Diabetic neuropathy

Q	What is diabetic neuropathy and how does it occur?
A	Diabetic Neuropathy is a condition that damages the nerves in the body. The exact mechanism is not known. Research is still on but there are a few theories going around. High blood sugar levels affects the way nerves use glucose, leading to an accumulation of a sugar called sorbitol and depletion of a substance called myoinositol within the nerves. High blood sugar levels affect the amount of Nitric Oxide in the blood. Nitric Oxide helps to dilate the small blood vessels carrying oxygen to the nerves. Low levels of Nitric Oxide lead to constriction of blood vessels supplying to the nerve, contributing to nerve damage.	Top
Q	What are the symptoms of Diabetic Neuropathy?
A	The symptoms vary depending on the type of neuropathy and whether it is peripheral (affecting the limbs), autonomous (affecting the internal organs) neuropathy, or focal or mono neuropathy	Top
Q	What are the symptoms in peripheral neuropathy?
A	In peripheral (affecting the limbs) neuropathy, the symptoms usually are -numbness or inability to feel touch, pressure, vibration, pain and temperature changes. These present as tingling, burning, or prickling sensation, sharp pains or cramps, extreme sensitivity to touch, even light touch, loss of balance and coordination particularly in the dark.	Top
Q	What are the symptoms in autonomous neuropathy?
A	In autonomous (affecting the internal organ) neuropathy, the symptoms are nausea, vomiting, feeling of bloating and lack of appetite, because of delay in stomach emptying due to the damage to the nerves supplying the stomach. Difficulty in swallowing, and diarrhoea or constipation occur when the nerves to oesophagus (food pipe) or to the bowels are affected. Urinary infection and incontinence due to retention of excess urine happens when the nerves to the bladder are damaged and affect the emptying of the bladder completely. Impotency (loss of sexual response) in men and women may occur due to nerve and circulatory problems to the sexual organs. A drastic fall in blood pressure on standing and sitting suddenly as well as silent heart attacks (as the perception of pain is affected) are other serious manifestations of autonomic neuropathy. Profuse sweating due to the inability of the body to control temperature as the nerves to the sweat gland may get affected, as well as hypoglycemia unawareness also occurs due to neuropathy. The body's normal response to low blood sugar or hypoglycemia is impaired, making it difficult for the patient to recognize the symptoms.	Top
Q	What are the symptoms of focal or mono neuropathy?
A	Focal or mono neuropathy affects one nerve or group of nerves. The symptoms appear suddenly and affect specific nerves, most often in the body, leg, or head area. Pain in the front of the thigh; in the lower back or pelvis; or in the chest, stomach, or flanks may occur. Chest or abdominal pain may sometimes be mistaken for angina, heart attack, or appendicitis. Aching behind an eye, inability to focus the eye or double vision occurs due to damage to nerves supplying the eye muscles. Paralysis on one side of the face and problems with hearing or a ringing or buzzing sound in the ear are other manifestations.	Top
Q	What tests are done to check for neuropathy?
A	Various simple physical examinations and tests are done to check for neuropathy. Touch and pain sensation is tested using a monofilament. A thin nylon filament is applied on different parts of the feet to check touch and pain sensation. Applying a vibrating tuning fork to bony prominences tests ability to sense vibrations. Ability to detect temperature changes by checking for warm and cold sensation. Electromyography (EMG) is used to check the response of muscles to electrical impulses transmitted by nearby nerves. A slower or weaker response suggests damage to the nerve or muscle. Nerve conduction studies check the flow of electrical current through a nerve. Impulses that seem slower or weaker than usual indicate a possible damage to the nerve. Changes in blood pressure response on standing; changes in heart rate when hands are dipped in cold and warm water; and ultrasound examination to see the functioning of the bladder and other parts of the urinary tract are the tests done to check for autonomic nerve damage.	Top
Q	What treatment is available for Diabetic Neuropathy?
A	The aim of the treatment is to relieve discomfort and reduce pain. Appropriate medication to help relieve pain like the usual painkillers, may not work very well. Other medications such as imipramine, amitryptaline, which are used as anti depressants, are more efficient in such cases. To reverse or prevent further nerve damage and control the pain or loss of sensation, it is important to bring the blood sugar levels under control. To reduce problems related to foot, special care of the feet must be taken by following the rules of foot care. To reduce symptoms if any of indigestion, such as bloating, nausea and vomiting small frequent meals, with low intake of fat and fibre must be used. In severe cases medication may be prescribed. To reduce diarrhoea suitable medication for diarrhoea is prescribed. To reduce problems affecting the urinary tract drink more fluids, and pass urine regularly every 3-4 hours even if there is no sensation of bladder fullness. Urinary infections must be treated quickly. To reduce dizziness and weakness: sitting or standing slowly, raising the head of the bed, wearing elastic stockings, and some medications are given by the doctors. To reduce sexual problems; counselling to help relieve stress, medication to help improve impotence in men, medication to reduce vaginal and urinary tract infections in women, and sometimes surgery for men is advised. To reduce muscle weakness; physiotherapy and physical exercise may be advised, insulin treatment is also reported to improve muscle weakness.	Top
Q	Can kidney damage due to diabetes (diabetic nephropathy) be prevented or stopped from becoming worse?
A	Nephropathy can be prevented or its advance halted by tight control of blood sugar, use of low-protein diet and control of blood pressure. A class of blood pressure lowering drugs called Angiotensin converting enzyme inhibitors (ACE-inhibitors) have been shown to be of benefit in slowing the progression of diabetic nephropathy even if there is no high blood pressure.	Top
Q	What problems do persons with diabetes face during surgery?
A	Surgery is a stressful condition and is accompanied by damage to the tissues. This worsens the diabetic state. Further, poor diabetes control prior to, during and after surgery delays wound healing as well as increases the risk of infection. Persons with diabetes have an increased risk of blood clotting which is worsened with prolonged bed rest post surgery.	Top