Diabetic neuropathy is a disease of the nerves that can develop as part of a long-term diabetes mellitus (diabetes mellitus). Symptoms typically begin in the area of ​​the feet and can be expressed with a loss of sensibility and tingling, but also with paralysis symptoms.

What is diabetic neuropathy?

The diabetic neuropathy manifests itself first by nonspecific leg pain and discomfort in the limbs. Typical is an increasing tingling, which is often associated with sensory disturbances and numbness.
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A neuropathy is a disease of the nerves (more specifically, the peripheral nerves, that is, all the nerves of the body except the brain and the spinal cord), which may have various causes. Diabetic neuropathy is the typical nerve damage that can be the result of diabetes (diabetes mellitus).

Diabetic neuropathy occurs in about 30% of diabetics during their lifetime. This nerve damage can lead to a variety of complaints. Diabetic neuropathy typically manifests itself in peripheral polyneuropathy, in which many nerves are equally affected, and in autonomic neuropathy, that is, in a disease of nerves of the involuntary nervous system.

causes

The exact factors of the development of diabetic neuropathy are not yet well understood. Undoubtedly, increased blood sugar levels play a crucial role in the development of diabetic neuropathy.

Thus, in diabetics with poor blood sugar control, neuropathy develops on average much faster than in well-adjusted patients.

One factor responsible for the destruction of nerve cells in diabetic neuropathy is the formation of sugar-protein compounds, which can arise at high blood sugar levels and have a direct damaging effect on nerve cells.

Symptoms, complaints & signs

The diabetic neuropathy manifests itself first by nonspecific leg pain and discomfort in the limbs. Typical is an increasing tingling, which is often associated with sensory disturbances and numbness. In diabetic neuropathy, the legs are more sensitive to touch stimuli.

This often causes a strange sensation when putting on socks or tights, which usually starts with the toes and radiates from there to the lower legs. Also characteristic are the small, usually barely visible wounds on the foot, which can increase in the course of the disease and cause irreversible damage.

Furthermore, the disease may manifest itself as a malaise. The typical malaise occurs especially in chronic complaints. It manifests itself through pale skin, regular sweats and cardiovascular discomfort. The skin areas affected by the neuropathy also feel cold and often show a noticeable discoloration.

If diabetic neuropathy is not treated, serious sequelae can occur. First, there is a risk of vascular damage and embolism. It can lead to an undersupply of different organs, which can cause further complications. In addition, there is an increased risk of infection at the affected areas of the leg, which can result in abscesses and ulcers.

Diagnosis & History

Often, the diagnosis of diabetic neuropathy is made only when the patient experiences symptoms such as tingling in the feet.

However, the diagnosis can be made earlier if patients with a diabetes mellitus are specifically sought for symptoms of diabetic neuropathy. Peripheral polyneuropathy is often initially characterized by decreased sensibility and temperature sensitivity, which typically initially engages the toes, feet and lower legs in a hosiery shape.

One way to make an early diagnosis is to use a tuning fork to check the vibration sensation at these points. The temperature sensation can also be checked by touching the foot with warm or cold objects.

By examining the reflexes with a reflex hammer, the function of the nerves can also be examined more closely. A closer examination of the nerves is possible by means of electroneurography (ENG) and electromyography (EMG).

In the context of autonomic neuropathy it comes in diabetic neuropathy to dysregulation of the cardiovascular system, the z. B. in the long-term ECG and the so-called Schellong test, which consists of blood pressure measurements while lying down and after getting up, show.

complications

Diabetic neuropathy develops as part of diabetes. The fact that the concentration of sugar in the blood is continuously increased, it comes to a variety of complications. Sugar molecules can bind to proteins, which can consequently clog up the smallest of vessels, resulting in a lack of supply to various organs.

An example of this is nerves (diabetic neuropathy), which can lead to sensory disturbances and paralysis phenomena. This is especially the case at the foot. The affected person usually does not notice that there are smaller wounds on the foot and ignores them. The wounds can enlarge in the course of time and cause irreversible damage, as it also leads to wound healing disorders due to diabetes.

In addition, the risk of infection is increased. This may cause the foot to die and in the worst case, be amputated (diabetic foot). In addition, vessels in the retina become blocked, which can lead to disorders in the eyesight. In the worst cases, this can even lead to blindness (diabetic retinopathy).

Typically, diabetes leads to a disorder of renal function, which can even lead to complete failure (diabetic nephropathy). The quality of life is severely compromised and dialysis may have to be intervened if necessary, or even transplantation of the kidney.

When should you go to the doctor?

If the person suffering from disorders of sensitivity, numbness or a tingling sensation on the skin, this is considered unusual. If the symptoms persist or increase in intensity and extent, a doctor must be consulted. If it comes to paralysis, a doctor should be contacted as soon as possible.

For aching legs or impaired locomotion, it is advisable to have a check-up. If there is any hypersensitivity to the sensation of touching another person's skin or garments on the skin, there is cause for concern. A doctor should be consulted so that the cause of the inconvenience can be found.

If an altered perception of temperature influences in the toes, feet and lower legs develops, a doctor's visit is necessary. In case of a general feeling of discomfort or a vague feeling that there are discrepancies, a doctor should be consulted. The symptoms can be on the whole body, but the main concern is the legs and feet.

Therefore, especially in the case of irregularities in the limbs, a doctor should be consulted as soon as possible. If you have a feeling of having ants running on the skin or if you have a burning and burning pain, you should have a check-up, as medical care is needed. Some sufferers report a feeling of fuzziness, which is considered an indication for a doctor's visit.

Treatment & Therapy

A key factor in the treatment of diabetic neuropathy is the consistent cessation of blood glucose levels to curb the progression of the disease.

This can be done depending on the severity and type of diabetes by weight loss, by tablets (so-called oral antidiabetics) or insulin injections. Pain that can occur in the context of polyneuropathy can be treated symptomatically with analgesics.

Here also play so-called co-analgesics that affect the perception of pain, such. As antidepressants or antiepileptics, an important role. Further treatment options include the administration of B vitamins (vitamins B1, B6 and B12) as well as fatty acids such as alpha-lipoic acid and gamma-linolenic acid.

Some consequences of autonomic neuropathy can be treated specifically. Thus, diabetic neuropathy can lead to impotence, indigestion, and increased blood pressure, each of which can be treated with specific medications.

Outlook & Forecast

Although diabetes is not curable, the prognosis of diabetic neuropathy is considered favorable in patients who have diabetes for a short time.

In long-term patients, the prognosis worsens. Lifetime is severely shortened with additional diabetic neuropathy, especially in patients who have had diabetes for several years. It comes increasingly to impaired kidney function and blindness may occur. The quality of life is reduced and the risk of developing a mental disorder is increased.

Patients diagnosed with diabetes just a few months ago have a good chance of alleviating the symptoms if their lifestyle is changed and their medical treatment is good.

The aim of treatment is the prevention of disease progression. This is possible with today's medical options in these patients in almost all cases. If the blood sugar value is optimally adjusted and the patient lives healthy, the health will improve. In addition to sufficient movement and keeping the normal weight, overstraining should be avoided.

The reduction of stress and the use of relaxation techniques to compensate for the daily challenges, additionally help in coping with the disease. If the recommendations are followed, the patient can prevent the occurrence of further complaints.

prevention

The best precaution for diabetic neuropathy is the good management of diabetes mellitus. An early detection of diabetes also plays a role in this, in order to minimize the time in which the patient has uncontrolled high blood sugar levels.

In addition, alcohol should be avoided, especially in the case of incipient signs of neuropathy, since this can lead to additional damage to the nerves. A dreaded complication of diabetic neuropathy is the diabetic foot syndrome: Due to the reduced sensitivity, small foot wounds occur more frequently, which heal worse due to diabetes.

Often, amputation is required in the end. To prevent this, the feet should be examined daily, for example, with a mirror and in case of problems quickly see a doctor.

aftercare

Due to the chronic course of a diabetic disease, the patient should come regularly to the control of the family doctor as well as to the appropriate specialist. Since diabetes mellitus often affects the nerves, the patient should go to the neurologist to check the function of the nerves and if necessary initiate treatment. The nerves are damaged to such an extent that numbness or muscle weakness develops.

The family doctor should therefore look in the office hours on the foot, as due to the nerve damage often injuries are overlooked by the patient. In the case of extensive damage to the foot (diabetic foot), in the worst case, amputation may also be considered. In addition, the sugar should also be checked to control the discontinuation of the medication and possibly initiate a change.

In a newly discovered diabetes mellitus, the patient should be stopped with medication and trained, as the intake can be very complex. Besides the nerves, other organs are often affected by diabetes mellitus. The patient should therefore also annually to the control of the ophthalmologist who can detect a change in the retina by the fundus, which can lead to blindness.

In addition, a nephrologist should be consulted regularly, as damage to the kidney are not uncommon and may result in unopposed diabetes mellitus to kidney failure.

You can do that yourself

Diabetic neuropathy generally requires medical treatment. However, the diabetic can also become active in order to protect himself from the consequences of the nerve disorder.

One of the most important measures is measuring blood sugar. This should be done in consultation with the doctor and at clearly defined times. Also of importance are the control of blood fat, body mass index (BMI), blood pressure and the size of the waist. In addition, the diabetic is recommended to take good care of his nerves and avoid stress as possible. Equally advisable is the renunciation of nerve damaging factors such as nicotine and alcohol.

If the diabetic is overweight, it is recommended to reduce it. A balanced diet and enough exercise help. Anyone who wants to do sports in spite of diabetic neuropathy is well advised to talk to the doctor in advance to clarify the individual limitations and options.

Thus, the feet are not burdened by every sport to the same extent. The use of diabetic footwear or insoles also plays an important role. Equally important is a daily check and care of the feet.

In addition, it makes sense that the diabetic undergoes regular check-ups and once a year can be checked for possible nerve damage. The emphasis is primarily on the feet.

Which measures are ultimately best suited to the individual should be discussed with the attending physician.

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