Diabetic Peripheral Neuropathy

Diabetic neuropathy is a form of nerve injury that can emerge as a result of diabetes. High blood sugar (glucose) levels can harm nerves all over your body but mostly affect the nerves in the legs and feet. Diabetic neuropathy symptoms can range from discomfort and numbness in your legs and feet to complications with your digestive system, urinary tract, blood vessels, and heart, depending on which nerves are impacted. Some people only experience minor signs and symptoms; while for others, it can be quite stressful. Diabetic neuropathy is a severe diabetes syndrome that affects up to 50% of people with the disease. However, proper blood sugar management and a healthy lifestyle can typically avoid or slow the progression of diabetic neuropathy.

There are four main types of diabetic neuropathy. You can have one or several types of neuropathy.
Your symptoms will be determined by the type of nerve damage you have and which nerves are affected. Usually, symptoms develop gradually. It’s possible that you won’t notice a thing until significant nerve damage has happened.

Peripheral Neuropathy

Another term used is distal symmetric peripheral neuropathy. Diabetic neuropathy of this sort is the most frequent. The feet and legs are initially affected, followed by the hands and arms. The following are some of the signs and symptoms of peripheral neuropathy that are often worse at night:

• Sharp pains or cramps
• Increased sensitivity to touch
• Severe foot problems, such as bone and joint discomfort, infections, ulcers, etc.

Autonomic Neuropathy

The autonomic nerve system regulates your heart, bladder, stomach, intestines, sex organs, and eyes. Diabetic nerve injury can occur in any of these regions, resulting in the following symptoms:

• Low blood sugar levels go unnoticed due to a lack of awareness
• Bladder or bowel problems
• Changes in the capacity of your eyes to adapt from light to dark

Proximal Neuropathy

This type of neuropathy, also known as diabetic amyotrophy or diabetic polyradiculopathy, frequently affects the nerves in the thighs, hips, buttocks, or legs. However, it might impact the chest and abdomen as well. The symptoms normally appear on one side of the body, although they can move to the other.

• Severe hip, thigh, or buttock pain
• Eventual weak and shrinking thigh muscles
• Difficulty rising from a sitting position
• Severe stomach pain

Mononeuropathy

Mononeuropathy is classified as either cranial or peripheral. Damage to a specific nerve is referred to as mononeuropathy. Mononeuropathy may also lead to:

• Difficulty focusing or double vision
• Aching behind one eye
• Weakness in your hand might cause you to drop things

• You have an infected or non-healing cut on your foot.
• Burning, trembling, weakness, or discomfort in your hands or feet that impacts everyday activities or sleep
• Changes in digestion, and urination
• Dizziness and fainting

The American Diabetes Association suggests that diabetic neuropathy screening begins shortly after a person is diagnosed with type 2 diabetes and five years after a person is diagnosed with type 1 diabetes. After that, screening is recommended annually.

Neuropathy’s exact cause is unknown. Researchers believe that untreated high blood sugar destroys nerves and interferes with their ability to send signals over time, resulting in diabetic neuropathy. Likewise, blood sugar also weakens the walls of capillaries, which deliver oxygen and nutrients to the nerves.

Risk factors

Anyone who has diabetes can develop neuropathy. However, the following risk factors make nerve injury more likely:

Poor Blood Sugar Control

Uncontrolled blood sugar increases the chance of every diabetic complication, including nerve damage.

Diabetes History

The longer you have diabetes the risk of diabetic neuropathy rises, especially if your blood sugar isn’t well maintained.

Kidney Disease

When the kidneys fail, toxins enter the blood and cause nerve damage.

Being Overweight

A BMI of 25 or higher increases your risk of acquiring diabetic neuropathy.

Smoking

Smoking causes your arteries to narrow and harden, limiting blood flow to your legs and feet. This makes the healing process more difficult and harms peripheral nerves.

Diabetic neuropathy is usually diagnosed by performing a physical exam, and carefully reviewing medical history and symptoms.

Your doctor will check your:

• Overall muscle strength and tone
• Tendon reflexes
• Sensitivity to touch and vibration

The specialists at Padda Institute, may perform or order specific tests to help diagnose diabetic neuropathy along with the physical exam, such as:

Filament Test

Brushing a soft nylon fiber (monofilament) on your skin to test your sensitivity to touch.

Sensory Testing

Non-invasive test to check how your nerves respond to vibration and changes in temperature.

Nerve Conduction Testing

This test is often performed to diagnose carpal tunnel syndrome. It tests the electrical conductivity of the nerves in your arms and legs.

Muscle Response Testing

Electromyography is often done with nerve conduction studies. This procedure measures the electrical discharge produced by muscles.

Autonomic Testing

Depending on your position and whether you sweat normally, special tests may be performed to measure your blood pressure.

It is possible to prevent further nerve damage by controlling your blood sugar. Unfortunately, it won’t reverse the damage or relieve the pain caused by diabetic nerve damage. It may be necessary to receive a specific diabetic nerve pain treatment.

Oral drugs, which just mask the symptoms, are the most commonly used strategy.

• Opioids are used to treat 50 percent of diabetic peripheral neuropathy patients
• Anti-inflammatory medicines are used by 40% of people.
• Serotonin reuptake inhibitors are used by 20% of patients (SSRI)
• Tricyclic inhibitors are used by 11% of people.
• Anticonvulsants are used by 11% of people (Neurontin and Lyrica)

Although a variety of pharmacological medications are available to treat the pain associated with diabetic neuropathy. The US Food and Drug Administration (US FDA) has only approved duloxetine and pregabalin for the treatment of diabetic neuropathic pain.

Pregabalin (Lyrica, Pfizer), the “gold standard” in treating peripheral neuropathy, helps 39 percent of patients attain a 50 percent reduction in their discomfort and pain, but it also causes problems in at least 38 percent of patients. These drugs have significant downsides and side effects. The FDA has not approved over-the-counter pain relievers to treat this type of discomfort.

Combined Therapy

Specialists at Padda Institute use combined therapy to successfully treat diabetic neuropathy. The therapy combines two well-known techniques into a program. It is showing significant promise as a treatment for diabetic and idiopathic neuropathies. Combination therapy consists of two procedures, a local anesthetic Ankle Block and Electronic Signal Therapy (EST), which utilizes a highly sophisticated electro anesthetic wave generator.

Ankle Block

Five nerves important for sensory supply distal to the ankle are targeted by the ankle block. Four branches of the sciatic nerve (superficial peroneal, deep peroneal, sural, and posterior tibial nerve) and a cutaneous branch of the femoral nerve (the saphenous nerve) comprise the nerves. The common peroneal and tibial nerves are two terminal branches of the sciatic nerve.

Electronic Signal Treatment

EST uses electrical signals to regenerate nerves and increase blood flow by stimulating nerve function in the damaged areas. Electronic signal treatment relies on both varied amplitude (AM) and frequency (FM) of electronic signals using computer-controlled, exogenously delivered specific parameters of cell signals.

When applied to the human body, this digitally created electronic sinusoidal alternating current with associated harmonics creates scientifically documented and/or theorized physiological consequences. The electronic signal treatment medical device employs sophisticated communications technology to generate and transfer higher frequency signal energy via customized electrodes in a constantly altering sequential and random manner. This switching between sequential and random electronic signal supply removes neuron accommodation.

With the use of 0.25 percent Marcaine, a local anesthetic, and a vasodilator (opens blood vessels for a short time to enhance blood flow). When your nerves are stimulated, they receive more blood flow, which results in faster regeneration.

Combined therapy is believed to:

• Increases cellular growth
• Increases Metabolic Activity
• Reduces swelling around the nerve
• Stimulates nerve function
• Directly increases blood and oxygen to the nerves
• Promotes wound healing
• Anti-inflammatory action
• Reduces scar tissue development

With a successful and acceptable pain management treatment plan, the patient will be able to regain more mobility.

Auricular vagal nerve stimulation. Where medication and metabolic management have not brought the pain under control, we use the NS-100 — an FDA-cleared Class II programmable peripheral electrical nerve stimulator made by Nalu. It is applied to the auricular branches at the ear and acts as a vagal stimulator, working through how pain signals are processed centrally rather than by interrupting the nerves in the feet. It is worn for up to 30 days, most often around 20. Placement uses local anesthetic with no sedation, you drive yourself home, and there are no activity restrictions. Peripheral nerve stimulation is a covered category under Medicare’s national coverage determination for electrical nerve stimulators, with criteria set by local coverage policy — your own coverage is verified before scheduling. Read more about peripheral nerve stimulation.

Diabetic neuropathy raises the risk of a fall, but it is not the only reason a diabetic patient becomes unsteady — inner-ear function is affected independently of the nerves in the feet. Balance and fall-risk testing measures both.