1362404995 diabetes and nerve problems

Diabetes and Diabetes and Nerve Nerve

ProblemsProblems

What is Diabetes?

Diabetes is a condition in which there is too much sugar (glucose) in the blood. Although sugar is needed to provide energy for the body, when in excess, it causes problem.

Persons with diabetes have excess sugar because they lack or have deficient supply of insulin.

Diabetes

“Mild Disease”

Serious consequences

Diabetes Mellitus A Serious Disease

Leading cause of newcases of blindness 25 times more prone to eye problems

6 times higher risk forParalysis (stroke)

5 times more prone toKidney failure

20 times more prone tolower limb amputationNerve damage causes loss of sensation

2-3 times higher risk forheart attack

The Nervous System The nerves in our body serve as a communication system.

The nervous system conveys messages from the brain to our

� legs, hands, feet and other parts of the body (peripheral nervous system)

� internal organs such as heart, stomach and bladder (autonomic nervous system)

The nervous system sends sensations to the brain so that appropriate actions can be taken in response

� touch, pain, pressure, vibration and temperature � smell, taste, sound, and sight

Long periods of high blood sugar can damage nerve fibers, impairing their ability to carry messages to and from the brain

Damaged nerve fibers relay signals (sensations) slowly or don’t relay them at all

Restoration of the blood sugar level quickly to with-in target range may allow damaged nerve fibers to heal and

function properly again

The Nervous System

Cause of Nerve Damage

High blood sugar can harm nerve cells in two ways:� High sugar level in blood causes high amount of sugar to enter the

nerve cells. As the nerve cells cannot use all of it, toxic substances accumulate and affect the nerves' ability to transmit signals

� High blood sugar also damages the small blood vessels that carry oxygen and nutrients to the nerves

Diabetes and Nerve Problems

Diabetic Neuropathy is a common complication of diabetes

It does not always cause obvious symptoms. When it does, you may experience:

� Loss of sensation in your feet and hands� Pain and other kind of discomfort

These symptoms are more likely to occur during periods of poor blood sugar control

Diabetes and Nerve Problems

Diabetic foot ulcers (common accompaniment to neuropathy) are a common cause of prolonged hospitalizations

Parts of the body most commonly affected by nerve problems in people with diabetes:

� Leg, feet and hands� Genitals� Eye muscles � Heart � Stomach� Intestines� Bladder

Parts most often affectedDiabetes and Nerve Problems

Symptoms of Diabetic Neuropathy

Feet and Hands

Symptoms include various types of uncomfortable feelings such as:

� Tingling, like a feeling of “ants crawling” or “pins and needles.”� Numbness and heaviness “feeling of walking on cotton” � Reduced ability to sense heat and cold� Stabbing or burning pain� A persistent “restlessness” in the feet and legs� Extreme sensitivity to touch, even light touch � Loss of balance and coordination � Dry skin susceptible to cracks and infections

Most serious consequence of nerve problem is the loss of protective sensation in the feet

Without an intact “pain-alarm-system,” minor injuries may occur and go unnoticed until they develop into serious foot ulcers

Poorly fitted shoes can led to painless lesions that quickly develop into ulcers


Feet and Hands

Serious burns or foreign body impaction (thorns; pebbles) may occur without pain

Never walk barefoot. Sharp objects can cause injury at work or home when you least expect them

Don’t underestimate the importance of daily foot inspection and care – especially if you have nerve problems in your feet


Feet and Hands

Six pairs of eye muscles work together to turn both eyes in the direction of your choice. These muscles are controlled by three pairs of nerves.

If blood sugar control has been poor, one or more of these nerves can be affected and can paralyse one or more eye muscles causing double vision. This can occur suddenly without warning.

Severe unexplained pain behind the eye may also be due to diabetic neuropathy


Eye Muscles

Symptoms of Diabetic Autonomic Neuropathy

Stomach and Intestines� Nausea, vomiting, feeling of bloating and lack of appetite, because of

delay in emptying of stomach� Difficulty in swallowing� Diarrhoea or constipation because stagnation due to poor bowel

movement� Weight loss

Urinary Tract and Genitals� infection and incontinence of the bladder due to retention of urine � impotency and loss of libido (sexual response) in men and women

Heart and blood vessels � Sudden fall in blood pressure on standing and sitting suddenly� Silent heart attacks as the perception of pain of heart attack may be

affected� Abnormal heart beats and irregular pulse

Other� Profuse sweating and inability of the body to control temperature as

the nerves to the sweat gland may get affected � Hypoglycaemia unawareness -the body's normal response to low

blood sugar is impaired, making it difficult for the person to recognize the symptoms

Symptoms of Diabetic Autonomic Neuropathy

You may also have serious nerve damage without any symptoms

Insist on your doctor examining your nervous system when you are diagnosed or as soon as possible

See a neurologist (nerve specialist) regularly for examination if and when advised by your doctor


When to Check for Nerve Problems

The overall health of your nervous system should be checked as part of your regular visits to the clinic

Children >10 years and adults < 30 years within 3-5 years of diagnosis and thereafter once a year

Adults > 30 years at the time of diagnosis and thereafter once a year

Those already diagnosed with abnormal findings need to be tested more frequently as advised by their doctor

Preventing Nerve Damage Keep blood sugar levels as close to normal as possible to

slow the onset and progression of diabetic neuropathy Avoid smoking as it worsens circulatory problem increasing

the risk of neuropathy Reduce alcohol drinking as it can worsen neuropathy Take Insulin, if advised

Testing for Nerve Problems

Your doctor should ask you about: � Vision problems� Any tingling, unusual pain or numbness� Any change in your ability to sweat� Heart palpitations� Bowel problems, such as constipation or diarrhea� Difficulty emptying your bladder� Problems with impotence

Your doctor will examine you to check for sensations� Pressure and deep sensation threshold test using a monofilament –

the doctor will apply a thin sharp plastic filament to the skin on the feet and hands

� Vibration perception threshold using a tuning fork – the doctor will apply a vibrating tuning fork on bony prominences to check for vibration sensation

� Light touch sensation – using a cotton swap- doctor will lightly touch the skin of the legs and hands to check presence of light touch sensation


Your doctor will examine you to check for sensations � Thermal threshold to check for warm and cold sensation – using test

tubes filled with hot and cold water� Check reflexes – Strike parts of body with a small rubber hammer or

touch parts of body to examine for reflex reactions � Cold pressor test – doctor may ask you to dip your hands in ice cold

water and check for changes in your pulse or heart rate� Blood pressure response on standing – doctor will check BP in lying

down and while standing to see if blood pressure suddenly falls on standing


Other Tests� Biothesiometry – to check for sensations. Biothesiometer is an

electrical device that varies the intensity of vibrations� Electromyography (EMG) - to check muscles response to electrical

impulses transmitted by nearby nerves. A slower or weaker response suggests damage to the nerve or muscle

� Nerve conduction studies – to check the flow of electrical current through a nerve. Impulses that seem slower or weaker than usual indicate possible damage to the nerve

� ECG – to check regularity of heart rate � Ultrasound - to check functioning of the bladder and other parts of the

urinary tract


Treatment For Neuropathy To prevent further damage and reverse the changes of

neuropathy - bring the blood sugar levels under control� Take Insulin, if advised

The aim of treatment is to relieve discomfort and reduce pain� Appropriate medication to help relieve pain; usual pain-killers may not

work well. Imipramine, Amitriptyline (anti depressants) are more efficient in such cases

� Insulin treatment improves painful neuropathy

Treatment For Neuropathy To reduce problems related to foot take special care of the feet

Follow the rules of foot care

To reduce muscle weakness� Physiotherapy and physical exercise may be advised

� Insulin treatment is also reported to improve weakness

To reduce GI symptoms – such as indigestion, bloating, nausea and vomiting

� Stop some types of anti diabetes medications � Small frequent meals, with low intake of fat and fibre� In severe cases medication may be prescribed

To reduce diarrhoea� Stop some types of anti diabetes medications � Suitable medication for diarrhoea is prescribed

Treatment For Neuropathy

To reduce dizziness and weakness related to postural hypotension

� Sit or stand slowly from lying down position� Wear elastic stockings� Medication may be prescribed


To reduce problems affecting the urinary tract� Drink more fluids� Pass urine regularly every 3-4 hours� Antibiotics to treat urinary infections

To reduce sexual problems� Counselling to help relieve stress� Medication to help improve impotence in men� Medication to reduce vaginal dryness and urinary tract infections in

women� Suction devices or Surgery for men


It has now been proven that prevention of nerve damage- like prevention of other long term complication of diabetes- is best achieved through tight blood sugar control

Take Insulin, if advised Strive to keep your blood sugar with in your target

� < 120 mg/dl Fasting and < 180 mg/dl PP

You are in the best position to accomplish this goal through regular blood sugar testing and appropriate adjustments in your medication,diet and exercise

Conclusion

1362404995 diabetes and nerve problems

Health & Medicine