In sensorimotor diabetic polyneuropathy, sensory disturbances in the feet and legs are the first symptoms to appear. (image: elnur/fotolia.Com)
Nervous disorders as a consequence of diabetes – symptoms and treatment
Diabetic neuropathy or nerve damage is a typical, chronically progressing secondary disease of diabetes mellitus, in which mostly nerve tracts of the peripheral nervous system are damaged and gradually die off. The most common form is diabetic polyneuropathy (peripheral sensorimotor polyneuropathy), initially recognizable by sensory disturbances in the feet. A dreaded complication that can accompany this damage to the nerves is diabetic foot. Since treatment options are limited and a complete cure cannot be expected, early detection is the most important switch for slowing the progression of the disease and preventing further possible sequelae.
A brief overview
People with diabetes should be especially vigilant when it comes to their health, because diabetes increases the risk of a number of secondary diseases. Early warning signs should be taken seriously and affected individuals should seek medical advice immediately. Afterwards you will find a short overview with the most important information about neuropathy, followed by a detailed description of the symptoms.
In sensorimotor diabetic polyneuropathy, sensory disturbances in the feet and legs are the first symptoms to appear. (image: elnur/fotolia.Com)
How to recognize sensorimotor diabetic polyneuropathy?
Early warning signs include sensory disturbances and pain, especially in the feet and legs:
- Skin tingling ("ants’ feet") and feelings of furiness,
- Sensory disturbances for pressure and temperature,
- Severe, burning pain (often at night).
What is diabetic foot?
In this serious complication, increased corneal formation and skin cracks on the sole of the foot are often the first symptoms to appear. Due to sensory disturbances, painful injuries to the feet go unnoticed, and poorly healing and inflamed wounds result, favored by circulatory disturbances. Deep layers of tissue are affected and death is the result. in the worst case, amputation may occur.
What are other common sequelae of diabetes??
- Diabetic macroangiopathy (damage to the large arteries) and microangiopathy (damage to small blood vessels), ,
- Diabetic nephropathy (kidney damage),
- Diabetic cardiomyopathy (heart disease), ,
- High blood pressure with subsequent symptoms such as stroke or heart attack,
- Eye damage,
- lipometabolic and wound healing disorders.
Definition
The collective term diabetic neuropathy covers various types of nerve damage, usually affecting the peripheral nervous system (nerves outside the brain and spinal cord), caused by diabetes. Basically, a distinction is made between whether only a single nerve is affected (diabetic mononeuropathy) or whether damage occurs simultaneously in many peripheral nerves. The latter also characterizes the most common form of manifestation: sensorimotor diabetic polyneuropathy. Among the many symptoms, sensations and pain in the feet and legs are particularly common. Typically, a diabetic foot develops in this form in the further course of the disease.
Diabetic foot can develop as a severe consequence of nerve damage and insensitivity in polyneuropathy. (picture: kirov1969/fotolia.Com)
More rarely, nerves of the so-called autonomic (vegetative) nervous system are also affected; in this case, one speaks of an autonomic diabetic neuropathy.
These diseases, known as late sequelae of diabetes mellitus, occur relatively frequently. Today, neuropathy is diagnosed at a very early stage in about ten to twenty percent of patients with type 2 diabetes. The secondary diseases also occur in type 1 diabetes. The frequency increases with the duration of the diabetes disease and reaches almost half of all affected persons after about 25 years.
Symptoms
A variety of symptoms can be attributed to diabetic neuropathy, depending on which nerve pathways are affected. In the most common form, sensorimotor polyneuropathy, early signs include sensory deficits, sensory disturbances and pain, usually in the feet and legs or, less frequently, in the hands and arms:
- Skin tingling ("formication") and furry sensations,
- Sensory disturbances for pressure and temperature,
- Severe, burning pain (often at night).
It is also associated with burning feet syndrome and restless legs syndrome. In addition, diabetic foot syndrome is a serious complication that relatively often results from a polyneuropathy. The first, often unnoticed signs are an increased formation of cornea and skin cracks on the sole of the foot. The reason for this is incorrect loading due to sensory disturbances in the foot. Due to a reduced sensation of pain, injuries to the feet often go unnoticed. Mostly favored by existing circulatory disorders, poorly healing and inflamed wounds reach into deep tissue layers and can thus cause death. In the worst case, even amputation is threatened.
In the advanced stages of polyneuropathy, there may also be shooting, cramping, or persistent pain in the legs and arms. As well as numbness or hypersensitivity. For example, even touching the legs with the bedspread and mattress while sleeping can cause severe pain. In the further course, motor deficits and even paralysis may develop.
The symptoms of diabetic neuropathy are most frequently manifested in disorders of the peripheral nervous system; the autonomic nervous system is less frequently affected. (image: heilpraxisnet.De/original: normaals/fotolia.Com)
If the autonomic nervous system, which controls the autonomic functions of the body, is also affected, cardiac arrhythmias, circulatory disorders, dizziness, nausea, vomiting, incontinence, diarrhea or constipation can accompany the disease. Abnormal sweating and sexual dysfunction are also possible.
Causes
The causal factors for the development of diabetic neuropathy have not yet been clearly researched and proven. According to experts, however, there is a link between suboptimal blood glucose control (elevated blood glucose levels) and nerve damage. A central risk factor appears to be a blood glucose level that is too high over a long period of time (hyperglycemia).
The elevated blood glucose level can lead to the formation and deposition of degradation products that impair the functions and metabolic processes of nerve cells. In addition, sugar molecules ("saccharification") can be deposited on the body’s own fats and proteins, which are important building blocks for the nerves. Clogged blood vessels and thickened blood vessel walls occur. As a result, the blood cannot flow easily through the narrow capillaries, which impedes the supply of the nerves. The resulting lack of oxygen and nutrients further damages the nerves. The progression of these symptoms gradually leads to the death of the nerve tissue.
Diagnosis
Because there are only limited treatment options for a pronounced clinical picture of polyneuropathy, prevention and early detection are of particular importance. People diagnosed with diabetes should have their nerves examined regularly, whether or not they have neuropathic pain or other symptoms. This is also referred to as neuropathy screening, in order to prevent complications or to detect them at an early stage. People with type 2 diabetes are advised to be screened at the time of diagnosis. People with type 1 diabetes should do this after five years at the latest. If no neuropathy is detected, screening must be performed once a year.
Neuropathy is a very common secondary disease of diabetes, especially when blood glucose levels are too high. (picture: dmitry lobanov/fotolia.Com)
In order to identify a sensorimotor diabetic polyneuropathy, a patient’s history is first taken during a general practitioner or specialist examination in order to record possible symptoms, the medical history and the existing diabetes disease as accurately as possible. For further diagnosis, both legs and feet are examined and compared, and shoes and stockings are examined for possible foot malpositions. The motor function and possible limitations are examined.
Furthermore, neurological examinations will take place, often using very simple methods to test primarily the following sensations and reflexes:
- Pain sensation,
- Sensation of pressure and touch,
- Temperature sensation,
- Vibration sensation,
- Muscle reflexes.
All results together should provide information about the possible presence of a polyneuropathy and also about the current severity of any existing nerve damage. If the diagnosis is not clear and further clarification is needed, other special procedures may be used. In these cases, a detailed neurological examination of the nerves usually takes place. This usually focuses on a pain diagnosis and the nerve conduction velocity. In addition, a comprehensive blood test can provide further information and, in rare cases, a skin biopsy (tissue sampling) can also be performed.
Diagnosis of autonomic diabetic neuropathy is often more difficult. The patient’s medical history and possible complaints may subsequently make various examinations necessary. These will focus on possible dysfunction of the cardiovascular system, gastrointestinal tract, and urinary and genital tracts, as sequelae are often seen in these areas.
An electrocardiogram (ECG) can reveal irregularities in the heart rate. Blood pressure measurements several times in succession while lying and standing, or even over 24 hours, should determine whether there is a severe drop in blood pressure and dizziness when standing up in connection with the neuropathy (neurogenic orthostatic hypotension).
In polyneuropathy, nerves and nerve tracts are damaged and gradually die without appropriate therapy. (picture: sagittaria/fotolia.Com)
Autonomic neuropathy affecting the gastrointestinal tract is difficult to detect because gastrointestinal symptoms can have many other causes. Therefore, it is important to rule out other possible causes. Ultrasound or endoscopic examinations are often used, as well as various functional tests. If other causes have been ruled out, other clues can help diagnose diabetic nerve damage, such as prolonged diabetes with poor blood sugar control and metabolic fluctuations.
It may be necessary to measure the urine flow during bladder emptying and any residual urine. In men, the prostate is also palpated. In the case of erectile dysfunction, the testosterone level and other laboratory values and tests are used.
Treatment
At present, there is no complete cure for diabetic neuropathy. Therefore, the primary goal of treatment is to slow the progression of the disease, relieve pain, and treat possible sequelae. However, a variety of treatment options are available.
The most important therapeutic measure is a permanently constant and optimal adjustment of the blood glucose level. The optimal blood glucose level depends on many factors and must be determined individually for each patient. In addition, blood lipid and blood pressure values should also be well adjusted.
sufferers are advised not only to monitor their own blood glucose levels regularly, but also to watch their weight and adopt a healthy lifestyle, including a balanced diet and exercise. In general, alcohol and smoking should also be avoided, as these can cause additional nerve damage.
B vitamins, especially benfothiamine (B1), are used as supportive agents when necessary.
The first treatment measure for a polyneuropathy is the optimal adjustment of the blood sugar level. (picture: henrik dolle/fotolia.Com)
In pain therapy, the aim is to reduce the perception of pain. This can be achieved with pharmaceuticals such as antiepileptic drugs (anticonvulsants) and antidepressants. In the case of very severe pain, also by means of opioids. In any case, these medications are available by prescription only. Whether it makes sense to take the medication should be decided with the help of a pain analysis, taking into account individual factors. In addition, the therapy requires medical monitoring as it progresses. Side effects are possible with all of the drugs mentioned. In the case of opioids, there is a particular need to warn against the development of tolerance and subsequent dose increases or dependence. Commercially available analgesics (for example ibuprofen, diclophenac or acetylsalicylic acid) should not be used for neuropathic pain. Only rarely is paracetamol used for a therapy trial for a limited period of time.
Specific therapeutic measures for autonomic neuropathy depend on the type of nerve damage and the associated symptoms. It is advisable to seek specialized medical advice according to the symptoms.
Naturopathic treatment
In addition to the above-mentioned attention to a healthy diet and lifestyle, which is considered indispensable in any naturopathic treatment, regular medical foot care plays an important role. This can prevent the development of diabetic foot in particular. The feet should also be extensively examined for injuries, bathed and creamed every day. Appropriate footwear is also part of the preventive measures.
Furthermore, especially for pain relief, various measures from the field of naturopathy can promise success. Naturopathic treatments can be used to support conventional medical therapy or even offer alternative treatment options.
Physical therapies
For pain therapy in polyneuropathy, various physical treatments can be applied, such as physiotherapy, cold-heat treatments, alternating and exercise baths, or electro-treatments of paralyzed muscles. In addition to pain relief, these therapies also aim to improve circulation, strengthen weakened muscles, and increase and maintain mobility.
For the prevention of diabetic foot, regular medical foot care is especially important. (picture: jennewein photo/fotolia.Com)
Electrotherapeutic procedures
Electrotherapeutic procedures such as transcutaneous electrical nerve stimulation (TENS) or high tone therapy, in which pain is combated with electricity, offer a special alternative treatment method. Electrodes are attached to the painful skin region of the patient, which transmit current pulses from a stimulation current device to the body or to the nerves. The stimulus generated transmits electrical signals through the nerve pathways to the spinal cord, where the actual effect of TENS takes place. When high frequencies (above 80 hertz) are used, signal transmission to the brain and thus the perception of pain is inhibited or interrupted. Low frequencies should in turn release chemical substances in the brain and thus lead to a reduced perception of pain. High-frequency therapy uses alternating electric fields in the frequency range from about 4 to 30 kilohertz. This is to allow the energy to penetrate deeper into the tissues, affect cellular metabolism, and thus lead to a healing effect and pain relief. However, the effectiveness of these procedures has not been proven with certainty.
Traditional Chinese Medicine (TCM)
In Chinese medicine, a so-called "tan" is considered to be the central cause of polyneuropathy. This refers to substances that can no longer be excreted and thus cause inflammation. Medicinal therapy, which is individually adapted to each patient, should succeed in dissolving and eliminating these substances. Acupuncture is also said to have a supporting effect.
Other alternative agents and methods
In addition to medicinal pain therapy, various alternative active ingredients from the field of naturopathy offer further possibilities for alleviating complaints. to combat pain, a chili preparation can be applied externally to intact skin (capsicum plaster or cream, capsaicin ointment). The alpha-lipoic acid protects against damage to the nerve fibers through its antioxidant properties. Evening primrose oil, hemp oil and pomegranate seed oil are also suitable for treatment, as the gamma-linolenic acid they contain can improve nerve function. Unfortunately, these active ingredients can have unpleasant side effects, especially in the area of the digestive organs. There is no general therapy recommendation for the active substances mentioned.
Along with other naturopathic treatments, electrotherapy can help relieve neuropathic pain. (image: werner/fotolia.Com)
Further measures from naturopathy, which experience has shown to be particularly helpful in the case of incipient symptoms, are dark-field microscopy, milieu therapy and (classical) homeopathy. Oxygen therapy can also improve blood flow to the tissues and thus minimize secondary damage. The psyche also plays a decisive role in the management of pain. Psychotherapy or pain management training can also help to alleviate the symptoms. (jvs, cs)