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Diabetic Neuropathy and Diabetic Foot Care (Cause, Risk Factors, Prevention, and Control)
I once had a difficult diabetic patient who would not stop smoking and taking alcohol even when it was so apparent that it would worsen his condition. True to my words, after he refused to desert the consumption of alcohol and cigarette smoking, he developed this ailment. This is what I had told the patient a month before he developed neuropathy:
But what is diabetic neuropathy?
Neuropathy definition: It is a type of nerve damage that you can get if you have diabetes. It is important to note that high blood sugar slowly eats away your body cells, especially the nerve cells in your body resulting to extreme pain or numbness. Diabetic neuropathy often harms the nerves in your feet and legs and you can experience either numbness or extreme neuropathy pain.
It can also affect the heart, digestive system, blood vessels, and urinary tract depending on the nerves that it attacks. Diabetic neuropathy is common and serious problem and it is necessary for people with diabetes to prevent it or slow its progress if you’re already experiencing it. The best way to do this is to ensure you have a healthy lifestyle and controlling your blood sugar.
Neuropathy Symptoms and Types of Diabetic Neuropathy
There are 4 major types of diabetic neuropathy. It is possible for a person to have more than one kind of neuropathy. The symptoms displayed are dependent on the type of diabetic that you have and the nerves affected. Normally, the symptoms grow steadily and it is possible not to notice anything wrong until there is considerable nerve damage.
This is the most common category of diabetic neuropathy. First, the peripheral neuropathy affects the legs and feet, followed by the arms and hands. The symptoms of this ailment are usually worse at night and they may comprise the following:
- Numbness (lessened ability to feel pain or change in temperature)
- Serious foot predicaments such as infections, ulcers, and joint and bone pain
- Burning feeling or a tickly sensation
- Sharp cramps or pain
- Sensitivity to touch increases (Some people can experience pain even on the weight of a bed sheet)
- Balance and coordination loss
- Weakness in the muscles
- Reflex loss, particularly in the ankle
2. Autonomic Neuropathy
The autonomic neuropathy disease affects the autonomic nervous system that controls your eyes, heart, sex organs, intestines, and stomach. After diabetes affects the nervous systems in this area, it probably results to:
- Constipation/uncontrolled diarrhea
- Difficulty in swallowing
- Decrease or increase in swallowing
- Gastroparesis (slow stomach emptying), causing vomiting , nausea, and appetite loss
- Hypoglycemia unawareness (lack of awareness that your blood sugar levels are low)
- Bladder hiccups, entails urinary tract infections
- Alteration in the way the eyes change from light to dark
- Surge heart rate at rest
- Decrease and increase in sweating
- Hiccups controlling the body temperature
- Erectile dysfunction
- Decrease in blood pressure after standing and sitting that may result you to faint
- Lessen sexual response
- Vaginal dryness
3. Radiculoplexus Neuropathy/ Diabetic Amyotrophy
The neuropathy affects the nerves in the hips, thighs, legs, and buttocks. The ailment is common with type 2 diabetes individuals and old adults. It is also referred to as proximal neuropathy and femoral neuropathy. The signs may be felt in one side of the body and may spread on the other side as the disease progresses. Most people with this disease improve partially over time, though the signs and symptoms can worsen before you become better. The symptoms may include:
- Weight loss
- Harsh pain in the thigh, buttock, or hip that can occur once or more times in a day
- Abdominal swelling in case the abdomen is affected
- Difficulty while rising from a sitting spot
- Weak and shrinking thigh muscles
It is also referred to as focal neuropathy. It occurs as a result of injuring a particular nerve in the face, leg, or middle of the body. The disease is common in older individuals. It strikes suddenly and can result in severe hurt and pain. Nonetheless, it does not result or cause any long-term hiccups. The symptoms of mononeuropathy generally go away over a few weeks or months even without treatment. The symptoms depend on which nerve is involved and you may have pain in the:
- Foot or shin
- Pelvis or lower back
- Front of thigh
- Abdomen or chest
In case it affects the nerves in the face or eyes it results to:
- Difficulty focusing
- Pain behind one eye
- Double vision
- Bell’s palsy or paralysis on one side of the face
Usually, mononeuropathy happens when there is nerve compression. Carpal tunnel disorder is a common form of compression in individuals with diabetes. The ailment can result to tickling or numbness in your fingers and hand, except your little finger. This may cause your hand to feel weak and you may drop things.
What causes diabetic neuropathy?
The major cause of diabetic neuropathy is uncontrolled high blood sugar. The uncontrolled high blood glucose injures nerves and obstructs their capability to send signals causing diabetic neuropathy. Also, the unrestrained high blood sugar weakens the walls of capillaries that supply the nerves with nutrients and oxygen. Nonetheless, other factors can also result in nerve damage, including;
Alcohol abuse and Smoking – I have dealt with addicts of both alcohol and cigarette who finds it hard to abandon their addiction and it is a very painful experience as a doctor (I don’t want to talk about that now). Alcohol and drug abuse will not only damage the blood vessels and nerves but will significantly surge the risk of infection.
Genetic Factors – There are distinct genetic factors that can makes some individuals likely to get their nerve damaged.
Nerve Inflammation – An autoimmune reaction can result to inflammation in the nerves as they mistake the nerves as foreign objects and can attack them.
What are the Risk Factors of getting Diabetic Neuropathy?
Any person who has diabetes can easily develop neuropathy but the following risk factors can make you more likely to get your nerve damaged.
- Poor control of your blood sugar – If you have hysterical blood sugar puts you at a risk of having diabetes complication.
- Diabetes history – The longer you have diabetes, the higher your risk of diabetic neuropathy, particularly if you don’t control your blood sugar.
- Kidney Ailment – Diabetes can damage your kidneys. When the kidney is damaged, it sends poison/toxins into the blood, which can cause nerve damage.
- Overweight – If you have a body mass index (BMI) is higher than 24 may surge your risk of diabetic neuropathy.
- Smoking – Smoking hardens and narrows your arteries, lessening the flow of blood to your feet and legs. Smoking makes it harder for wounds to heal as it damages the peripheral nerves.
Serious Complications: Dangers of having Diabetic Neuropathy
Diabetic neuropathy can result in a number of severe problems, including:
a. Loss of leg, foot, or toe
If your nerve is damaged, it can make you lose the feeling in your legs and feet. The foot sores and cuts can be as a result of stern infections or develop into ulcers. The minor sores in your feet that don’t heal can result
The damage in your nerve can result to a condition referred to as Charcot joint that causes your joint to deteriorate. It usually happens in the small joints in your feet. The symptoms entail joint swelling and loss of sensation, joint deformity, and instability. If you get timely treatment, it can assist you to heal and stop further damage in your joint.
c. Urinary incontinence and Urinary Tract Infections
The moment the nerves that control your bladder get damaged, you may not be capable of fully emptying your bladder. The bacteria can build up in the kidney and bladder, resulting to urinary tract infections. Also, the nerve damage can affect the capacity to sense when you need to urinate or to manage the muscles that discharge urine causing leakage (incontinence).
d. Hypoglycemia unawareness
If your blood sugar is low say below 70 mg/dL, it will usually result
e. Sharp drops in the blood pressure
There can be a
f. Digestive Challenges
In case your nerve damage occurs in the digestive tract, you can have diarrhea or constipation. The diabetic-related nerve injury can cause gastroparesis or a condition where the stomach doesn’t empty at all or take too slow to empty. The ailment can hinder with digestion and harshly affect the blood sugar levels and nutrition. The symptoms include bloating, nausea, and vomiting.
g. Sexual Dysfunction
Autonomic neuropathy usually damages the nerves that distress the nerves that affect your sex organs. Women can have challenges with arousals and lubrication while men can practice erectile dysfunction
h. Decreased or increased sweating
The damage in the nerve can disrupt the way in which your sweat glands work and make it hard for your body to manage its temperature appropriately. Some individuals with autonomic neuropathy have extreme sweating, mostly while eating or at night. A person develops anhidrosis (too little or no sweating) which can result to a life-threatening condition.
Experiencing these Symptoms? It’s time to you see a doctor
- A cut or sore on your leg or foot that won’t heal and is infected
- Alteration in urination, digestion, or sexual function
- Burning, pain, tickling, or weakness in your feet or hands that impede with daily events or sleep
The signs do not necessary means that you have damaged nerves but they can mean another medical condition that necessitate medical care. It is necessary that you get early diagnosis and management of any health situation gives you the best way to control your diabetes and avert future challenges.
Prevention of Diabetic Neuropathy: Do the following simple prevention methods
The can prevent diabetic neuropathy or slow down its effects and its complications by taking good care of your legs and feet and keep control of your blood sugar.
a) Blood Sugar Management
Check at-home blood sugar screen/monitor to check your blood sugar and make certain it consistently stays within a target range. It is necessary to do this regularly to avoid any shift in blood sugar levels that can hasten nerve damage.
The American Diabetes Association proposes that individuals with diabetes have the A1C test at least twice or thrice a year. This blood test specifies your average blood sugar level for the past three or two months to check if you need proper management and change in medications.
Effective methods of controlling your blood sugar:
- Avoid taking food with excess sugar such as fruit juices, sodas, coffees and sweetened drinks, and processed snacks.
- Eat foods that are high in fiber as they assist to keep blood sugars at a stable state
- Consume food that contains healthy fats such as nuts and olive oil and selects those that gives lean proteins such as turkey and chicken
- Consume vegetables and plant protein foods such as beans regularly
- Exercise for 30 minutes for at least five times a week. The exercise should include weight training and aerobic events in your timetable.
- Take oral medications such as metformin or insulin as directed by your doctor or endocrinologist.
- Monitor your blood sugar in accordance with the recommendation by your doctor recording your levels. This can assist you to identify the unusual changes and pattern in your blood sugar that can be helpful in advancing your treatment.
- Buy a diabetic foot massager for easy circulation of blood in your legs
b. Have Good Care of your Foot
Diabetic neuropathy leads to foot challenges that include sores that don’t heal, ulcers, and amputation. There is a possibility that you can prevent these challenges by having a detailed foot examination at least once annually. Ensure that the doctor checks your feet at every office visit and ensure you take good care of your feet while at home.
This is what you can do to ensure you take care of the health of your feet:
- Check your feet daily – check your legs for cuts, blisters, bruises, redness, peeled or cracked skin, and swelling. You can ask a family member or friend to check on parts of your feet that are hard to examine or see.
- Ensure you maintain your feet clean and dry – It is necessary that you wash your feet daily with lukewarm water and mild soap. As you wash, avoid soaking your feet and overstaying in the water. Afterward, dry your feet and between the toes carefully using a soft towel. Moisturize/dampen the feet to avoid cracking and ensure you don’t apply lotion between your toes as this can encourage the growth of fungal.
- Wear clean and dry socks – There are recommended socks for people with diabetes that are made of either moisture-wicking fibers or cotton that don’t have thick seams or tight bands.
- Cut your toenails – Trim your toenails straight across and ensure you file the edges to ensure no prickly or sharp edges.
- Wear well-fitting cushioned shoes – It is vital that you wear slippers or shoes that protect your feet from harm or injury. It is important that your diabetic shoes fit well allowing your toes to move. This article can teach you the best methods of buying properly fitted shoes to avoid hiccups such as calluses and corns.
A small sore can swiftly turn into severe illness if they’re left untreated. Always, visit a doctor for treatment if you experience any problem to avoid more-serious situations.
Is neuropathy worse at night?
Yes, research confirms that people with peripheral neuropathy may require more pain pills late at night. If you have neuropathy, you can stop for a minute and try to remember the last time you had yourself a sound night rest. Has it been a day or a week? When was the last time you experienced a restful night sleep without feeling stabbing or burning pain that keeps you up.
In your inquest, you’ll find that the chronic nerve pain usually worsen or flare up at night, but why?
i) Fewer Distractions at Night
During the night hours, there are few or no phone calls, meetings, errands to run, or after-school events to run. When it’s time to sleep, it’s just you and your thoughts and this is when you become aware of the surroundings. At that time, you will notice that your body is hurting more in the feet or hands and this causes you to focus on the pain. Thus, the brain is concerned with the nerve pain and it refuses to shutoff and fall asleep.
Try to visualize something that you love such as your spouse, dream safari, or favorite food and avoid focusing on the pain that you’re feeling with an aim of falling asleep.
ii) Cooler Temperatures
People with diabetic neuropathy and who suffers from chronic nerve pain dread the cooler temperatures at night as the perception of pain usually shifts as the temperature drops. The reason for this is that your peripheral neuropathy signals your brain whether it’s hot or cold and this sends pain signal. The cool temperatures can make your heart to beat slowly resulting to the flow of blood moving slowly.
Additional blankets, warm cloth, and socks can be a quick fix for cooler temperatures.
iii) Stressful Nights
Physical and emotional stress on your body can result to extra pain. If you have work related stress or any other condition, it can have a negative effect on your body. Thus, you can find that when you want to sleep, your body will be trying to recover from the day’s stress and you can start experiencing pain.
Consider raking a 10-minute walk to relieve you from the emotional stress. Also, reduce or alternate your physical activities to ensure that your body is not strained.
What to do tonight to avoid the pain
It takes your effort and time to rethink on your perception of pain, but it’s worth every struggle. Try not to think about pain by taking a deep breath and try to visualize the wonderful things that nature can offer. If you can be able to shut off the brain and calm your body, you can enjoy a peaceful night’s rest.
Frequently Asked Questions (F.A.Qs)
Can diabetic neuropathy be reversed?
“Is diabetic neuropathy reversible?’ No
The nerve damage that results to Diabetic neuropathy is irreversible but there are many ways to prevent further harm of the nerves.
Does diabetic neuropathy ever go away?
Can diabetic neuropathy cure? A lot of people want to know if diabetic neuropathy can be healed. No, it has no cure and cannot be healed but you can control it to avoid further damage to the nerves. The objectives of treating the disorder include relieving pain, slowing the growth of the ailment, and managing complications and restoring function.
What is the best medication for diabetic neuropathy?
There are various medications that work and help to reduce the pain such as:
- Capsaicin cream can be applied to the skin to lessen pain sensation in some individuals. The side effect may entail skin irritation and a burning sensation.
- Alpha-lipoic acid is a powerful antioxidant that is found in some food and can assist to relieve nerve pain signs in some individuals.
- Acupuncture offers an immediate relief and they do not have notable side effects. It requires several sessions and assists you to relieve neuropathy pain.
- Transcutaneous Electric Nerve Stimulation is a therapy that can be prescribed by your doctor, which can assist to prevent the pain signals from reaching to your brain. It sends some minute electrical impulses to particular nerve pathways through tiny electrodes that are placed on your skin. It may be painless and safe, but it doesn’t work for all type of pains or everyone.