Diabetic pain caused by neuropathy
Diabetic neuropathy – lesions of nerves that belong to the peripheral nervous system. These are the nerves with which the brain and spinal cord control muscles and internal organs. Diabetic neuropathy is a common and dangerous complication of diabetes. It causes a variety of symptoms.
What is diabetic neuropathy?
Neuropathy is a common name for complications affecting the nervous system. Diabetic patients who do not take enough care in controlling their diabetes stand a higher risk of developing diabetic neuropathy.
A reduced sense of touch is the most common symptom of diabetic neuropathy.
This condition can either be short-term (acute) or long-term (chronic). Acute neuropathy usually disappears when the diabetes has been properly cared for, while chronic neuropathy has more serious implications.
The neuropathy can affect the nervous system in different ways:
- Abnormal sense of touch – usually reduced sensation, which can lead to small injuries being ignored, or pain.
- Muscle function (motor control) – incoordination.
- The inner organs and blood vessels (the autonomic system) – such as bowel and bladder control, leading to incontinence or diarrhea.
What causes diabetic neuropathy?
Diabetic neuropathy is caused by a prolonged, high blood glucose level. Once the blood glucose level rises above a certain point, the nerves throughout the body gradually begin to be damaged.
What are the symptoms of diabetic neuropathy?
Neuropathy in the sensory system is associated with pain – described as tingling, stabbing, burning or shrill – and usually occurs at night.
The reduced sense of touch is the most common form of neuropathy in the sensory system. It is painless, although, sometimes, it might feel as if you are walking on cotton.
The reduced sense of touch most often occurs in the feet and legs, less often in the arms and hands.
Neuropathy that affects motor control and muscle function is not as common. Symptoms of this kind are a reduction in muscle function such as weakness in the arms and legs. Sometimes this results in an abnormal way of walking and misalignment of joints, mostly in the feet.
Neuropathy in the inner organs, namely the autonomic nervous system, can give rise to the following symptoms:
- dizziness, especially after standing up too quickly
- nausea and vomiting after meals
- diarrhea or constipation
- problems urinating
- problems detecting low blood glucose level
- impotence in men.
Diabetic neuropathy prevention
The best preventive measure against diabetic neuropathy is to keep the blood glucose levels as near normal as possible.
Neuropathy is most common in the feet which should be inspected daily to avoid sores. This is a very important aspect of treatment as carelessness in this area could result in infections and, in the worst cases, amputation.
All diabetics should see a chiropodist regularly for treatment of calluses, nails, etc.
Diabetic neuropathy diagnosis
The diagnosis is made by checking for the following:
- the presence of common symptoms
- reflex response
- sense of vibration using a tuning fork
- blood pressure, laying down and standing up
- results of electrocardiogram (ECG)
- other areas of concern, at the doctor’s discretion.
Acute neuropathy, which is very rare, usually goes away in a matter of weeks or months after the blood glucose levels have been normalized.
Chronic neuropathy does not disappear but can be kept under control by optimizing diabetic control.
How is diabetic neuropathy treated and with which kind of medicines?
The most important aspect in treating neuropathy is controlling the blood glucose level and checking your feet daily to prevent the development of foot sores.
The reduced sense of touch cannot be treated with medicines.
The pain associated with touch can be controlled by medicines such as:
- light painkillers (paracetamol or aspirin)
- in some cases with the tricyclic antidepressants amitriptyline or nortriptyline (unlicensed use).
- the antiepileptic medicine gabapentin is licensed for nerve pain and is an effective alternative to a tricyclic antidepressant.
- some opioid painkillers, such as tramadol or dextropropoxyphene, may be useful if other treatments have failed.
- capsaicin cream may also be useful.
- Compression stockings can be tried as a treatment for dizziness from standing up too quickly.
- Nausea and vomiting can be treated with anti-emetics.
- Tetracycline can be used for diarrhea (unlicensed use).
- Codeine phosphate or other antimalarial medicines may also be tried.
- Learning how to self-catheterize the bladder can be helpful for bladder problems.
- Impotence can be treated with tablets or injections.