Neurological Complications Due to Diabetes
Patients with diabetes have more complications from nerve damage, called neuropathy, because of diabetes.
High blood sugar can damage the nerve fibers of the entire body, but the lower limbs and feet are usually the most vulnerable.
Depending on the nerve injury, the symptoms can vary from pain, loss of sensation in the lower extremities to symptoms of the digestive system, urinary tract, blood vessels, and heart.
Some patients have mild symptoms but many patients also have terrible pain, incapacity and even death.
Neurological disease due to diabetes is the most serious complication of diabetes.
Symptoms
Neurological disease due to diabetes has four main types. Patients may have a form or a symptom of many types at once.
Most of the symptoms manifest slowly as the patient did not notice them until a serious injury.
Some patients have symptoms even before diabetes is diagnosed.
Symptoms of neurological disease due to diabetes vary depending on what type and how nerve injury:
Peripheral neuropathy
Peripheral neuropathy is the most common neurological disease due to diabetes.
It hurt the nerves in the feet, lower limbs, arms, and hands, but the lower limbs and feet are usually affected most.
These symptoms include:
* Numbness or decreased sensation of pain, hot and cold temperatures, especially in the feet.
* Stinging sensation, such as tingling, burning starts in your toes and gradually spreads to the feet.
Pain like a knife stabbing, such as electric shocks or knives, often up at night.
* Increased sensitivity to touch, feel – a few patients, even the feel of a blanket is painful.
* Loss of balance and coordination
* Muscle weakness and difficulty walking
* Many leg problems are severe, such as ulcers, infection, deformity, and painful joints.
Autonomic neuropathy
Autonomic nervous system controls the operation of the: heart, bladder, lung, stomach, digestive, reproductive organs, and eye.
Diabetes can damage the nerve fibers in any organ, causing:
* Bladder problems: recurrent urinary tract infection
* Digestive problems: heartburn and abdominal pain
* Constipation, diarrhea, uncontrollable, or a combination of constipation and diarrhea
* Indigestion caused by gastric (stomach paralysis), leading to nausea, vomiting or loss of appetite.
* Erectile dysfunction affects over 50% of men with diabetes over 60 years old.
* Vaginal dryness and difficulty in sexual activity in women.
* Increased or decreased sweating
* The inability to regulate blood pressure and heart rate, leading to postural hypotension when the patient changes posture to sit or stand.
* Issues related to regulating body temperature.
* Change the way the eyes adjust from light to dark.
Also known as femoral neuropathy or muscle atrophy caused by diabetes.
This often occurs as pain in the hip, thigh, and buttocks, usually starting on one side and eventually leading to muscle weakness and muscle atrophy.
It is most noticeable when patients change positions from sitting to standing.
Focal neuropathy
Focal neuropathy is manifested in the rapid weakness of a nerve, or group of nerves, leaving the muscles weak and/or in pain.
Focal neuropathy can affect any nerve in the body, but usually occurs in the torso, leg, or head.
Common in elderly patients. Neurological disease that can cause localized pain and may disappear after a few weeks.
Symptoms include:
* Difficulty focusing eyes, double vision, or pain behind the eyes.
* Paralyze the side of the face
* Pain in the lower leg or foot.
Sometimes neurological disease is caused by localized pinched nerve fibers.
Carpal tunnel syndrome is the most common form of focal neuropathy in patients with diabetes.
Symptoms of carpal tunnel syndrome:
* Numbness, swelling, or stinging in the fingers while driving or while holding the newspaper.
* Pain spreading from the wrist up the arm, shoulder, or spreading to the palms, fingers.
* Feeling of weakness in the hand and a tendency to drop objects.
Cause
A complex system of nerves running throughout the body, connecting the brain to the muscles, the skin, and other organs.
Through the nerves, the brain will feel the pain and temperature, control, and operation of automated tasks.
High blood sugar can damage the nerve fibers, but the exact reason is not known.
High blood sugar affect the capillaries that supply blood and nutrients to the nerve fibers.
Other factors
Other factors may contribute to neurological disease caused by diabetes, including:
* Autoimmune inflammatory response of nerve fibers. When the immune system mistakenly attacks the body’s organs.
* Alcohol and tobacco, both damage nerves and blood vessels, increasing the risk of infection.
Risk Factors
* Poor blood sugar control. This is the biggest risk factor for all diabetes complications, including neurological complications.
Keeping blood sugar stable is the best way to protect the nerves and blood vessels.
* The risk of neuropathy due to diabetes increased over time with diabetes, especially if blood sugar is not well controlled.
* Age. Older patients are more at risk from diabetic neurological problems.
* Gender. Men are more prone to neurological diseases than women.
* Increased cholesterol. Increased bad cholesterol (LDL Cholesterol) can damage the small blood vessels that feed the nerves.
* Cigarette smoking. Smoking causes the arteries to harden and narrow and reduces blood flow to the legs.
Diagnostic tests
Neurological disease due to diabetes is usually diagnosed based on symptoms, medical history, and physical examination.
The doctor will examine your muscle tone, bone tendon reflexes, touch sensation, thermal sensation, and vibration sense.
Other tests
In some cases, the following tests may be performed:
* Assessment of neurotransmitters. This test is used to evaluate the conductive speed of nerve fibers in the limbs, usually used to diagnose carpal tunnel syndrome.
* Foot examination at least once each year to detect signs of inflammation, cracked skin, calluses, and deformed joints
Complications
Neurological disease due to diabetes can cause many serious complications
* Loss of sensation in the legs
The patient does not detect the injury, swelling, and pain in the leg, and any wound infection can be severe.
There is a very high risk of infection due to decreased blood flow to the legs.
Infection can spread to the bone and tissue necrosis.
It is difficult to treat, and may require amputation of arms or legs, or feet. This is extremely serious!
* Charcot Joints. This occurs when the joints in the legs become disfigured by nerve damage
* Primary infection. Neurological damage to the bladder.
Creates conditions for germs to develop in the bladder and kidneys, leading to infection in the urinary tract.
Nerve damage also affects the ability to sense when you urinate and the control of urination.
* Hypoglycaemia without warning. Normally, when blood sugar drops too low, patients will have symptoms such as trembling hands, sweating, and heart palpitations.
Here are the warning symptoms of patients.
Neuropathy if not treated promptly, can lead to coma and even death.
* Low blood pressure. Neurological damage control, the circulatory system will impact the ability to adjust the body’s blood pressure.
With low blood pressure, changing positions from sitting to standing can cause symptoms of dizziness or shock.
This is called postural hypotension.
* Gastrointestinal disorders.
Automatic nerve damage to the digestive system can cause constipation, diarrhea, nausea, vomiting, bloating, or loss of feeling good.
* Sexual dysfunction.
Automated nerve damage affecting the genitals, causing erectile dysfunction in men and vaginal dryness in women.
* Increased or decreased sweating.
When the sweat glands do not function normally, the body will not be able to regulate body temperature.
Typically, neurological diseases cause more sweating, especially at night.
Drugs and treatment
Treatment of neurological diseases caused by diabetes to focus on:
* Slow progression of the disease
* Reduce pain
* Treatment of complications
* Rehabilitation
Slow progression of the disease.
Keeping blood sugar constant within the normal limits will help slow the progression of peripheral neuropathy and can reduce symptoms.
To help slow the nerve damage:
* Foot care as recommended by your doctor
* Keep blood pressure within limits
* Eat a healthy diet
* Regular physical activity
* Maintain ideal body weight
* Stop smoking
* Stop drinking or limit your consumption
Analgesic
Treatment of pain in neurological diseases caused by diabetes is very difficult.
These medications include:
* Anti-epileptic Drugs
* Antidepressants. The new antidepressants provide better pain relief and fewer side effects.
* Lidocaine patch. Patch containing lidocaine local anesthetic and helps relieve pain.
*Capsaicin when applied on the skin, can reduce pain.
* Other drugs. Painkillers such as codeine or oxycodone (OxyContin) may be used to relieve pain.
Other types of treatment
Many non-drug treatments can help relieve pain. Can be combined with drugs to treat:
* Acupuncture. The National Institutes of Health of the United States have applied acupuncture in the treatment of chronic pain including neuropathic pain.
* Relaxation techniques. Reduce the pressure and pain. Relaxation techniques include deep breathing exercises, looking at pictures, and yoga.
Prevention
Patients can prevent and delay complications of neurological disease due to diabetes by keeping blood sugar within permissible limits, foot care, and lifestyle changes.
Foot care
To protect your feet to avoid serious complications:
* Check feet every day
* Wash your feet daily with warm water.
If your feet can not feel temperature, test the temperature of the water by an absorbent towel to touch other body areas, such as the wrist, the elbow, or use for testing.
Cut toenails carefully.
* Calluses. Use a pumice or nail file for filing calluses. Do not cut calluses.
* Wear clean socks.
* Wear shoes. Always wear shoes to protect your feet, just to avoid foot injuries.
Lifestyle changes
* Control blood pressure. Diabetic patients are at risk of hypertension 2 times higher than people without diabetes.
* Choose foods that have health benefits. Select a balanced diet, especially greens, fruits, and whole grain wheat.
* Physical activity daily. Daily activities to help protect the heart and improve blood flow, and which help stabilize blood sugar and blood pressure.
* Stop smoking. Diabetic patients who smoke have an increased risk of stroke and myocardial infarction.
