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Complications of Diabetes

Diabetic Neuropathy

What is diabetic neuropathy?

IllustrationThe peripheral nerves have a function in conducting signals from the brain to the muscles as well as returning information from the skin such as sensations of touch, pain, temperature and position.  Diabetic neuropathy is a complication of diabetes which leads to loss of some of these nerve functions. Many other organs such as the heart, blood vessels, sweat glands and gut are also supplied by a meshwork of nerves and the function of these organs may also be affected in diabetic neuropathy.

What causes neuropathy?

There are many causes of neuropathy other than diabetes mellitus. In diabetes it is accepted that poorly controlled blood glucose concentrations are responsible. The exact mechanism for this association is not very well understood though many theories exist. People with diabetes who smoke, drink alcohol or have poor glucose control seem to have more neuropathy than other people with diabetes.

What are the symptoms?

  • Neuropathy affects sensory nerves so it is not surprising that loss of sensation is a prominent symptom. This commonly begins in the feet which feel numb or 'dead'. Ability to feel pain and heat is impaired which could lead to injury or burns. Neuropathy may exist without your knowledge - many individuals with diabetic neuropathy have no symptoms whatsoever. occasionally, diabetic nerve damage may be associated with painful symptoms. Patients variably describe shooting or stabbing pains with superficial burning sensations or pins and needles. The skin may be very sensitive to light touch and even the weight of the bedclothes at night may cause discomfort.
  • 'motor nerves' or nerves supplying muscles are less commonly affected in diabetic neuropathy. This may manifest as difficulty in walking or loss of dexterity.

Tell me more about neuropathic pain

Neuropathic pain can be intractable and disabling. Often these symptoms respond poorly to treatment and have a profound impact on quality of life. Some of the problems associated with long term painful neuropathy include:

  • disturbed sleep
  • poor concentration and memory
  • depression and mood swings
  • inability to work or perform activities of daily living

Who is at risk?

The risk of developing diabetic neuropathy increases with:

  • age and duration of diabetes.
  • Poorly controlled diabetes
  • smoking
  • other diabetic complications such as eye disease or kidney disease

What is the treatment?

For patients with painful neuropathy there are drug treatments available for pain relief including amitriptyline, carbamazepine and gabapentin.

Where can I access more information?

See: www.neuropathy-trust.org

 

Dr Nishan Wijenaike, Consultant Physician
West Suffolk Hospital Diabetes Service
October 2002