WHAT IS IT?
Diabetic neuropathy refers to changes in the nervous system seen in diabetes. Thirty to seventy percent of diabetic individuals are affected. The causes are considered to be related to the metabolic upset of hyperglycemia with direct and indirect neurological injury as a consequence of poor blood circulation (ischemia). Areas of the body affected by neuropathy include the arms and legs, but more frequently the legs. Dysfunction of the autonomic nervous system includes the glands, heart, digestive system, bladder, and, in men, sexual functioning.
HOW IS IT DIAGNOSED?
History: The individual may complain of a dull burning ache, tingling and/or numbness (paresthesias) of the fingers or, more commonly, the feet. Other complaints may include swelling of the hands or feet, loss of body hair, muscle cramps and weakness. Individuals may experience dizziness with position changes, unusual sweating, nighttime diarrhea and/or constipation, difficulty urinating, or impotency. The individual may also have difficulty sleeping due to pain.
Physical exam may reveal a decreased skin temperature, a reddish-blue discoloration of the hands, lower legs and feet with loss of skin color to the tissues when the arm or leg is elevated (vascular insufficiency). There may be a decrease or absence of ankle reflexes, and the individual may not be able to distinguish sharp from dull or hot from cold when applied to the skin (two-point discrimination). The most subtle finding is the decrease of light touch and pain sensation in the toes. The physician may also find a decrease or absence of pulses or a drop in blood pressure with positional changes from lying or sitting to standing (postural hypotension). The individual's nails may be very thick and have ridges with dryness and cracks in the skin.
Tests: Certainty of diagnosis is high based on blood glucose test but, typically, a screen for other causes of neuropathy are considered.
HOW IS IT TREATED?
Treatment may include close monitoring of the blood glucose, early intervention of treatment to cuts and sores, elevation of the affected arm or leg and individual attention to good skin care. Additional medical intervention includes control of pain with medication and/or topical creams, anti-depressants for the insomnia and anxiety, muscle relaxants for muscle pain, hemorheologic agents for relief of numbness and tingling, and aldose reductase inhibitors for partially reversing some of the damage done ot the nerves by hyperglycemia. The individual may be asked to set up a regular pattern of urination (bladder training) to ensure emptying of the bladder and to avoid a bladder infection.
WHAT MIGHT COMPLICATE IT?
Complications of diabetic neuropathy can include bladder infections, muscle wasting (diabetic amyotrophy), burns, infection, gangrene or amputation of affected arm or leg.
PREDICTED OUTCOME
The outcome is based on how well the individual controls the diabetes, protects the skin from injury, and seeks appropriate early intervention. If well controlled, there can be a reduction in the progression of the diabetes, but reversal of the process is rare.
ALTERNATIVES
Other possibilities could include atherosclerosis, phlebitis, diseases of immune system, nutritional abnormalities, and systemic infectious diseases (such as Guillain Barr syndrome,
infectious mononucleosis and
syphilis).
APPROPRIATE SPECIALISTS
Neurologist and podiatrist.
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