Diabetic neuropathy: everything there is to know!

Diabetic neuropathy: what is it? 

According to studies, the number of people with diabetes continues to increase every year and represents a major public health concern. It affects more than 5 million people in the UK, and is expected to affect more than 783 million adults worldwide by 2045.

Complications associated with diabetes are very common. One of the complications affects the nerves, and is known as diabetic neuropathy. 

Diabetic neuropathy is mainly due to long-term exposure to high blood glucose levels, or episodes of prolonged hyperglycaemia. These high sugar levels damage the peripheral nerves in particular, disrupting the transmission of signals between the brain and the rest of the body, as well as the autonomic nervous system, which controls the functioning of the viscera. 

Diabetic neuropathy therefore alters the activity of the peripheral nerves. This alteration may be functional, resulting in a slowdown in electrical conduction, and/or structural, destroying the nerve itself. Peripheral nerves are part of the nervous system and are located outside the central nervous system, i.e. they are not part of the brain or the spinal cord.

This condition remains silent for a long time but when it fully develops, it significantly affects the quality of life of patients. This is why annual screening is recommended by numerous health authorities throughout the world.  

How is diabetic neuropathy diagnosed?  

To diagnose diabetic neuropathy, a simple clinical examination by a GP may be sufficient. It usually includes questioning the patient, the assessment of blood glucose level, an examination of the feet and certain functional signs (cardiac, digestive, urinary). 

The doctor (a GP, a diabetes doctor or a neurologist) may then decide to assess the patient's sensitivity using various tests, such as: 

• An electromyogram (EMG), an examination that records the electrical activity of the nerves and muscles,
  
• The monofilament test, which involves applying constant pressure to the skin and then comparing the skin's sensitivity with the norms,
  
• Various other clinical neurological tests, such as the needle test for pain sensitivity, hot and cold water tubes, etc.

What are the symptoms of diabetic neuropathy?  

The symptoms of diabetic neuropathy vary depending on the nerves affected and may differ from patient to patient. 

They can include: 

• Sensory disturbances: sensations of tingling, burning, pain or numbness in the feet and hands. This loss of sensation can lead to the development of wounds that have been rendered painless. In severe cases, these wounds can become infected, leading to gangrene or even amputation, 
  
• Orthostatic (or postural) hypotension (a fall in blood pressure when standing up),
  
• Accelerated heart rate,
  
• Digestive disorders (diarrhoea, constipation),
  
• Excessive or insufficient sweating,
  
• Urinary problems (poor bladder and micturition control) or sexual problems,
  
• Loss of reflexes, 
  
• Impaired sensitivity to pain.
  

 The nerves affected are often those of the lower limbs. When several nerves are affected, such condition is known as polyneuritis.  

How to prevent diabetic neuropathy?  

Diabetic neuropathy can affect patients with both type 1 and type 2 diabetes, and is associated with various risk factors such as hypercholesterolaemia, obesity, smoking and high blood pressure, as well as poor diabetes management, which manifests itself in repeated hyperglycaemia.

To prevent the onset of diabetic neuropathy, blood sugar levels need to be monitored regularly and rigorously. It is indeed vital to maintain correct glucose levels. This can be achieved through insulin injections, of course, but also through a well-balanced diet, regular exercise and by taking the prescribed medication.

Particular attention must also be paid to the feet. This involves daily cleaning, inspection of the feet for any signs of infection, pedicure if necessary and wearing comfortable shoes to avoid injury. A foot examination by a doctor or a chiropodist is recommended every year.

How can diabetic neuropathy be treated?  

First and foremost, diabetic neuropathy can be managed by scrupulously following your diabetes treatment. It is essential to combine a healthy lifestyle, the right medication and regular blood sugar monitoring, to be able to limit the development of diabetic neuropathy as much as possible. 

The next step is treating the various disorders caused by diabetic neuropathy, and taking extra care of any wounds or injuries you may get. Treatment should be specifically adjusted to the organ affected or to the type of the injury. For example, a foot injury needs to be treated with a special dressing, urinary problems with anticholinergic drugs (regulators of the autonomic system responsible for the functioning of the viscera, the heart and the bladder), blood pressure problems with anti-hypertensive drugs, etc.

There also exist various options for treating pain caused by neuropathy, such as painkillers or local anaesthetics. If pain becomes disabling and and has too strong an impact on your everyday life, there are other solutions, such as transcutaneous electrical nerve stimulation (TENS). 

Physiotherapy is another option: it can help improve muscle strength and coordination, and thereby reduce the symptoms of diabetic neuropathy.

To conclude  

Diabetic neuropathy is a serious complication of diabetes, and also the most common one. With appropriate management, it is possible to minimise its effects on the quality of life of those affected.

Prevention remains the key, with rigorous blood sugar monitoring and appropriate foot care. Patient education plays a vital role in reducing the impact of this complication. 

If you develop any new symptoms, do not hesitate to see a healthcare professional for diagnosis and appropriate treatment plan.