Diabetic neuropathy is defined as the nerve damage occurring due to uncontrolled hyperglycemia. After a few years of diabetes with poor glycaemic control, small vessels undergo degenerative changes which are referred to as microangiopathy. The small vessels supplying the nerves known as Vasa vasorum are damaged to cause diabetic neuropathy. Diabetic neuropathy can be classified into three types on the basis of symptoms, sensory neuropathy, motor neuropathy, and autonomic neuropathy.
What Are The First Symptoms Of Diabetic Neuropathy?
In sensory neuropathy, the patient experienced tingling, pins and needle sensation as the earliest symptoms of the neuropathy. It is the most common type of neuropathy observed in the diabetes mellitus. Other symptoms include numbness, burning pain, tightness, etc. It commonly progressive towards glove and stocking type of pattern in which the distal-most nerves at the periphery of limbs suffers from loss of sensory sensation like a person has worn gloves on the hands and stockings on the legs.
In motor neuropathy, focal loss of muscle innervations at the distal end of limbs occurs with loss of fine motor skills as the earliest symptom. Hand coordination movements like moving fingers in a rhythm, opening a jar, etc. become difficult and sometimes fine tremors may also appear. In later stages, proximal muscles may also get involved and various daily activities become difficult like standing from the position of sitting, difficulty in raising the arms above shoulders, etc. This type of neuropathy is least commonly observed in diabetes mellitus.
In autonomic neuropathy, the symptoms can belong to any system of the body like cardiovascular, gastrointestinal, genitourinary, etc. It is not the common but most widespread and dangerous type of neuropathy found in many cases of diabetes mellitus. It includes syncope as the most common and earliest symptom. Other autonomic symptoms include like ataxia, gait instability, abdominal pain, constipation, vomiting, diarrhea, palpitations, arrhythmias, urinary incontinence, straining while micturition, heat intolerance, decreased sweat formation, etc.(1)
How To Test For Diabetic Neuropathy?
It, in the cases of poor glycemic control or uncontrolled diabetes and complete physical examination, is done to find out the peripheral, motor or autonomic symptoms. Examination of the skin is done for dryness, cracks, fungal infections, erythema, the breaking of nails, etc. As the sensory neuropathy is the commonest one, the examination is started with testing of sensory symptoms at the distal parts of the limbs. The vibration and pinprick sensation are checked at the end of the great toe with progressive testing at the higher levels to determine the extent of neuropathy.
For motor neuropathy, the signs of muscle wasting are checked. The small and distal muscles of the hands and feet get atrophied in the absence of nerve trophic factors and the movement becomes restricted and uncoordinated. The testing of deep tendon reflexes is done as these become hypoactive or absent. Peripheral arterial pulses like distal-most pedis artery, posterior tibial artery are felt because these are usually less prominent in diabetic neuropathy.
For autonomic neuropathy, testing is done in a specialized autonomic laboratory with objective techniques. The cardiovagal, sudomotor, adrenergic functions are assessed to rule out autonomic neuropathy. Blood pressure is checked in supine and upright positions and the results are compared for testing of orthostatic hypotension which is a common finding in diabetic neuropathy. Electrocardiograph is done to check for arrhythmias and irregularities in heart rate.(1)
Diabetic neuropathy is a complication caused due to microangiopathic changes occurring in long term exposure of small vessels to the high blood glucose levels. It appears many years after the diagnosis of diabetes mellitus and become in those people having poor treatment history for diabetes. It is nearly equally found in both type 1 and type 2 diabetes mellitus.
It can be easily avoidable with the maintenance of normal blood glucose levels and adequate treatment. Early detection can limit the damage to the nerves and extent of the disease.
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