Neuropathy Poses a Risk to Diabetics

Also referred to as peripheral neuropathy or peripheral neuritis, neuropathy occurs when illness, injury, inflammation, medication, or other factors disrupt the ability of nerves outside the spinal cord to relay messages between the brain and muscles, skin, nerves, joints, or internal organs.

Neuropathy can affect:

• Sensory nerves, which control sensation
• Motor nerves, which control movement
• Autonomic nerves, which control involuntary or semi-  involuntary body functions
• Any combination of these three main types of nerves

Researchers have identified more than 100 types of neuropathy. Symptoms, which may take days, weeks, or months to develop, depend on the type or types of nerves affected and on whether neuropathy affects a single nerve or group of nerves (mononeuropathy) or more than one nerve group (polyneuropathy).

Damage to sensory nerves can reduce or intensify sensation. This can prevent patients from realizing they’ve been injured or are experiencing pains warning of heart attack or other life-threatening emergency. Or, it can make even a gentle touch extremely painful. Nerves farthest from the brain and spinal cord are usually the first to malfunction. Pain and other symptoms often appear on both sides of the body, beginning in the feet and progressing toward the center of the body. Neuropathy that affects sensory nerves also causes nerve pain, burning, tingling, and numbness. Inability to determine joint position impairs coordination.

Cramping may indicate motor nerve damage, which reduces or destroys muscle control and can result in weakness and loss of muscle. Other symptoms of muscle involvement include:

• Paralysis
• Twitching
• Breathing or swallowing problems
• Falling
• Absence of fine motor skills needed for such tasks as tying shoes 

When autonomic nerves are damaged, diminished ability to sweat or otherwise regulate body temperature can cause heat intolerance. Vision may blur, and falling blood pressure can cause fainting or dizziness. Other symptoms include:

• Diarrhea
• Constipation
• Abdominal bloating
• Feeling full after eating very little
• Nausea or vomiting after meals
• Unintentional weight loss 
• Urinary hesitancy or incontinence
• A sense that the bladder doesn’t fully empty
• Impotence

Symptoms of acute neuropathies begin suddenly and worsen rapidly. Damaged nerves heal slowly. Initial symptoms of chronic neuropathies are subtle. These conditions progress slowly and may remain unchanged for months or years. Symptoms may abate before they recur. Chronic neuropathies may worsen over time, but are rarely fatal.

Injury is the most common cause of nerve damage. Broken or dislocated bones can press on nearby nerves. Slipped disks can pinch nerves emerging from the spinal cord. More severe trauma can crush, compress, stretch, or sever nerves. Causes include vitamin deficiencies, excessive alcohol use, medication, and exposure to toxic compounds or very cold temperatures. Some people inherit a tendency to develop neuropathy. This condition can also be a complication of systemic or metabolic disorders such as cancer or uremia and of infectious or inflammatory conditions such as HIV/AIDS, hepatitis, Lyme disease, lupus, or rheumatoid arthritis. High blood glucose levels characteristic of diabetes are a main cause of neuropathy. About 60–70% of people who have diabetes have mild to severe nervous system damage.

“Neuropathy poses a risk to a diabetic patient,” notes Luigi Meneghi, MD, director of the Diabetes Research Institute’s Kosow Diabetes Treatment Center at the University of Miami. “Loss of sensation might cause injury or infection to go undiscovered until the problem is well advanced. It’s important to detect significant loss of protective sensation and, when detected, to make sure the patient understands how to care for the feet to prevent problems.”