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Diabetics needn’t suffer numbly
Peripheral, focal and autonomic neuropathy are the types of neuropathy that affect individuals with uncontrolled Diabetes and the risk rises with age and longer duration of diabetes.
By
migrator
migrator
Chennai
Peripheral neuropathy is the most common type and can cause pain, tingling, weakness, burning, crawling or pricking sensation in the legs, feet, toes, arms, hands or fingers. At its most advanced stage, neuropathy can lead to loss of perception and numbness or the inability to know where your feet are—a danger for driving and walking. Due to unequal distribution of pressure in the feet the skin over certain areas of the sole thicken to form a callus and if neglected will progress to form a corn. With continued shearing force caused while walking the callus and corn will rupture to form a neuropathic ulcer. This ulcer will most often occur over the base of great toe and the ball of the foot.
Loss of sensation due to Neuropathy makes it difficult for people to notice wounds and it may go untended. If you don’t check regularly, a minor cut could become infected. Foot deformities, previous ulcers, obesity, poor blood circulation, smoking, high cholesterol levels and uncontrolled diabetes are the risk factors.
People with uncontrolled diabetes are more susceptible to infections in the first place because of poor immune function. Impaired blood circulation delays wound healing further due to poor availability of antibiotics at the site of infection. Even the smallest wound can quickly get out of control, especially when the blood flow to the legs is reduced. If early medical intervention is given infected wounds can be treated successfully.
Autonomic neuropathy affects the system that controls body processes that don’t require conscious thought. It can cause problems with digestion leading to bloating sensation, nausea, alternating diarrhea and constipation. Sexual dysfunction, loss of libido, excessive sweating, disturbances in heart rhythm and blood pressure may be due to autonomic neuropathy. Nerve damage can prevent the urinary bladder from emptying urine completely, allowing bacteria to grow in the bladder and causing urinary tract infections. Urinary incontinence where a person may not be able to sense when the bladder is full or control the muscles that release urine is another major social issue due to autonomic neuropathy.
The most important thing is that lack of symptoms doesn’t mean lack of neuropathy. Neuropathy may be asymptomatic in many. There are several noninvasive and inexpensive tests to detect neuropathy such as the monofilament, biothesiometry, sensitometry, ansicope, uroflowmetry, ultrasound, nerve conduction study which help in early detection. Investigation will depend largely on the type of neuropathy.
Combating neuropathy begins with trying to keep blood glucose levels in a healthy range. Beyond that, treatment depends on the type of neuropathy. For treating pain from peripheral neuropathy, medications may be prescribed. Control of blood glucose, cholesterol and triglyceride levels ,exercise, foot care and not smoking will go a long way toward ensuring a happy nerve ending.
Foot Care
Healthy foot care habits that are developed early in life make a big difference in later years. Foot inspection should be an important part of your daily routine and diabetes self- management. You should look for the following signs and compare one foot to the other. Use a long handled mirror.
- Change in the size or shape of the foot.
- Change in skin color (becoming red or blue).
- Change in skin temperature (warmer or cooler).
- An open area of skin (boil, blister or sore) with or without pus / fluid discharge.
- An ingrown toe nail.
- Structural deformities of the foot (hammer toes or bunions).
- Corns or calluses Cracks, peeling and flaking of skin, Pain, burning, tingling, or numbness in your feet.
- Look between toes and at the base of toes for web space infection, cuts, fissures.
- An annual foot examination is recommended for identification of conditions that may require further investigation or treatment. Amputation is preventable.
— The writers are diabetologists
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