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Diabetic Neuropathy

It is a common nerve disorder caused by diabetes. It is as a result of nerve damage and generally manifests itself in the form of tingling, burning, pins and needles, numbness, coldness and pains. In many instances the blood sugar is too high for extended periods and this is what contributes to the nerve damage.

4 Types of Diabetic Neuropathy

Diabetic neuropathy can be classified as peripheral, proximal, autonomic, or focal. They have varied effects on different body parts.

• Peripheral neuropathy, which was discussed in last week’s article, is the most common type of diabetic neuropathy. It causes loss of feeling and pains.

• Proximal neuropathy pains are generated in the thighs, butt or hips, and contribute to weakness in the legs.

• Autonomic neuropathy affects digestion, bowel and bladder function, sexual response, and perspiration. It can also affect the nerves that serve the heart and control blood pressure, as well as nerves in the lungs and eyes.

• Focal neuropathy manifests itself via sudden weakness of the nerves resulting in pains and muscle weakness.

Peripheral neuropathy affects the
• feet
• toes
• legs
• arms
• hands.

Proximal neuropathy affects the
• hips
• thighs
• legs
• buttocks.

Autonomic neuropathy affects the
• digestive system
• heart and blood vessels
• sweat glands
• lungs
• urinary tract
• sex organs
• eyes.

Focal neuropathy affects the
• lower back and pelvis
• eyes
• legs
• chest
• facial muscles
• ears
• thighs
• feet
• abdomen.

How is it diagnosed?

Doctors diagnose neuropathy on the basis of symptoms and a physical exam. During the exam, your doctor may check blood pressure, heart rate, muscle strength, reflexes, and sensitivity to position changes, vibration, temperature, or light touch.

Foot Exams

A comprehensive foot exam is recommended annually to check for peripheral neuropathy. The nature of this ailment requires more frequent foot exams which include assessesment of the skin, muscles, bones, circulation, and sensation of the feet. For assessing feeling in your feet, a nylon monofilament—similar to a bristle on a hairbrush—attached to a wand may be used or the foot pricked with a pin.

If you are unable to sense pressure from a pinprick or monofilament, and have lost protective sensation, you’re at risk for developing foot sores that may not heal properly. Your doctor may also check temperature perception or use a tuning fork, which is more sensitive than touch pressure, to assess vibration perception.

How is Diabetic Neuropathy treated?

There is no cure for diabetic neuropathy. Treatment focuses on slowing the development of the condition and making lifestyle changes. These lifestyle changes not only help slow nerve damage, but also promote overall health.

They include:

• Controlling blood pressure
• Eating a healthy diet
• Maintaining a healthy weight
• Exercising regularly
• Not smoking
• Limiting alcohol use.

Treatment focuses on alleviating pain and discomfort. Medication, physiotherapy/massage therapy, electrical treatment or aqua therapy are the means available to aid in easing neuropathy pain. Visit your doctor/podiatrist/chiropodist/foot health specialist for advice on the appropriate treatment.

Foot Care for Diabetics with Neuropathy

Extra special care is needed for persons with diabetic neuropathy. The feet carry the longest nerves and these tend to be the most affected ones. Injuries and cuts that lead to ulcers can develop and go unnoticed due to loss of sensation in the limbs. Poor circulation can cause darkened spots and also increase the chances of foot ulcers.

In the United States over 80,000 persons go under the knife for lower limb amputations. Over 50% of these persons are diabetic and the amputations are, in a number of cases, as a result of poor circulation and neuropathy, but more importantly lack of / poor foot care.

Steps to better foot care:

• Wash your feet with lukewarm water and an antibacterial soap daily. Ensure that when drying, between the toes are dried carefully.

• Foot inspection is critical on a daily basis. Check for blisters, swelling, callouses, redness/darkening or any unusual signs. If you are unable to inspect under the feet yourself, get someone to check it out as often as possible.

• Moisturising on top of and beneath the feet twice daily is important.

• Toenails should be trimmed straight across when necessary.

• Never walk barefooted.

• Use seamless socks and stockings.

• Shoes with improper support aren’t advised, ensure they fit well.

• It is advised that diabetics see their doctor every 3-6 months depending on the stage of diabetes; and their chiropodist/podiatrist/foot health practitioner every 1-2 ½ months to assist if needed in the trimming of the toenails or general cleaning up of the feet.

How to Cope

On occasion patients don’t get relief from treatment; their bodies don’t respond well to it and the pain sometimes intensifies. At times this may lead to serious disabilities such as difficulty in standing, walking, exercising or driving. Since performing routine activities could become difficult, it would help to do advance planning of activities. Space out tasks, and ask family and friends for assistance. Seek counseling if the situation becomes overwhelming at times.

We see a large percentage of diabetics at our Clinic, many of whom have benefitted from treatment; the key, however, is overall discipline in following the prescribed treatments and lifestyle changes.

Your feet mirror your general health . . . cherish them!

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