Nerve Damage (Neuropathy)

What exactly is Neuropathy?

Damage to nerve cells is called “neuropathy.” Nerve cells are like insulated wires. When blood sugar is high, the sugar causes damage to the insulation of the nerve. After time, the nerves become unable to send signals through the body the way they should.

Nerve damage can happen slowly, and you very well might not even notice that you are beginning to lose feeling in your feet and hands (a symptom of neuropathy).

Besides loss of feeling in your feet and hands, there are other signs that you have nerve damage. You may sweat more than normal or feel light-headed when you stand up. You might also find it difficult to tell when your blood sugar is low. You may have stomach and/or bowel problems. You may experience difficulty in urinating, and you may have bladder or kidney infections. Some people also experience sexual problems. Men can have impotence. Women may experience decreased vaginal lubrication and pain during sexual intercourse.

For people with diabetes, there are two key types of neuropathy:

Peripheral Sensory Neuropathy

Peripheral sensory neuropathy refers to the nerves that carry information about sensation and feeling to your brain. The word "peripheral" means that we're talking about the extremities, as compared to your central nervous system. This is the most common type of diabetic neuropathy, causing pain, numbness, or weird sensations in your feet, legs, or hands.

This is why foot care is of such great concern to people with diabetes. Neuropathy can make it hard to feel an injury, then compounds the problem by weakening your ability to heal quickly and making your feet more susceptible to infection.

As always, the best route is prevention.

Autonomic Neuropathy

Autonomic neuropathy describes damage to the nerves that serve the internal organs and any systems we don't consciously control. Sometimes there are symptoms when neuropathy is present, but often there are none. 

Because nerve damage frequently results in a loss of sensation, neuropathy can mask pain, making it hard to identify a blood sugar low or even a heart attack.

The best advice? Talk openly with your primary physician and any specialists you see. Let them know that you want to be careful about neuropathy and be sure to follow through on any tests they recommend. In some cases, testing is the only way to know if your nerves remain disease-free. Day-to-day, make sure your blood sugar is within the limits. You can substantially reduce your odds of ever feeling—or not feeling—the onset of neuropathy.

Who Is At Risk Of Neuropathy?

People with diabetes are more likely to develop damage to nerve cells than other people. The longer you have diabetes, the greater the chances that you may suffer from nerve damage. The Diabetes Control and Complications Trial (DCCT) was a 10-year study of people with type 1 diabetes. The purpose of the DCCT was to see if keeping blood sugar levels under tight control affected complications from diabetes. The study showed that tight control may reduce your chance of getting neuropathy by up to 60%.

Symptoms Of Neuropathy

• Numbness, tingling, burning or pain in the hands, lower legs and feet. It can feel like "pins and needles" or a sunburn, and is often worse at night. Taller people, with longer nerves in the legs and feet, are at greater risk.
• No pain from cuts, bruises, or injuries to feet or hands
• Digestive discomfort, including constipation, diarrhoea, or nausea.
• Trouble with your bladder, including incontinence, difficult or painful urination, or cloudy or bloody urine. You may also become aware of lower back pain or a fever, but not always.
• Sudden weight loss or a change in appetite if the nerves in your stomach are damaged, making you feel satisfied before you've really had enough to eat.
• Any sudden, severe pain focused on a specific part of your body can also be a sign of neuropathy.
• Chest pain. This can be an important early warning sign of problems with the nerves serving your heart.
• Abdominal pain
• Nausea and vomiting
• Bloating
• Problems with sexual health:
  • impotence in men (less able to have and keep an erection)
  • women less able to have an orgasm or climax
• Feeling light-headed when changing from a lying to a standing position

A thorough knowledge of the symptoms of nerve disease is a good start, but it's not enough. After all, more than a third of nerve problems have no symptoms at all. Only your doctor can watch for them. Do your part by making—and keeping—regular appointments for the tests your healthcare team recommends.

Symptoms of neuropathy may come and go. Also, symptoms may be less noticeable when blood sugar levels are closer to normal range.

Treatment Of Neuropathy

Let's face it. Neuropathy isn't any fun. Damage to your nerves can be a painful, problematic proposition. But there's good news on two fronts: 1) There have been tremendous advances in alleviating the discomfort associated with nerve problems; and, 2) With careful blood sugar control, you may be able to reverse the damage.

There are many treatments for neuropathy including various medications, dietary changes, and tight control of blood sugars. If you have any of the symptoms on the list above, tell your diabetes specialist nurse so you can get the help you need.

Depending upon the type of neuropathy you're experiencing, there are some simple things you can do.

Your Feet.
If you have numbness or pain in your extremities, make sure you're warm. Always wear shoes (but check them first for rough spots or stones) to keep your whole body warmer. Test bath water with an elbow, so you know if it's too hot for your feet. And stay away from electric blankets and pads, which can burn without you knowing it.

Blood Pressure.
If you feel dizzy when you get up from bed or a chair, it may be that your blood pressure isn't being regulated properly. Make an effort to get up slowly. And talk to your doctor. You may find that increasing the salt in your diet (on his or her recommendation) or elastic stockings can help. You'll also want to look for exercises that don't require quick changes in your body's position. Water aerobics, walking on a treadmill, or stationary cycling are a few good possibilities.

Sensitive Skin.
If your sheets or pants hurt your skin, your doctor may suggest an over-the-counter cream to take the sting out.

Digestive System.
There are many treatments for digestive problems, and your doctor will be happy to help determine the right one for you. He or she may prescribe medication to overcome the symptoms, ask you to eat several smaller meals throughout the day, or reduce your intake of fat, fiber, or wheat products.

Bladder Trouble.
If you're having difficulty urinating or knowing when you need to, the first steps are often to drink more water and urinate on a schedule—often every 3 or 4 hours when you're awake. This will also help you avoid infection from any urine that remains in your bladder. Your doctor may also prescribe medication or make other suggestions to solve the problem.

Muscle Spasms.
Stretching exercises can strengthen muscles and ease the pain and discomfort of spasms. In some cases, your doctor may even recommend physical therapy. And comfortable shoes can make a big difference for your feet and legs—say no to high heels, cowboy boots, or other styles that stress your feet.

Pain During Treatment.
As you work with your doctor to control your blood sugar and lessen the effects of neuropathy, your pain may worsen. It's the natural result of the nerves swelling up as they begin to heal. Luckily, it's a temporary side effect, and your doctor can recommend pain killers or prescription medication to get you through it.

How To Prevent Or Delay Neuropathy

• Keep your blood sugar levels close to normal range. (Discuss your target range with your diabetes healthcare team.)
• Lower your blood pressure, if high.
• If you smoke, stop! Smoking can also damage nerve cells.
• Do a daily “foot check” to look for any cuts, calluses, or changes to your feet. Remember to call your diabetes healthcare team if you do see changes.
• Exercise daily to improve blood flow to your feet and hands.
• Report any symptoms to your diabetes specialist nurse.
• See your diabetes specialist nurse every 3-4 months to monitor your diabetes.

Neuropathy is tough to live with, but it can be beaten. Your number-one weapon is great blood sugar control. Get it back on track, and you may be able to stop or even turn neuropathy around. Looking for exercises that will help you feel better, without aggravating your symptoms?