Diabetic Nerve Pain (Neuropathy)

Diabetic Nerve Pain (Neuropathy)

Nerve pain with diabetes is called neuropathy. Nerves are like wires that bring feeling to your brain from other parts of the body. High blood sugar level can damage those nerves. It is a long-term complication of diabetes. The longer you have high blood sugar, the more likely you are to get nerve damage. Nerve damage can happen with no symptoms. Others may have symptoms such as pain, tingling, or numbness (loss of feeling) in the hands, arms, feet, and legs.
Nerve problems can occur in every organ system, including the digestive tract, heart, and sex organs. About 60 to 70 percent of people with diabetes have some form of neuropathy. People with diabetes can develop nerve problems at any time, but risk rises with age and longer duration of diabetes. The highest rates of neuropathy are among people who have had diabetes for at least 25 years. Diabetic neuropathies also appear to be more common in people who have problems controlling their blood glucose as well as those with high levels of blood fat and blood pressure and those who are overweight.
The causes are probably different for different types of diabetic neuropathy. Nerve damage assumed as a result of combination of factors below :
1. Metabolic factors, such as high blood glucose, long duration of diabetes, abnormal blood lipid levels, and possibly low levels of insulin.
2. Neuro vascular factors, leading to damage to the blood vessels that carry oxygen and nutrients to nerves.
3. Autoimmune factors that cause inflammation in nerves.
4. Mechanical injury to nerves, such as carpal tunnel syndrome.
5. Inherited traits that increase susceptibility to nerve disease.
6. Lifestyle factors, such as smoking or alcohol consumption.
Symptoms depend on the type of neuropathy and which nerves are affected. Symptoms are often minor at first, and because most nerve damage occurs over several years, mild cases may go unnoticed for a long time. Symptoms can involve the sensory, motor, and autonomic (involuntary) nervous systems. In some people, mainly those with focal neuropathy, the onset of pain may be sudden and severe. Symptoms of nerve damage can include :
1. Numbness, tingling, or pain in the toes, feet, legs, hands, arms, and fingers
2. Ailing of the muscles of the feet or hands
3. Dizziness or faintness due to a drop in blood pressure after sudden standing or sitting up
4. Indigestion, nausea, or vomiting
5. Diarrhoea or constipation
6. Weakness
7. Problems with urination
8. Erectile dysfunction in men or vaginal dryness in women
Symptoms that are not by cause of neuropathy, but often follow, include weight loss and depression.

Classification of diabetic neuropathy that can affects different parts of the body in various ways :
Peripheral neuropathy, the most common type of diabetic neuropathy, causes pain or loss of feeling in the toes, feet, legs, hands, and arms. Peripheral neuropathy, also called distal symmetric neuropathy or sensorimotor neuropathy, is nerve damage in the arms and legs. Your feet and legs are likely to be affected before your hands and arms. Many people with diabetes have signs of neuropathy that a doctor could note but feel no symptoms themselves. Symptoms of peripheral neuropathy may include :
1. Numbness or insensitivity to pain or temperature
2. A tingling, burning, or prickling sensation
3. Loss of balance and coordination
4. Sharp pains or cramps
5. Extreme sensitivity to touch, even light touch
These symptoms are often worse at night. Peripheral neuropathy may also cause muscle weakness and loss of reflexes, especially at the ankle, leading to changes in the way a person walks. Foot deformities, such as hammertoes and the collapse of the midfoot, may occur. Blisters and sores may appear on numb areas of the foot because pressure or injury goes unnoticed. If foot injuries are not treated promptly, the infection may spread to the bone, and the foot may then have to be amputated. Some experts estimate that half of all such amputations are preventable if minor problems are caught and treated in time.
Autonomic neuropathy affects the nerves that control the heart, regulate blood pressure, and control blood glucose levels. Autonomic neuropathy also affects other internal organs, causing problems with digestion, respiratory function, urination, sexual response, and vision. In addition, the system that restores blood glucose levels to normal after a hypoglycemic episode may be affected, resulting in loss of the warning symptoms of hypoglycemia. Autonomic neuropathy affects the nerves in your heart, stomach, intestines, bladder, sex organs, sweat glands, eyes, and lungs.
Hypoglycemia Unawareness
Normally, symptoms such as shakiness, sweating, and palpitations occur when blood glucose levels drop below 70 mg/dL. In people with autonomic neuropathy, symptoms may not occur, making hypoglycemia difficult to recognize. Problems other than neuropathy can also cause hypoglycemia unawareness.
Heart and Blood Vessels
The heart and blood vessels are part of the cardiovascular system, which controls blood circulation. Damage to nerves in the cardiovascular system interferes with the body’s ability to adjust blood pressure and heart rate. As a result, blood pressure may drop sharply after sitting or standing, causing a person to feel light-headed or even to faint. Damage to the nerves that control heart rate can mean that your heart rate stays high, instead of rising and falling in response to normal body functions and physical activity.
Digestive System
Nerve damage to the digestive system most commonly causes constipation. Damage can also cause the stomach to empty too slowly, a condition called gastroparesis. Severe gastroparesis can lead to persistent nausea and vomiting, bloating, and loss of appetite. Gastroparesis can also make blood glucose levels fluctuate widely, due to abnormal food digestion.
Nerve damage to the esophagus may make swallowing difficult, while nerve damage to the bowels can cause constipation alternating with frequent, uncontrolled diarrhea, especially at night. Problems with the digestive system can lead to weight loss.
Proximal neuropathy causes pain in the thighs, hips, or buttocks and leads to weakness in the legs.
Focal neuropathy results in the sudden weakness of one nerve or a group of nerves, causing muscle weakness or pain.

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