Friday, November 13, 2009

Complications of Diabetes (Neuropathy) Part 2

Good day to you all. I’d like to get right back in to our discussion on neuropathies caused by diabetes. These I also know something about as I have and do experience a number of them already. This has been caused partly by going so many years undiagnosed, allowing the diabetes to run rampant through my body.

One type of neuropathy I deal with is peripheral neuropathy. My feet, as I said in my previous post, have shown signs of neuropathy since I was diagnosed. My hands have carpal tunnel syndrome and I have custom made casts for both. It is A-typical (not typical), and linked to the diabetes. I often don’t feel it when I have hurt myself. I do some light woodworking and most of my own home renovations and I must be very careful handling my power tools. Often I don’t know I have cut myself until I see the blood flowing. A dangerous thing to be sure.

I suffer several of the symptoms listed below. Numbness and insensitivity to pain I deal with daily. When a new area is going to go permanently numb, I will first feel tingling, burning and prickling in that area, sometimes for several months. Often through the day I have unexplained sharp pains and cramps. And loss of balance and coordination just to round things off and make life interesting.

Peripheral neuropathy is responsible for damage in the arms and legs. The lower extremities (feet and legs) are usually affected before the upper extremities (hands and arms). Often diabetics feel no symptoms. Regular diabetic appointments with your doctor are recommended because he may be able to detect signs of neuropathy that you can’t yet.

Symptoms of peripheral neuropathy include:

  • numbness or insensitivity to pain or temperature
  • a tingling, burning, or prickling sensation
  • sharp pains or cramps
  • extreme sensitivity to touch, even light touch
  • loss of balance and coordination
  • These symptoms are often worse at night

Muscle weakness and loss of reflexes can be caused by peripheral neuropathy. Loss of reflex at the ankle can change the way a person walks. Foot deformities, like hammertoes and the collapse of the mid-foot can result.

Having feet that are numb or have lost feeling makes it easy not to notice injuries.

For instance, a few days ago I sliced the bottom of my foot, on the ridge back of the toes. I barely felt it, even to walk on. Had I not immediately taken care of it I would run the risk of infection. The infection can then spread to the bone resulting in amputation. Not something anyone would want.

A few years ago I had a friend who was diabetic. He had an injury to his ankle and despite being under a doctor’s care infection set in. He has now had several amputations to that leg as the doctors attempt to get rid of the infection that had spread to the bone. Every time the infection has started once again in the stump.

Please take care of ANY injuries promptly and if there is ANY sign of infection get in to your doctor immediately. If you are diabetic don’t try to care for an infection yourself. Your immune system is weak and may need help to battle it. Even a very small cut, if it won’t heal, can cause a life and/or limb threatening infection.

Autonomic neuropathy affects the nerves that control the heart, regulate blood pressure, and control blood glucose levels. Other internal organs can also be affected. Problems with digestion, respiratory function, urination, sexual response, and vision can result. One may not experience the warning symptoms of hypoglycemia because the system that restores blood glucose levels to normal after a hypoglycemic episode (low blood sugar) can be affected,

I know something about hypoglycemia unawareness. I used to have definite signs of having a “low”. Shaking, sweating, nausea, weakness, and palpitations. I only had to get below a 5 to start feeling the signs. Now I don’t feel them. I am nauseous much of the time to begin with, so I no longer have that signal to rely on. The symptoms don’t happen now till I am under a 4 and usually not till I am approaching a reading of 3.5 or less.

The heart and blood vessels are part of the cardiovascular system. This is the system that controls blood circulation. Autonomic neuropathy can affect this system as well. When the nerves are damaged in this system it interferes with the body’s ability to adjust blood pressure and heart rate. Blood pressure can drop sharply after sitting or standing, making one feel light-headed or even cause one to faint. Damage to the nerves that control heart rate can make your heart rate stay high instead of rising and falling. A normal part of body function and physical activity.

Nerve damage to the digestive system most commonly causes constipation. It can also cause the stomach to empty too slowly, a condition called gastroparesis. It can cause persistent nausea, vomiting, bloating, and loss of appetite. Something I suffer from. Because you cannot digest your food properly gastroperesis can cause your blood glucose to fluctuate wildly. Damage to the esophagus can make it difficult to swallow, and damage to the bowels can cause constipation alternating with frequent, uncontrolled diarrhea, especially at night. A faulty digestive system can also cause weight loss.

Autonomic neuropathy often affects the organs that control urination and sexual function. The bladder cannot empty completely, which can allow bacteria to grow in the bladder and kidneys, causing urinary tract infections. When the nerves of the bladder are damaged, a person may be unable to sense when the bladder is full or control the muscles that release urine. Urinary incontinence, either partial or total, can be a result. Many of us, as we get older, experience some incontinence. Like dribbling when we laugh, etc. The neuropathy makes it worse, of course.

Autonomic neuropathy can also decrease sexual response, although the sex drive may not change. A man may not be able to get an erection or may climax without ejaculating normally. A woman may have difficulty with arousal, lubrication, or orgasm.

The nerves that control sweating can be affected by autonomic neuropathy too. Damage to the nerves can prevent the sweat glands from performing properly and the result is that the body cannot regulate it’s temperature properly. This damage can also cause profuse sweating at night or while eating. Something I go through on a regular basis, though in my case menopause is a factor as well.

Autonomic neuropathy can affect the eyes. The pupils become less responsive to changes in light. A person may not be able to see well when a light is turned on in a dark room because the eyes won’t adjust quickly to the change, or you could have trouble with your night vision while driving. It seems to me that my vision is not only affected when in a dark room, or for driving but, due to the fact I wear bi-focal lenses now, I have a hard time focusing or getting the correct distance from the page to use either the upper portion of my glasses, or the lower portion meant for reading. On my computer my head is at an awkward angle in order to see the screen. Often this causes eye strain, and neck strain resulting in headaches.

Proximal neuropathy, sometimes called diabetic amyotrophy, amongst other names too hard to understand, starts with pain in the thighs, hips, buttocks, or legs, normally on one side of the body and is more common in those with type 2 diabetes and in older adults with diabetes. It causes weakness in the legs and difficulty going from a sitting to a standing position without help. Treatment for weakness or pain is usually needed. The recovery period varies, depending on the type of nerve damage.

Focal neuropathy appears suddenly and affects specific nerves, most often in the head, torso, or leg.
It may cause an inability to focus, double vision, aching behind one eye, paralysis on one side of the face, (called Bell’s palsy), severe pain in the pelvis or lower back, pain in the front of a thigh, pain in the side, stomach or chest, pain on the outside of the shin or inside of the foot, chest or abdominal pain (sometimes mistaken for heart disease, a heart attack, or appendicitis.It happens mostly in older adult diabetics and is painful and unpredictable, though it does tend to improve on its own over weeks or months and no long-term damage is caused.

People with diabetes also tend to develop nerve compressions, (or entrapment syndromes). Of these the most common is carpal tunnel syndrome. Carpal tunnel syndrome is typified by numbness and tingling of the hand and occasionally muscle weakness or pain. Other nerves susceptible to entrapment can cause pain on the outside of the shin or the inside of the foot.


I think I have covered most of the effects and types of neuropathy so, at this point I would like to thank my readers for coming back. I hope you are finding the information valuable and I look forward to your comments. The next installment(s) will be addressing prevention, diagnoses and treatment of diabetic neuropathies.

Wednesday, November 11, 2009

Complications of Diabetes (Neuropathy) part 1

Well here I am again. I woke up this morning with my feet half asleep and slightly numb. Ah ha, I thought, here are my next several posts. The complications of diabetes.

These can be many and varied, including, but I think, not limited to :

  • diabetic neuropathy: the nerve damage
  • heart disease and stroke
  • diabetic retinopathy (diabetic eye disease)
  • erectile dysfunction
  • hypoglycemia (low blood glucose)
  • kidney disease and failure
  • sexual and urological problems
  • stomach nerve damage (gastroperisis)
  • liver damage
There are several on the list that I now know something about. Like diabetic neuropathy.


When I was first diagnosed and attended my first diabetic clinic they tested my nerve feeling in my feet. First they had me look away and (I saw afterward) ran a feather around my feet. I couldn't feel it. A sign of some nerve problems already.


Next they poked my feet with something (a pin I think). This I could feel, indicating that the nerve damage wasn't too bad yet, but was definitely there.


Some people with nerve damage have no symptoms. Others may have symptoms such as pain, tingling, or numbness—loss of feeling—in the hands, arms, feet, and legs.

These symptoms depend on the type of neuropathy and which nerves are affected.


The first symptom is often numbness, tingling, or pain in the feet. This is often minor at first and because most nerve damage occurs over several years, mild cases may go undetected for a long time. However, for some people the onset of pain can be sudden and severe. Symptoms can involve the sensory, motor, and autonomic—or involuntary—nervous systems.


Symptoms of nerve damage may include:


  • numbness, tingling, or pain in the toes, feet, legs, hands, arms, and fingers
  • wasting of the muscles of the feet or hands
  • indigestion, nausea, or vomiting
  • diarrhea or constipation
  • dizziness or faintness due to a drop in blood pressure after standing or sitting up
  • problems with urination
  • erectile dysfunction in men or vaginal dryness in women
  • weakness

Though my muscles are not wasted, yet, I fight with just about everything on the list! Even as I write this my hands are fairly numb. My toes and half my feet are going numb off and on, depending on where I put them.


I don't have vomiting most of the time. I have constant nausea which I take another medication for. And acid reflux disease, a severe form of indigestion which I take yet another medication for. I have gone through several medications and developed a resistance to them so I have had to change every so often.

I experienced numbness, and tingling. My feet and hands go numb (what most would call "going to sleep") quite a bit, and on the side of my knee I had felt a tingling sensation, (somewhat itchy too when it tingled), for a long time. Now the area is just numb. At least on the surface. I can still feel a good poke in those areas though.


I have bouts of alternating diarrhea and constipation. The bouts of diarrhea are the worst. I can't go out of my home or be very far from a bathroom, which makes it difficult to work at times even though I only work part time, one or two days a week. When it hits, with absolutely NO warning, I need a bathroom NOW!!


If I am faced with a bout of constipation I only have problems when my system starts working again. Then I experience excruciating cramps and pain until I am able to relieve myself. Often I will go from constipation right into a bout of diarrhea. Not a whole lot of fun to say the least.


Everywhere I go, I scope out where the nearest bathrooms are. I don't go out and visit much anymore either because I find it embarrassing to be hit with a bout of diarrhea while visiting.


Is it any wonder that some fight with symptoms that are not due to neuropathy, but often accompany it, including weight loss and depression.


Nerve problems can occur in every organ system, including the digestive tract, heart, and sex organs.

Up to 70 percent of diabetics have some type of neuropathy. And it can develop at any time, though there is an increased risk the older you are and the longer you have had diabetes. The highest rates of neuropathy are amongst people who have had diabetes for at least 25 years.


Diabetic neuropathy also seems to be more common in people who have problems controlling their blood glucose, also called blood sugar, as well as those with high levels of blood fat, high blood pressure and those who are overweight. Many diabetics on insulin become overweight. A side effect of insulin is weight gain and it's a catch 22. The more weight you gain the more insulin you need, the more insulin you need, the more weight you gain.


The causes are probably different for different types of diabetic neuropathy. Nerve damage is likely due to a combination of factors:

  • metabolic factors, such as high blood glucose, long duration of diabetes, abnormal blood fat levels, and possibly low levels of insulin
  • neurovascular factors lead to damage of the blood vessels that carry oxygen and nutrients to nerves
  • autoimmune factors cause inflammation in nerves
  • mechanical injury to nerves, like carpal tunnel syndrome
  • inherited traits that increase susceptibility to nerve disease
  • lifestyle factors, such as smoking or alcohol use

Classifications of diabetic neuropathy are peripheral, autonomic, proximal, or focal. Each affects different parts of the body in different ways.

  • Peripheral neuropathy, the most common type, causes pain or loss of feeling in the toes, feet, legs, hands, and arms.
  • Autonomic neuropathy causes changes in digestion, bowel and bladder function, sexual function and response, and perspiration and can affect the nerves that serve the heart and control blood pressure, nerves in the lungs and eyes. It can cause hypoglycemia unawareness as well, a condition in which people no longer have the warning symptoms of low blood glucose levels.
  • Proximal neuropathy causes pain in the thighs, hips, or buttocks and leads to weakness in the legs.
  • Focal neuropathy is the sudden weakness of one nerve or a group of nerves, causing muscle weakness or pain. Any nerve in the body can be affected.

Peripheral neuropathy affects:
  • toes
  • feet
  • legs
  • hands
  • arms

Autonomic neuropathy affects:
  • heart and blood vessels
  • the digestive system
  • the urinary tract
  • sex organs
  • sweat glands
  • eyes
  • lungs

Proximal neuropathy affects:
  • thighs
  • hips
  • buttocks
  • legs

Focal neuropathy affects:
  • eyes
  • facial muscles
  • ears
  • pelvis and lower back
  • chest
  • abdomen
  • thighs
  • legs and feet

I think I will stop here for today. Tomorrow I will discuss the various types of neuropathy in a bit further depth. I hope this blog on diabetes is helpful to some, especially those newly diagnosed. Till my next post, God bless.