diabetesand neuropathy

1. Diabetes andDiabetes and
NerveNerve
ProblemsProblems

2. What is Diabetes?
 Diabetes is a condition in which there is too much sugar
(glucose) in the blood. Although sugar is needed to provide
energy for the body, when in excess, it causes problem.
 Persons with diabetes have excess sugar because they lack
or have deficient supply of insulin.

3. Diabetes
“Mild Disease”
Serious consequences

4. Diabetes Mellitus
A Serious Disease
Leading cause of new
cases of blindness
25 times more prone to
eye problems
6 times higher risk for
Paralysis (stroke)
5 times more prone to
Kidney failure
20 times more prone to
lower limb amputation
Nerve damage causes
loss of sensation
2-3 times higher risk for
heart attack

5. The Nervous System
 The nerves in our body serve as a communication system.
 The nervous system conveys messages from the brain to
our
legs, hands, feet and other parts of the body (peripheral nervous
system)
internal organs such as heart, stomach and bladder (autonomic
nervous system)
 The nervous system sends sensations to the brain so that
appropriate actions can be taken in response
touch, pain, pressure, vibration and temperature
smell, taste, sound, and sight

6.  Long periods of high blood sugar can damage nerve fibers,
impairing their ability to carry messages to and from the
brain
 Damaged nerve fibers relay signals (sensations) slowly or
don’t relay them at all
 Restoration of the blood sugar level quickly to with-in
target range may allow damaged nerve fibers to heal and
function properly again
The Nervous System

7. Cause of Nerve Damage
 High blood sugar can harm nerve cells in two ways:
High sugar level in blood causes high amount of sugar to enter the
nerve cells. As the nerve cells cannot use all of it, toxic substances
accumulate and affect the nerves' ability to transmit signals
High blood sugar also damages the small blood vessels that carry
oxygen and nutrients to the nerves

8. Diabetes and Nerve Problems
 Diabetic Neuropathy is a common complication of
diabetes
 It does not always cause obvious symptoms. When it
does, you may experience:
Loss of sensation in your feet and hands
Pain and other kind of discomfort
 These symptoms are more likely to occur during periods
of poor blood sugar control

9. Diabetes and Nerve Problems
 Diabetic foot ulcers (common accompaniment to
neuropathy) are a common cause of prolonged
hospitalizations

10.  Parts of the body most commonly affected by nerve
problems in people with diabetes:
Leg, feet and hands
Genitals
Eye muscles
Heart
Stomach
Intestines
Bladder
Parts most often affected
Diabetes and Nerve Problems

11. Symptoms of Diabetic
Neuropathy
Feet and Hands
 Symptoms include various types of uncomfortable feelings
such as:
Tingling, like a feeling of “ants crawling” or “pins and needles.”
Numbness and heaviness “feeling of walking on cotton”
Reduced ability to sense heat and cold
Stabbing or burning pain
A persistent “restlessness” in the feet and legs
Extreme sensitivity to touch, even light touch
Loss of balance and coordination
Dry skin susceptible to cracks and infections

12.  Most serious consequence of nerve problem is the loss of
protective sensation in the feet
 Without an intact “pain-alarm-system,” minor injuries may
occur and go unnoticed until they develop into serious foot
ulcers
 Poorly fitted shoes can led to painless lesions that quickly
develop into ulcers
Symptoms of Diabetic
Neuropathy
Feet and Hands

13.  Serious burns or foreign body impaction (thorns; pebbles)
may occur without pain
 Never walk barefoot. Sharp objects can cause injury at work or
home when you least expect them
 Don’t underestimate the importance of daily foot inspection
and care – especially if you have nerve problems in your feet
Symptoms of Diabetic
Neuropathy
Feet and Hands

14.  Six pairs of eye muscles work together to turn both eyes in
the direction of your choice. These muscles are controlled
by three pairs of nerves.
 If blood sugar control has been poor, one or more of these
nerves can be affected and can paralyse one or more eye
muscles causing double vision. This can occur suddenly
without warning.
 Severe unexplained pain behind the eye may also be due to
diabetic neuropathy
Symptoms of Diabetic
Neuropathy
Eye Muscles

15. Symptoms of Diabetic Autonomic
Neuropathy
 Stomach and Intestines
Nausea, vomiting, feeling of bloating and lack of appetite, because of
delay in emptying of stomach
Difficulty in swallowing
Diarrhoea or constipation because stagnation due to poor bowel
movement
Weight loss
 Urinary Tract and Genitals
infection and incontinence of the bladder due to retention of urine
impotency and loss of libido (sexual response) in men and women

16.  Heart and blood vessels
Sudden fall in blood pressure on standing and sitting suddenly
Silent heart attacks as the perception of pain of heart attack may be
affected
Abnormal heart beats and irregular pulse
 Other
Profuse sweating and inability of the body to control temperature as
the nerves to the sweat gland may get affected
Hypoglycaemia unawareness -the body's normal response to low
blood sugar is impaired, making it difficult for the person to recognize
the symptoms
Symptoms of Diabetic Autonomic
Neuropathy

17.  You may also have serious nerve damage without any
symptoms
 Insist on your doctor examining your nervous system when
you are diagnosed or as soon as possible
 See a neurologist (nerve specialist) regularly for
examination if and when advised by your doctor
Symptoms of Diabetic
Neuropathy

18. When to Check for Nerve
Problems
 The overall health of your nervous system should be
checked as part of your regular visits to the clinic
 Children >10 years and adults < 30 years within 3-5 years of
diagnosis and thereafter once a year
 Adults > 30 years at the time of diagnosis and thereafter
once a year
 Those already diagnosed with abnormal findings need to
be tested more frequently as advised by their doctor

19. Preventing Nerve Damage
 Keep blood sugar levels as close to normal as possible to
slow the onset and progression of diabetic neuropathy
 Avoid smoking as it worsens circulatory problem increasing
the risk of neuropathy
 Reduce alcohol drinking as it can worsen neuropathy
 Take Insulin, if advised

20. Testing for Nerve Problems
 Your doctor should ask you about:
Vision problems
Any tingling, unusual pain or numbness
Any change in your ability to sweat
Heart palpitations
Bowel problems, such as constipation or diarrhea
Difficulty emptying your bladder
Problems with impotence

21.  Your doctor will examine you to check for sensations
Pressure and deep sensation threshold test using a monofilament –
the doctor will apply a thin sharp plastic filament to the skin on the feet
and hands
Vibration perception threshold using a tuning fork – the doctor will
apply a vibrating tuning fork on bony prominences to check for
vibration sensation
Light touch sensation – using a cotton swap- doctor will lightly touch
the skin of the legs and hands to check presence of light touch
sensation
Testing for Nerve Problems

22.  Your doctor will examine you to check for sensations
Thermal threshold to check for warm and cold sensation – using test
tubes filled with hot and cold water
Check reflexes – Strike parts of body with a small rubber hammer or
touch parts of body to examine for reflex reactions
Cold pressor test – doctor may ask you to dip your hands in ice cold
water and check for changes in your pulse or heart rate
Blood pressure response on standing – doctor will check BP in lying
down and while standing to see if blood pressure suddenly falls on
standing
Testing for Nerve Problems

23.  Other Tests
Biothesiometry – to check for sensations. Biothesiometer is an
electrical device that varies the intensity of vibrations
Electromyography (EMG) - to check muscles response to electrical
impulses transmitted by nearby nerves. A slower or weaker response
suggests damage to the nerve or muscle
Nerve conduction studies – to check the flow of electrical current
through a nerve. Impulses that seem slower or weaker than usual
indicate possible damage to the nerve
ECG – to check regularity of heart rate
Ultrasound - to check functioning of the bladder and other parts of the
urinary tract
Testing for Nerve Problems

24. Treatment For Neuropathy
 To prevent further damage and reverse the changes of
neuropathy - bring the blood sugar levels under control
Take Insulin, if advised
 The aim of treatment is to relieve discomfort and reduce pain
Appropriate medication to help relieve pain; usual pain-killers may not
work well. Imipramine, Amitriptyline (anti depressants) are more efficient
in such cases
Insulin treatment improves painful neuropathy

25. Treatment For Neuropathy
 To reduce problems related to foot take special care of the feet
Follow the rules of foot care
 To reduce muscle weakness
Physiotherapy and physical exercise may be advised
Insulin treatment is also reported to improve weakness

26.  To reduce GI symptoms – such as indigestion, bloating,
nausea and vomiting
Stop some types of anti diabetes medications
Small frequent meals, with low intake of fat and fibre
In severe cases medication may be prescribed
 To reduce diarrhoea
Stop some types of anti diabetes medications
Suitable medication for diarrhoea is prescribed
Treatment For Neuropathy

27.  To reduce dizziness and weakness related to postural
hypotension
Sit or stand slowly from lying down position
Wear elastic stockings
Medication may be prescribed
Treatment For Neuropathy

28.  To reduce problems affecting the urinary tract
Drink more fluids
Pass urine regularly every 3-4 hours
Antibiotics to treat urinary infections
 To reduce sexual problems
Counselling to help relieve stress
Medication to help improve impotence in men
Medication to reduce vaginal dryness and urinary tract infections in
women
Suction devices or Surgery for men
Treatment For Neuropathy

29.  It has now been proven that prevention of nerve damage- like
prevention of other long term complication of diabetes- is best
achieved through tight blood sugar control
 Take Insulin, if advised
 Strive to keep your blood sugar with in your target
< 120 mg/dl Fasting and < 180 mg/dl PP
 You are in the best position to accomplish this goal through
regular blood sugar testing and appropriate adjustments in
your medication,diet and exercise
Conclusion