Diabetic Neuropathy: Challenges and Management

Diabetic Neuropathy Treatment in Bangalore

Overview 

Diabetic neuropathy is one of the major complications in patients with uncontrolled diabetes, affecting about 50% of the total cases. The condition is characterised by nerve damage in different parts of the body, such as the legs, urinary tract, digestive tract, etc., and the symptoms tend to vary from person to person depending on the affected area. 

India is currently the Diabetes Capital of the world with 1 in every 5 patients being from our country. This burden is further expected to rise steeply in the future. Evidence suggests diabetic neuropathy to be common in the Indian population, the most common being peripheral neuropathy (the nerves of the extremities are affected), reported being about 34.5% - 42% in different studies. 

Diabetic neuropathy is a leading cause of lower limb amputation globally. A lower limb is lost every 20 seconds due to diabetic neuropathy. In India, approximately 45,000 lower limbs are amputated every year due to diabetes, and the majority of these are preventable. 

Types and Clinical Features 

Diabetic neuropathy is categorised into 4 main types, namely:

  1. Peripheral Neuropathy or Distal Symmetric Peripheral Neuropathy: One of the most common types of diabetic neuropathy that majorly affects the legs and feet, hands, and arms. 

Signs and symptoms include numbness, burning sensation, and sensitivity to touch which often worsen at night. The foot is prone to infections, ulcers, bone and joint pain.

  1. Autonomic Neuropathy: Diabetes can affect the autonomic nervous system that controls the stomach, bladder, heart, eyes, etc. 

Some common signs and symptoms include bowel issues, bladder problems, slow gastric emptying resulting in nausea and vomiting, low blood sugar levels (hypoglycaemia), inability to adjust eyes from light to darkness, etc.

  1. Proximal Neuropathy or Diabetic Polyradiculopathy or Diabetic Amyotrophy: Diabetes can affect the nerves in the hips, thighs, buttocks, or legs. 

Some common signs and symptoms include pain in the hip, thigh or buttock, thigh muscles gradually becoming weak and shrinking, trouble to stand from a sitting position, stomach ache, etc. 

  1. Mononeuropathy or Focal Neuropathy: Mostly affects a single nerve in the eyes, wrist, thigh, or foot and may lead to eye pain, double vision, weakness and numbness in the hand or fingers (except little finger), etc. 

Complications 

Diabetic neuropathy can cause serious complications such as:

  • Inability to register signs and symptoms of hypoglycaemia or low blood glucose levels. 

  • Nerve damage can make your feet numb causing cuts and infections to go unnoticed. This can result in loss of a toe, foot, or leg.

  • Urinary tract infections

  • Damaged nerves that control blood flow can result in a sudden drop in blood pressure leading to dizziness and fainting.

  • If the nerves that control digestion are damaged it can lead to digestive problems like delayed gastric emptying, nausea, vomiting, constipation, or diarrhoea. 

  • Sexual dysfunction such as erectile dysfunction in men and trouble with lubrication and arousal in women.

  • Changes in sweating and difficulty in maintaining normal body temperature. 

Risk Factors 

Factors that can make you more likely to get diabetic neuropathy includes:

  • Poorly controlled blood sugar levels

  • Diabetes for many years

  • Kidney disease

  • Being overweight or obese

  • Smoking 

Prevention

Annual screening and health check-ups for every patient are important to prevent diabetic neuropathy. Diabetic neuropathy and its associated complications can be delayed or prevented by:

  • Physical examination. Get a complete physical examination done that includes assessing muscle strength, tendon reflexes and sensitivity to touch and vibration. 

    • Filament test. Sensitivity to touch is evaluated by rubbing your skin with a soft nylon fibre brush. 

    • Sensory testing. This is a non-invasive test used to assess sensitivity to vibration and changes in temperature.

    • Nerve conduction testing. The electrical activity of the nerves in your arms and legs are measured.

    • Muscle response testing or electromyography. Nerve conduction studies are used to measure electrical activity produced in your muscles.

    • Autonomic testing. Determines how your body responds to blood pressure changes 

  • Blood Glucose Control. Patients are advised to get their HbA1C (glycated haemoglobin) checked at least twice a year. This test records the average blood glucose levels for the past three months and should be less than 7%. This allows you to make appropriate changes in the medication or diet if the values are >7%.

  • Foot care. Proper foot care can prevent ulcers, infection and even amputations. 

    • Check your feet for cuts, blisters, bruises, cracked and peeling skin, bleeding, redness, swelling, etc., every day.

    • Wash your feet regularly. Make sure to dry your feet thoroughly especially between the toes.

    • Moisturize your feet to prevent cracking. Avoid lotion between your toes as it might cause fungal growth.

    • Trim your toenails carefully and avoid sharp edges.

    • Wear clean and dry cotton socks. 

    • Wear well-fitted cushioned shoes to protect your feet.

Medical Management

  • Your doctor may prescribe you medicines to treat diabetes-related nerve pain 

  • You may require an appointment with specialists for managing complications involving the urinary system, digestive tract, sexual dysfunction, heart, etc.

Visit the Neurology Hospital in Bangalore for Diabetic Neuropathy Treatment in Old Airport Road, Bangalore.

 

Dr. Veena Vedartham

Associate Consultant - Neurology

Manipal Hospital, Old Airport Raod, Bangalore

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