Diabetic Neuropathy - Causes, Diagnoses and Treatment

So what, then causes diabetic neuropathy? The pathology can be detailed under four arms. The first is Micro-vascular disease or microangiopathy. What is that all about?

Well as with most diabetes complications, the major culprit here is sugar. Because diabetes is characterized by the bodies inability due to lack of insulin or insulin resistance to take up blood sugar, nerve fibers experience an over long exposure to it.

This not only affects the ability of the nerves to transmit signals but also weakens and constricts the walls of the small blood vessels (capillaries) supplying the nerves with nutrients and oxygen such that supplies of both to the nerves is diminished. It is this nerve damaging condition that is known as microangiopathy.

Now, since blood vessels require normal nerve function and nerves depend on adequate blood flow, failing nerve function leads to further deterioration in the blood circulatory system. This sets up a cycle that eventually snowballs into the complications of Diabetic Neuropathy.

Secondly, we have the Polyol pathway (or sorbitol/aldose pathway). This pathway is fingered as a likely agent in diabetic complications that result in microvascular damage to nervous tissue.

It is activated by elevated glucose levels and increases reactive oxygen radicals and sorbitol. This decreases the activity of plasma membrane NA+/K+ATPase pump required for nerve function, thus contributing greatly to the neuropathy.

Advanced glycated end products, product of a non-enzymatic covalent bonding with proteins induced by elevated intracellular levels of glucose, is another factor in the onset of DN. This bonding alters the protein structure and interferes with their function.

Lastly the increased levels of glucose leads to an increase in intracellular diacyglycerol. This activates Protein Kinase C or PKC an inhibitor of neuronal blood flow and thus nerve conduction.

Apart from excess sugar in the blood stream, other risk factors for Diabetic neuropathy are the length of time one has the diabetes. With the risk of coming down with diabetic neuropathy increasing the longer one has diabetes.

In addition to this, being overweight-that is having a body mass index greater than 24 is another risk factor for developing diabetic neuropathy. Further kidney disease may equally increase the toxins in the blood and so contribute to nerve damage.

Furthermore, since smoking constricts and hardens the arteries, reducing blood flow to the legs and feet, it makes it more difficult for wounds to heal and causes damage at the same time to the peripheral nerves. Thus smoking is also a risk factor for getting diabetic retinopathy.

There are several serious complications associated with Diabetic neuropathy.

First, anyone suffering from the disease, runs the risk of limb loss. This happens usually when nerve damage causing a lack of feeling in the feet, mean that sores or cuts may go unnoticed, and as such become ulcerated or infected.

Where such infections spread to the bone, become gangrenous and untreatable, amputation of the affected toe, foot or leg may be the only solution.

Another complication that may arise is urinary tract infection. Where damage to the nerves that control the bladder prevents it from emptying out completely, bacteria can gain access to and multiply in the bladder and kidneys leading to the infections.

In addition to that, the ability to detect when you need to urinate or to control the muscles that release urine may be impaired by nerve damage and as such also occasion incontinence.

Further, the incidence of Charcot joint is another phenomena that must be considered.

This takes place when a joint usually in the foot because of nerve damage, deteriorates. The condition is evidenced by swelling, loss of sensation, instability and at times deformity in the joint. The good news here is that early treatment can arrest further damage and in fact stimulate healing.

Furthermore, Hypoglycaemia unawareness, the condition where the sufferer becomes unaware that his blood sugar has dropped too low-below 70 miligrams per deciliter (mg/dL) or 3.9 milimoles per iter (mmol/L), can also be occasioned by Diabetic neuropathy.

So too can low blood pressure and digestive problems, where nerve damage to the digestive system can lead to diarrhoea, constipation and Gastro paresis. Gastro paresis is a condition in which the stomach does not empty or does so too slowly thus leading to nausea, bloating and loss of appetite.

Again, increased or decreased sweating is another function that may be impacted by the condition. Where there is a reduction of or total stoppage of perspiration (anhidrosis), this can be life threatening as the body is no longer able to use the sweating mechanism to regulate temperature properly and also assist in toxins excretion.

Yet again because autonomic neuropathy often damages the nerves affecting the sex organs, it may lead to sexual dysfunction in sufferers-erectile dysfunction in men and lubrication and arousal problems in women.

So how is a person diagnosed with Diabetic Neuropathy? This is done based on the symptoms experienced, a physical exam and the medical history of the person.

The physical exam will take note of tendon reflexes, muscle strength and tone as well as sensitivity to touch, temperature and vibration.

Other tests which may be conducted are the Filament test, to test sensitivity to touch; the nerve conduction studies to measure how quickly the nerves in the arms and legs conduct electrical signals; Quantitative sensory testing used to assess nerve response to vibration and changes in temperature; Electromyography (EMG) which measure the electrical discharges produced in the muscle; Autonomic testing which measures patient blood pressure in different positions and sweating ability.

Further to this, the American Diabetic Association recommends that all people with diabetes have a comprehensive foot exam at least once a year to check for foot and joint abnormalities which may evidence the condition.

So supposing you get tested for the condition and the tests return positive, what then is the prognosis for the cure? Well sadly for now, Diabetic neuropathy has no cure. Treatment is however centered on relieving pain, slowing down the progression of the disease, managing complications arising from it and restoring function.

How is this done? Generally, maintaining your doctors recommended blood sugar range is a great prevention or slow down tactic that can improve some of the symptoms.

Thus blood sugar levels of between 80 and 120 mg/dL or 4.4 and 6.7 mmol/L for people age 59 and younger who have another underlying medical condition; between 100 and 140 mg/dL or 5.6 and 7.8 mmol/L for people age 60 and older or those who have other medical conditions, such as heart, lung or kidney disease has been recommended by some.

Pain relieving treatment on the other hand may include anti-seizure medications- gabapentin, pregabalin and carbamazepine; antidepressants- tricyclic antidepressant medications, serotonin and norepinephrine reuptake inhibitors and capsaicin cream.

Physical therapy and acupuncture have also been known to relieve pain. Other alternative treatment forms include the use of alpha-lipoic acid and transcutaneous electrical nerve stimulation (TENS).

For other specific complications however for example sexual dysfunction, the drug sildenafil and for urinary tract problems, antispasmodic medications may be enlisted.

Apart from following your doctors advise, further recommendations for slowing down nerve damage include following a healthy-eating plan, maintaining a healthy weight, keeping your blood pressure under control, getting plenty of exercise, stopping smoking and the avoidance of alcohol, or moderacy in drinking it where allowed.

As such, notwithstanding the non-availability of a cure, with the uptake of the foregoing advice and use of available medication, the sufferer can find relieve, improve his condition and enjoy a better quality of life than he would otherwise have had.