That tingling feeling? It can be nerve problems from diabetes 

Having diabetes makes it more likely for you to develop several health issues, such as eye problems and nerve damage that may occur in your arms or legs, or affect the function of your organs[1]. This condition -  diabetic neuropathy - happens when high blood sugar damages small blood vessels that supply nourishment to the nerves in your body, causing  nerve fiber damage as well[2].  Left untreated, it can even lead to infection or amputation[3].This affects a lot of diabetics (42% in 2000 alone [4]) - so read on to know how you can detect, test for, treat, and prevent this problem.

Types and symptoms of diabetic neuropathy
Symptoms vary according to the type of neuropathy that you have:

Peripheral neuropathy typically starts with numbness or loss of feeling,  from the feet and goes up to the legs, or with your hands going up to your arms.  This  can be potentially dangerous as the pain that you may not feel from an untreated cut, wound, blister ,broken bones; and can result in infection or worse, amputation.

Symptoms include: 

  • Tingling and numbness on your feet or hands.
  • Loss of ability to feel pain and/or changes in temperature, or increased sensitivity to touch
  • Inability to feel the position of your joints; and
  • Burning or shooting pain that is worse at night, or cramps

When this affects your foot, you may develop Charcot’s Joint, which is when the joint breaks down and becomes non-functional due to nerve damage. It also affects the muscles as well, leading to instability and loss of balance, resulting in the inability to walk properly. [5]

The autonomic nervous system controls all of our internal organs.  Since diabetes affects nerves, it also affects organ function. You may experience autonomic neuropathy [1], a common symptom, which is when the bladder no longer responds to the pressure when urine accumulates. Because of this, urine will not be released unless there is  push/pressure on  your lower abdomen. Long-term complications of this are urinary tract infections and incontinence.

Potential issues may include [1]:

  • Irregular heartbeats (arrhythmia) even at rest, and dizziness or lightheadedness when changing positions.
  • Gastroparesis, which are irregular movements of your stomach muscles, which can induce  bloating, constipation, and diarrhea.
  • Impotence or inability to keep an erection for males; and vaginal dryness for women.
  • Heat intolerance, especially sweating when eating or sleeping.

Less common types are focal (also known as single nerve / mononeuropathy, like carpal tunnel syndrome) or  proximal neuropathy (also known as diabetic
amyothrophy, affects nerves in thighs, hips, buttocks and legs but is usually
confined) [1].

How is this diagnosed?
After gathering your past medical history and asking about your daily lifestyle, your doctor will do a physical examination and special tests to diagnose nerve damage. Foot examination is usually done quickly, and only when patients report symptoms about it; so don't be afraid to ask for a more thorough exam to check for and rule out feet-related issues.

Here are potential tests to identify the types of neuropathy that you may have.

For peripheral neuropathy:

  • Ankle reflex and vibration testing - checks for reflex function, detects problems in the nerves and muscles[6].
  • Nerve conduction velocity - identifies affected nerves and muscles. Measures how quickly nerves respond to electrical signals
  • Monofilament testing[6]. - tests protective sensation. Doctor will brush a soft fiber over areas of skin to test touch sensitivity. This test is available in Capitol Medical Center[7]., and Chinese General Hospital[8].

For autonomic neuropathy:

      Specific tests may be done on the specific organ involved

  • Ultrasound test - checks the state of your bladder[9]
  • X-rays and other tests to check the activity of your stomach[9]
  • Electrocardiogram to observe heart rate, especially in certain movements or positions[9]

Treatment options
The main points of the treatment are to maintain blood sugar levels and blood pressure within your target range [1], depending on your age and state of health. You also have to be mindful of your kidney health, and work with your doctor on how to relieve the pain on your hands or feet.
Commonly prescribed drugs to manage nerve pain include the following[10]:
  • Anti-seizure medications are used to manage nerve pain. Side effects may include drowsiness, dizziness, and swelling 
  • Antidepressants aid the chemical processes to ease the nerve pain, and can be given even if there is no depression. Side effects may include dry mouth or drowsiness

Prevention and Management
By maintaining a healthy lifestyle, eating a balanced diet, continuous monitoring of your blood sugar levels, and blood pressure, you will be able to prevent nerve problems while living with diabetes. Exercise is also a must and if you smoke, then you should stop .

Supplementation can be a key factor for better nutrition and symptom relief.  A Vitamin B12 supplement is generally safe when taken as directed, as well as alpha-lipoic acid and acetyl-L-carnitine. Because side effects can happen, it is always best to follow your physician before adding to or modifying your supplements that you take.[11]

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Checked by Dr. Zandra Notario, M.D.