Autonomic neuropathy , This nerve damage affects the autonomic nervous system, which controls such body functions as heart rate, digestion, blood pressure, sweating, and for men, erections.
Autonomic neuropathy can cause a multitude of symptoms, including racing heartbeat, dizziness, or light-headedness.
It can affect the digestive tract, causing vomiting, diarrhea, and/or constipation.
It can also cause a person not to empty his or her bladder efficiently, which can predispose the individual to bladder infections.
And for men, especially those who have had diabetes for many years, it may cause impotence (for more about impotence [also called erectile dysfunction] and diabetes, see the chapter “How Diabetes Affects the Reproductive System”).
Why do people with diabetes often develop certain types of neuropathy?
Most cases of chronic neuropathy are found in people who have diabetes.
In fact, roughly 60 to 70 percent of people with diabetes have some type of neuropathy.
Neuropathies in people with diabetes are thought to be caused by poorly controlled blood glucose levels.
High levels of blood glucose can eventually damage delicate nerve fibers, interfering with nerve-signal transmission and damaging the nerves themselves.
Although it is unknown why this happens, some researchers speculate that the damage is caused when glucose attaches to or affects the proteins found in nerve cells.
This condition may either cause a chemical imbalance inside the nerves or restrict the blood flow to the nerves.
Either way, once the network of nerves is damaged, the messages to and from different parts of the body are also affected.
The nerve signals may slow down or send the wrong cues, or eventually, the nerves may stop working.
What are some causes of peripheral neuropathy besides diabetes?
Numerous conditions can cause peripheral neuropathy.
The most common cause of chronic peripheral neuropathy is diabetes, also called diabetic peripheral neuropathy.
Other reasons for peripheral neuropathy include physical trauma (injuries such as broken bones can put pressure on nerves); infections (shingles, HIV infections, and Lyme disease often contribute to peripheral neuropathy); Guillain-Barré syndrome, a specific type of peripheral neuropathy triggered by infection; high consumption of alcohol; chronic liver and kidney diseases (both can cause peripheral nerve damage because of the imbalance in the body’s overall chemistry); cancers (lymphoma can cause peripheral neuropathy); folate vitamin deficiencies (the lack of B2 in the diet can contribute to nerve damage); repetitive injuries (carpal tunnel syndrome); exposure to toxins (insecticides and certain solvents can cause peripheral neuropathy); and some drugs (some chemotherapy medication used to treat HIV often causes damage to the peripheral nerves).
If the reason for the neuropathy is unknown, and it is estimated that the reasons for 30 percent of neuropathies are unknown, it is usually referred to as idiopathic peripheral neuropathy.
Are there any treatments for a person who has diabetes and a certain type of neuropathy?
Yes, there are treatments for people with diabetes and neuropathy, depending on where the nerve damage is located. For example, if a person with diabetes has digestive problems because of nerve damage (a type of autonomic neuropathy), then he or she may need to eat more fiber. If a person with diabetes has bladder problems caused by autonomic neuropathy, then oral drugs, or even surgery, may help improve bladder function or reduce incontinence caused by the neuropathy.
Can inflammation affect a person with peripheral neuropathy?
Yes, it is thought that peripheral neuropathy can be worsened by inflammation. This swelling of tissues, often accompanied by the area becoming hot, is the way the body fights off infection. But if there is too much inflammation along with neuropathy, these conditions can damage tissues and often cause pain.
How can nerve damage affect the extremities of a person with diabetes?
Nerve damage can affect the extremities of a person with diabetes in several ways.
These can include musculoskeletal complications in the hands, wrists, and shoulders, along with problems in the feet, toes, ankles, and legs.
Most of this damage is caused by uncontrolled or high blood glucose levels that damage the delicate nerve endings in the extremities. (For more information about nerve damage and hands, wrists, and shoulders, see the chapter “How Diabetes Affects Bones, Joints, Muscles, Teeth, and Skin.”)
What are some of the dangers if a person with diabetes develops diabetic peripheral neuropathy?
There are some concerns if a person with diabetes develops diabetic peripheral neuropathy.
For example, if a person has less sensitivity to vibrations, touch, and pain, owing to diabetic neuropathy (especially in the feet), then it could put him or her at a greater risk for foot injury.
Such nerve damage could mean that conditions such as too tight shoes, high-impact exercise injuries, or even stepping on an object that punctures the bottom of the foot would go unnoticed.
In extreme cases, a foot wound that goes overlooked for a long period could become infected, and if it does, the infection could lead to gangrene, eventually requiring amputation.
In addition, with neuropathy, there may be more bladder and kidney infections or a decrease in muscle mass (or even muscle damage).
If the person’s digestive system is affected by neuropathy, along with frequent bouts of vomiting, it can result in poor blood glucose control.
What are some of the symptoms of diabetic peripheral neuropathy?
Symptoms of peripheral neuropathy in people with diabetes include tingling, numbness, and reduced sensitivity to touch.
It may also cause itching, weakness, and loss of balance, especially when it affects the legs and feet.
In rare cases, it may also cause a burning or painful sensation in the extremities that continues up the arms or legs.
People with diabetes and peripheral neuropathy commonly describe the sensation in various ways.
For example, peripheral neuropathy in the feet has been described as “walking barefoot on cut glass.”
Why is it important for people with diabetes to care about their feet?
While everyone should practice good foot care, a person with diabetes should be extra vigilant.
One of the more common side effects of diabetes is the loss of sensation because of diabetic peripheral neuropathy.
Because of this, minor injuries to the feet could become a major problem.
For example, if a person with diabetes gets a blister and has lost some of the sensation in the feet, he or she may not treat it properly or even know it exists.
If the wound becomes infected, it may lead to ulcerations and, if severe enough, to amputation. (For more about diabetic foot problems, see the chapter “How Diabetes Affects Bones, Joints, Muscles, Teeth, and Skin.”)
Can diabetes cause a burning sensation on the soles of both feet?
Yes, a burning sensation on the soles of the feet is often reported by people who have diabetes.
This can be caused by something as simple as ill-fitting shoes.
But for a person with diabetes, it may be a sign of diabetic peripheral neuropathy, or damage to the peripheral nerves in the feet.
It can also be caused by alcoholism and less commonly by vitamin deficiencies or lead poisoning.
This burning sensation has even been attributed to a rare condition called erythromelalgia, a disorder that causes a burning feeling in the extremities brought about by an increase in blood flow to the hands and feet.
A sore on a foot for a diabetic person is much more prone to infection. If left untreated, the infection can get into the bones, even making amputation of toes, feet, or legs necessary.
Why do some foot injuries go unnoticed by people with diabetes?
In most cases, the main reason that foot injuries go unnoticed is nerve damage from the diabetes and/or peripheral artery disease (PAD; for more about PAD, see the chapter “How Diabetes Affects the Circulatory System”). If a foot injury goes unnoticed, it is mostly because peripheral neuropathy often impairs pain sensations, and there is a decrease in the blood flow or complete blockage in the arteries feeding the foot. Thus, a cut, blister, bleeding wart, or even an ingrown toenail can cause an undetected infection to spread.
If the infection becomes severe, the foot’s poor circulation from PAD or diabetic nerve damage exacerbates the problem by not allowing the body’s natural infection fighters, such as white blood cells and antibodies, to attack the invading infection.
If the infection remains uncontrolled, a foot ulcer can develop, which is a condition that needs immediate attention.
If not treated, the infection can penetrate into the lower layers of the skin and reach the bone, causing a bone infection.
If one or more toes, or another part of the foot, becomes involved, then the toes or even an entire foot often has be amputated.
In extreme cases, a leg may have to be amputated.
This is why it is often stressed that people with diabetes pay close attention to their extremities, especially the feet. (For more about foot ulcers, see the chapter “How Diabetes Affects Bones, Joints, Muscles, Teeth, and Skin.”)
What is Charcot’s arthropathy (or Charcot’s foot and ankle)?
Charcot’s arthropathy, also called Charcot’s foot and ankle or diabetic foot, is a syndrome that often affects a person with diabetes and who has severe diabetic peripheral neuropathy. (It can also affect other people who have loss of sensation in their feet for other medical reasons.) According to Harvard Medical School, this condition occurs when a person’s foot and ankle joints and/or bones are destroyed, including such problems as bone disintegration, fractures, and dislocation of bones.
These changes in the bones and joints can eventually cause deformities that interfere with walking.
It is also one of the most serious foot problems that a person with diabetes faces.
Initially, there is minor trauma to a joint or bone in the foot from daily wear and tear.
If this goes unnoticed, which often happens with severe diabetic peripheral neuropathy, then the damage often continues until the tissues are eventually destroyed.
Again, this is why doctors stress that people with diabetes pay close attention to changes in their feet and ankles.
If caught in time, the damage can potentially be minimized by changing the way a person walks (sometimes through physical therapy), modifying their footwear, or starting an exercise program.
The above graphic shows where dangerous ulcers most commonly develop on the feet of diabetics.
How does a physician initially diagnose diabetic peripheral neuropathy?
The initial tests for diabetic peripheral neuropathy can usually be conducted during a physician’s office exam.
In fact, it is estimated that 60 to 70 percent of people with diabetes have some signs of neuropathy that can usually be detected with a physical exam or special tests.
The best way to determine neuropathy is to test the reflexes and sensory perception of the patient.
Other means of diagnosing will also be conducted, such as looking at the person’s history (for example, any history of neuropathy in the family, exposure to toxins, medications taken, and alcohol consumption).
What are some special tests to check a person with diabetes for peripheral neuropathy?