KNOW ABOUT DIABETIC NEUROPATHY

The commonly encountered symptoms and signs are:

• Glove-stocking distribution of numbness
• Tingling sensation
• Pain, night time pain. The pain can feel like burning, pricking sensation, achy or dull. Pins and needles sensation is common.
• Loss of sense of position and vibration sensation perception
• Muscle weakness and stiffness
• Non healing foot ulcers, Charcot joints, hammertoes

Types of Diabetic Neuropathy

Diabetic neuropathy is broadly categorized as:

Generalised neuropathy - Can be sensory fibres or motor fibres or both sensorimotor fibres are involved

Focal or multifocal neuropathy, Eg:

• Cranial neuropathy like double vision, facial weakness
• Entrapment neuropathies such as carpel tunnel syndrome
• Lumbosacral radiculoplexus neuropathy eg: pain in the thighs

Diabetic neuropathy can also exclusively affect the very small nerve fibres and can cause small fibre neuropathy. Symptoms include:

• Burning pain mainly in the feet and hands
• Sometimes abnormal skin sensations such as tingling or itchiness.
• Pain is more severe during nights
• Increased sensitivity to pain- Pain to non-painful stimuli (Hypoesthesia)
• Reduced ability to differentiate hot from cold

Another rare form of diabetic neuropathy is Autonomic neuropathy causing symptoms

• Fainting /dizziness due to fall in blood pressure related to posture eg:Orthostatic hypotension and palpitations.
• GI symptoms such as bloating, diarrhea, nausea, malabsorption, constipation
• Urinary symptoms such as increase in urge, incontinence, retention, infections
• Heat intolerance, increased sweating or loss of sweating

Nature of damage in Diabetic Neuropathy

• Microangiopathy or small blood vessel damage to the nerves
• Toxic end products of abnormal glucose metabolism in diabetes eg: free oxygen radicles, Sorbitol and nitric oxide.

Diagnosis of Diabetic Neuropathy

A good clinical examination followed by some laboratory tests such as

• Blood test
• Check urine for protein
• Nerve conduction studies
• Tests for blood flow in the limbs .eg: doppler studies
• Imaging such as nerve ultrasound and MRI

Management of Diabetic Neuropathy

Good Glycemic control

• Tight and stable glycemic control is probably the most important for slowing the progression of neuropathy
• The Diabetes Control and Complications Trial (DCCT) demonstrated that tight blood sugar control in patients with type1 diabetes decreased the risk of neuropathy by 60% in 5 years.

Physical Measures such as Walking, Foot care, customised foot ware, physiotherapy, TENS/Ultrasound therapy

Drugs that help with symptomatic relief include Pregabalin, Gabapentin, Carbamazepine and Sodium Valporate, opoids for pain management, Tricyclic anti-depressants, SSRIs, Duloxetine

Vitamin supplementation such as Zinc sulfide showed improvement in glycemic control and B vitamins to reduce the symptoms of neuropathy

Surgical treatment is useful for entrapment neuropathies such as carpal tunnel syndrome. In extreme cases of foot ulcers, amputation is required to prevent spread of infection.

Measures such as compression stockings, fluid intake help prevent fall in blood pressure and also special drugs to help in the management of autonomic neuropathy causing gastric, urinary symptoms are used in clinical practice.

Diabetic neuropathy is thus a common complication of diabetes and needs diagnosis and treatment as early as possible to prevent complications. Occasionally patients get diagnosed with Diabetes Mellitus when they present with signs and symptoms of neuropathy. Awareness to seek medical help at the appropriate time is the key to successful management of Diabetic neuropathy.