How does nerve damage develop?
With chronically high glucose levels, products of impaired metabolism accumulate in nerve fibers, small vessels that feed them are damaged, and oxidative stress increases. The thinnest fibers responsible for pain and temperature sensitivity are the first to suffer, hence the burning sensation and loss of sensation of heat. Thick fibers that transmit vibration and sense of body position are then involved, and unsteadiness occurs when walking. Since the damage depends on the length of the nerve, symptoms begin in the toes and gradually move higher, later joining the hands.
- Distal symmetrical form is the most common
- Autonomic - disruption of the heart, stomach, bladder
- Focal forms - damage to a single nerve
- Radiculoplexopathy with pain and weakness in the hip
- Painful and painless forms are simultaneously possible
Causes and risk factors
The main factor is the duration of diabetes and the degree of its compensation: the higher the average level of glycated hemoglobin and the stronger the sugar fluctuations, the faster the nerves suffer. Additional contributions include smoking and alcohol abuse, high blood pressure, lipid disorders, excess weight and chronic kidney disease. It is important to remember that in a person with diabetes, neuropathy is not always diabetic: vitamin B12 deficiency, hypothyroidism, alcohol and taking certain medications give a similar picture, so the doctor excludes these causes.
- Long history of diabetes mellitus
- High glycated hemoglobin
- Smoking and alcohol abuse
- Arterial hypertension and dyslipidemia
- Overweight
- Chronic kidney disease
- Vitamin B12 deficiency
- Hypothyroidism and other metabolic disorders
Symptoms
There are two types of complaints. Positive symptoms - burning, tingling, crawling sensation, shooting pain, soreness from touching the sheet; they are worse at night and at rest. Negative - numbness, feeling of wobbly legs, loss of sensation of temperature and pain. The variant in which there is no pain at all is especially dangerous: the person does not feel the rubbing of shoes or hot water and discovers the wound too late. In the autonomous form, dizziness occurs when standing up, heaviness in the abdomen after eating, diarrhea or constipation, difficulty urinating, and decreased erection.
- Burning and tingling in the feet, worse at night
- Numbness like “socks” and “gloves”
- Decreased sensitivity to temperature and pain
- Cramps in the calves, unsteadiness when walking
- Dry and cracked skin on the feet
- Dizziness when standing up
- Digestive and urinary disorders
Diagnostics
The diagnosis is mainly clinical. The doctor checks the sensitivity of the feet with simple instruments: with a monofilament he evaluates protective tactile sensitivity, with a tuning fork - vibration sensitivity, with a needle and a cold object - pain and temperature, and also checks the Achilles reflexes. This examination is recommended for all patients with diabetes annually, and more often for existing neuropathy. The level of glycated hemoglobin shows the quality of sugar control. Electroneuromyography is needed for an atypical picture, asymmetry, or a rapid increase in weakness. Additionally, vitamin B12 deficiency, thyroid and kidney diseases are excluded.
- Examination of feet and assessment of sensitivity with monofilament
- Testing vibration sensitivity with a tuning fork
- Assessing reflexes and muscle strength
- Glycated hemoglobin and blood glucose
- Electroneuromyography according to indications
- Vitamin B12, TSH, creatinine
- Assessment of pulsation of the arteries of the foot
Foot treatment and care
The basis of treatment and the only way to slow nerve damage is steady compensation of diabetes without sudden changes in sugar, as well as smoking cessation, blood pressure and lipid control. To reduce neuropathic pain, the doctor selects drugs from the groups of anticonvulsants and antidepressants that act on pain pathways; Conventional painkillers are ineffective for this type of pain. Equally important is daily damage prevention: foot inspection, proper footwear, and careful nail care. Any wound on the foot with diabetes should be shown to a doctor and not treated on your own.
- Achieving Individual Glycemic Goals
- Quitting smoking and alcohol
- Blood pressure and lipid control
- Medicines for neuropathic pain as prescribed by a doctor
- Daily inspection of the feet, including between the toes
- Comfortable shoes without seams, seamless socks
- Checking the water temperature with your hand, not your foot
- Treatment of nails with a file, without cutting calluses
- Exercise therapy and walking as tolerated