By Joseph Kandel, M.D.
As this is national Diabetes month, I want to address a very common problem that patients with Diabetes face; Diabetic Neuropathy.
Diabetic Neuropathy is damage that occurs to nerves, usually as a result of high levels of glucose (sugar) over a prolonged period of time. It can affect multiple body parts, and is the most common complication of diabetes.
There are four types of diabetic neuropathy, and the symptoms that a patient will experience depends on which type of nerve becomes damaged.
1. Diabetic Peripheral Neuropathy: this refers to the small nerve twigs of the body, usually affecting the legs and the feet. Symptoms include pain, numbness, burning, and tingling in the lower extremities.
2. Diabetic Proximal Neuropathy: this refers to damage of the nerves of the hips, thighs, or buttocks. This can affect a patient’s ability to rise from a seated position, stand, and even walk.
3. Diabetic Autonomic Neuropathy: this affects the nerves of the autonomic (often thought of as the automatic) nervous system. This includes nerves of the gastrointestinal tract (stomach and bowel), urinary tract (kidney and bladder), genital system (penis or vagina), and vascular system (heart and blood vessels). These problems can include inability to control the bladder, stomach bloating and constipation, erectile dysfunction in men or vaginal dryness in women, changes in sweating, loss of the ability to regulate blood pressure and pulse (especially on standing after sitting for a while), poor body temperature regulation, and many more.
4. Diabetic Focal Neuropathy: this involves any one nerve anywhere in the body. Depending on where the affected nerve is, this could include problems with vision and focus, pain in the low back, shin, foot, pelvis, chest or abdomen. If the nerve gets compressed, it can lead to painful symptoms. One very common type of problem in diabetics is Carpal Tunnel Syndrome (pinching of the nerve at the wrist).
How Does this occur?
This occurs when the nerves are exposed to high blood sugar levels over a prolonged period of time. This seems to impair the ability of the nerves to send messages. It also seems to weaken the walls of the blood vessels which supply nutrients and oxygen to the nerves.
But there are other ways that the nerves can be injured; when your body has an immune reaction and the immune system attacks the nerves, thinking they are a foreign material. Genetics may play a role, making some people suffer nerve damage more easily. And smoking, alcohol use and caffeine may also play a role in accelerating nerve damage.
How do I go about getting this checked out?
First of all, you should see your family physician for a general medical check up if you think you have any of these problems. They will want to know about all of your symptoms, how long they have been occurring, if there is any worsening, what your diet and lifestyle are like, and any medicines/ supplements you are taking. If it is determined that you are experiencing nerve problems from diabetes, your physician will refer you to a neurologist, a specialist trained to diagnose and treat conditions of the nerves.
What will a Neurologist do to diagnose
After a history and physical exam, including an evaluation of your cognition, cranial nerves (nerves that affect the face, eyes, ears, mouth and tongue) muscle testing, coordination, reflexes, sensation (to touch, temperature, position and vibration) and assessment of your feet, most likely diagnostic testing will be ordered.
What are the neurologic tests to diagnose diabetic neurologic problems?
Nerve Conduction Tests (NCV): Usually performed by a certified technician supervised by a neurologist. This test determines how fast the nerves conduct electricity in the arms, hands, legs, and feet. This test can diagnose carpal tunnel syndrome.
Electromyography (EMG): Usually performed with the NCV, this explains how the nerves are supplying the muscles and how the muscles are working.
Autonomic testing: This will apply if there are symptoms of autonomic neuropathy; checking blood pressure and pulse sitting and standing, checking the ability to sweat are just some of the assessments that are done.
OK, assuming I have neuropathy. What’s next? How do I treat it?
There is no cure, BUT, you can slow the progression and minimize the symptoms and alleviate the pain. In general, exercise, weight loss, proper diet, limiting alcohol and tobacco are all essential. But there is more that can be done.
Pain Relief treatments:
Anti-seizure medications: Lyrica (approved for diabetic neuropathy), Neurontin, Tegretol; these medications may provide relief but often have side effects (dizziness, sedation, swelling) as well.
Antidepressants: Cymbalta (approved for diabetic neuropathy), Elavil, Pamelor, Tofranil are often used; side effects can include constipation, dry mouth, weight gain, sweating, dizziness.
Alternative treatments: topical creams, acupuncture, massage may help.
For more information about diabetic neuropathy and other neurologic conditions, contact: Neurology Office, Joseph Kandel, M.D. and Associates at 239-231-1414 or 239-231-1415 or check out our web page at www.NeurologyOffice.com.
Our goal is to provide concierge level care without the concierge price.
To see the expert therapy team at Neurology Office, call to make an appointment with Dr. Kandel 239-231-1414 (Naples) or 239-231-1415 (Ft. Myers) or check out the web site: www.NeurologyOffice.com