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DIABETIC NEUROPATHY WHAT YOU NEED TO KNOW One of the most common complications of diabetes – both type 1 and type 2 – is neuropathy, which simply means nerve damage.
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our nerves are the fibres in your body that send messages, electrically and chemically, between your body and your brain, so that your body knows what to do. Over long periods of time, high blood sugars can damage various nerve fibres in the body in different ways. We still don’t know the exact hows and whys of this, but research is ongoing, and there are clear recommendations and treatment options. There are three types of nerves that can be damaged: • ‘Sensory neuropathy’ is damage to nerves that detect touch or temperature. • ‘Motor neuropathy’ is damage to nerves that help with muscle movement. • ‘Autonomic neuropathy’ is damage to nerves that control the body’s involuntary actions, including digestion, breathing, and heart rate, among others. SENSORY NEUROPATHY
A person with sensory neuropathy may experience numbness, pain, tingling, or loss of feeling, often in the arms, legs, hands, and feet. The symptoms usually come on slowly and gradually – you may hardly notice them. Occasionally, however, there is sudden pain.
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DIABETES WELLNESS | Spring 2021
For many reasons, feet are particularly vulnerable to neuropathy. Once neuropathy in legs and feet becomes advanced, the need for amputation is a real risk. This is why it’s so important for people with diabetes to get regular foot checks. For more about caring for your feet, see www.diabetes.org. nz/blog/steps-to-healthy-feet. MOTOR NEUROPATHY
A feeling of unusual muscle weakness is often the main symptom of damage to motor nerves. Proximal neuropathy is one of the more common motor neuropathies. It affects hips, buttocks, and thighs. It weakens the legs, and can make it difficult to walk or to stand up from a sitting position. Another symptom is sudden pain in your hip, buttock, or thigh. Proximal neuropathy is seen most often in older people. With careful blood sugar management and good care, including medication and physiotherapy, proximal neuropathy can improve over months or years, although it may never go away altogether. AUTONOMIC NEUROPATHY
This involves damage to nerves in one or more organ systems, such as the cardiovascular system, the gastrointestinal system, the reproductive system, or the urinary system. Autonomic neuropathy is one of the least recognised complications of diabetes. There are many possible symptoms, and autonomic neuropathy can often be missed and diagnosed as something else. Anyone with diabetes, especially
if they have also been diagnosed with sensory or motor neuropathy, should also keep an eye out for or be checked for symptoms of possible autonomic neuropathy. Signs and symptoms of autonomic neuropathies can include: • resting tachycardia (a rapid heartbeat even when relaxed) • ongoing hypoglycaemia unawareness • postural hypotension (sudden blood pressure drops when moving from lying to sitting or sitting to standing) • gustatory sweating (excessive sweating when eating, or even sometimes when thinking about eating) • sexual dysfunction (such as erectile dysfunction or vaginal dryness) • neurogenic bladder (a lack of bladder control because of a nerve problem) • gastroparesis (where food stays in the stomach longer than it should) • other gastro-intestinal issues, such as diarrhoea • difficulty swallowing food. FOCAL NEUROPATHY
Diabetic neuropathy often affects a wide range of nerves at once, but focal neuropathy is when there is damage to just one nerve or a small group of them. It usually, but not always, affects the torso, leg, or head, particularly the eyes. Symptoms can include double vision or other difficulties focusing, aching behind the eye, paralysis, or pain in the lower back or other places.
