Apparently there is more added todiabetic neuropathy recently, and there has been some newclassifications added or revised. This article dated May 11, 2012has some terms I have not encountered recently. Therefore, I thinkthis could be very enlightening for others and especially members ofour informal group.
Diabetic neuropathy refers only topeople with any type of diabetes. Reading the first sentenceonly can be misleading. Therefore, I am quoting the conditions anddefinitions for clarity and accuracy.
“Different nerves are affected invarying ways. Relatively familiar conditions, which may be associatedwith diabetic neuropathy, include:
- Third Nerve Palsy: When the individual cannot move his eye normally due to damage of a cranial nerve.
- Mononeuropathy: When only a single nerve is affected - the nerve is physically compressed, resulting in a lack of blood supply.
- Amythrophy: Muscle pain due to progressive waste and weakening of muscle tissues.
- Mononeuropathy multiplex: Profound aching soreness regularly felt in the lower back, hips or legs, resulting in sharp loss of sensory function of the nerves. This can slowly develop over a number of years.
- Polyneuropathy: Most commonly, this disorder results in weaker hands and feet, as well as some loss of sensation in the affected areas. Some patients complain of a burning needles-like pain. This disorder occurs when many nerves throughout the body simultaneously malfunction. The patient might step on something that should hurt, but feel nothing. It can appear either without warning or steadily over a long period.
- Autonomic neuropathy: The visceral nerve is affected, which may impact on the heart rate, digestion, respiration, salivation, perspiration, blood vessels, and sexual arousal. This occurs when there is a failure from the heart arteries to adjust heart rate and vascular tone to keep blood flowing continually to the brain. Dizziness or fainting when standing up rapidly is common.
- Sensory motor neuropathy: When sensory nerve loss affects the face; in some cases it may spread to the upper arms.”
Read my blog here for comparison ofterms and notice the increase in terms used in this article. I amnot sure if some of these were extracted from some of the prior usedterms or are new definitions that needed to be explained. Terminology has increased from four to seven.
Recent studies have found thatapproximately 50 percent of people with diabetes develop diabeticneuropathy. The disturbing part of this is the signs (diagnosed by adoctor) and symptoms (felt by the patient and needs to be told to adoctor) tend not to be experienced for 10 to 20 years after diabetesdiagnosis. Even more frustrating is that the majority of individualswith neuropathy symptoms do not realize what is happening until thecomplications are severe or possibly permanent.
Because of their importance, again Iwill quote from the article, “Some of the signs and symptomsassociated with diabetic neuropathy:
- Numbness, electric pain, tingling and (or) burning sensations starting in the extremities and continuing up the legs or arms
- Heartburn and bloating
- Nausea, constipation or diarrhea
- Problems swallowing
- Feeling full when eating small amounts of food
- Throwing up after a few hours of having eaten
- Orthostatic Hypotension (feeling light-headed and dizzy when standing up)
- Faster heart rate than normal
- Chest pains, which sometimes can be a warning of an impending heart attack
- Sweating excessively even when temperature is cool or the individual is at rest
- Bladder problems - difficulty in emptying the bladder completely when going to the toilet, leading to incontinence
- Sexual dysfunction in men
- Sexual problems in women with vaginal dryness and lack of orgasms
- Dysesthesia - the patient's sense of touch is distorted
- Significant facial and eyelid drooping
- Eyesight may be affected
- Muscle weakness
- Speech impairment
- Muscle contractions"
How is diabetic neuropathy diagnosed? This is where a patient needs to communicate with the doctor whensome of the symptoms (more than one) of the above are noticed. Thedoctor should do or recommend some diagnostic tests before making adefinitive diagnosis. The doctor should also ask some very specificquestions and the patient needs to answer them honestly.
If your doctor orders an MRI, youshould question the validity for doing this as it is not the tool fordefinitive diagnosis as discussed in my blog here. The doctor mayorder an electromyogram (EMG). This records the electrical activityin the muscles. The doctor may also request a Nerve ConductionVelocity test (NCV). This test records the speed at which inducedsignals pass through the nerves. Both are excellent definitive testsand less expensive than an MRI.
During the physical examination, thedoctor will check your ankle reflexes, for loss of sensation in yourfeet, changes in skin texture and color, and for a sudden drop inblood pressure when you stand up from the prone position. The doctormay also use the filament test and the vibration test to check forloss of sensation.
Next blog will cover treatments andcomplications.
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