DIABETIC NEUROPATHY

Diabetic Neuropathy

Diabetic neuropathy is a condition characterized by nerve damage caused by prolonged high blood sugar levels in individuals with diabetes. Over time, this excess glucose in the blood can injure nerves throughout the body, most commonly affecting the legs and feet. The symptoms can vary widely, ranging from numbness and tingling to severe pain and weakness. Additionally, diabetic neuropathy can lead to serious complications such as foot ulcers and even amputation if left untreated.

Presentation of Diabetic Neuropathy

Diabetic neuropathy can manifest in various ways depending on the type of nerve affected and the severity of the condition. The presentation may include:

Peripheral Neuropathy
This is the most common form of diabetic neuropathy and typically affects the nerves of the feet and legs before progressing to the hands and arms. Symptoms may include numbness, tingling, burning sensations, or sharp pains. Some individuals may experience heightened sensitivity to touch, while others may have decreased sensation, leading to difficulty detecting injuries or changes in temperature

Autonomic Neuropathy
This type of neuropathy affects the autonomic nerves that control involuntary bodily functions. Symptoms can involve multiple organ systems and may include:

• Gastrointestinal symptoms such as nausea, vomiting, bloating, diarrhea, or constipation.
• Cardiovascular symptoms like orthostatic hypotension (a drop in blood pressure upon standing), abnormal heart rate, or exercise intolerance.
• Genitourinary symptoms such as urinary retention, incontinence, or erectile dysfunction.

Proximal Neuropathy
Also known as diabetic amyotrophy or diabetic lumbosacral radiculoplexus neuropathy, this type of neuropathy affects the nerves in the thighs, hips, buttocks, and legs. It often presents with severe pain, weakness, and muscle wasting, typically on one side of the body.

Treatment of Painful Diabetic Neuropathy

In some circumstances, diabetic neuropathy can be painful. Treatment of Diabetic Neuropathy required:

• Optimization of sugar control - Sugar control can be managed through exercise, diet and medications. While optimizing sugar control will not reduce the pain from diabetic neuropathy, it will help with slowing the progression of the disease.
• Nerve Pain Medications - As the pain from diabetic neuropathy is arises from the injury of a nerve, usual painkillers such as paracetamol and NSAIDS are unlikely to be very useful. Instead, nerve pain medications are used to reduce nerve activity and hence pain perception.
• What happens when Nerve Pain Medications fail - When nerve pain medications fail, further options can include: Acupuncture, Intravenous Ketamine Infusions, Spinal Cord Stimulation and Biofeedback therapy.