Relaxation training, hypnosis, or biofeedback
    Acupuncture


Autonomic Neuropathy


This type can lead to:


• digestive problems - feeling full, nausea, vomiting, diarrhea, or constipation


• problems with how well your bladder works


• problems having sex


• dizziness or faintness


• increased or decreased sweating


• loss of the typical warning signs of a heart attack


• loss of the warning signs of low blood glucose


• changes in how your eyes react to light and dark


People with diabetes can also have what is called focal neuropathy. This kind of nerve damage causes sudden weakness or pain. It can lead to double vision and a paralysis on one side of the face called Bell’s palsy. It can also cause pain in the front of the thigh or other parts of the body.


People with diabetes also are at risk for compressed nerves. Something in the body presses against a nerve preventing it from sending a signal. Carpal tunnel syndrome is a common cause of numbness and tingling in the fingers. It can lead to muscle pain and weakness as well.


Nerve damage can be hard to diagnose because its symptoms can be caused by other conditions. Symptoms can be very mild. Knowing the symptoms to look for and reporting them to your health care team can help. Make a list of your symptoms. Your doctor will give you an exam and a number of tests to check for nerve damage.


Some physical activities are not safe for people with neuropathy. Talk with a diabetes clinical exercise expert who can guide you.

Keep your blood glucose levels in your target range.Meal planning, physical activity, and medications, if needed, can help you reach your target range. The general targets recommended by the American Diabetes Association are listed below. Talk with your health care team about whether these targets are right for you.


Targets:

When I wake up and before meals: 80 to 130 mg/dl


2 hours after starting a meal: below 180 mg/dl


• Report signs of nerve damage to your doctor.
• If you have problems, get treatment right away.

Early treatment can help prevent more problems later on. For example, if you take care of a foot infection early, it can help prevent amputation.


• Take good care of your feet.

Check your feet every day. If you no longer can feel pain in your feet, you might not notice a foot injury. Look for sores, cuts, or breaks in the skin. Also check for corns, calluses, blisters, red areas, swelling, ingrown toenails, and toenail infections. If it’s hard for you to see or reach your feet, use a mirror or get help from a family member or foot doctor.


• Protect your feet.

If your feet are dry, use a lotion on your skin but not between your toes. Wear shoes and socks that fit well and wear them all the time. Use warm water to wash your feet and dry them carefully afterward.


• Get special shoes if needed.

If you have foot problems, ask your health care team about special shoes.


• Be careful when exercising.

Some physical activities are not safe for people with neuropathy. Talk with a diabetes clinical exercise expert who can guide you.