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A simple blister on your heel doesn’t sound like a big deal, does it? But for someone with diabetic neuropathy, the nerve damage that affects 60 to 70 percent of those who have diabetes, such a seemingly small problem can become a catastrophe.
The thinking is that elevated blood sugar causes damage not only to nerves, but also to the blood vessels that supply those nerves. The resulting numbness, pain and systemic issues can lead to serious health complications.
"The good news is that you can prevent diabetic neuropathy or slow its progression by keeping your blood sugars under tight control," says Rabia Malik, MD, a neurologist at Rush. "Aside from medications, this can be achieved by a combination of diet modification and exercise to maintain a healthy weight."
Diabetic neuropathy can damage nerves throughout the body, including sensory nerves that transmit sensations such as touch, temperature and pain; motor nerves that control movement; and autonomic nerves that control involuntary processes such as heart rate, blood pressure and digestion.
Signs of diabetic neuropathy include the following:
Malik points out that it’s important to have a thorough medical workup if you think you’re experiencing neuropathy, since even in diabetic patients neuropathy might be caused by other issues such as nutritional deficiencies, autoimmune disorders or a tumor that’s causing pressure on a nerve.
A neurologist will typically do a thorough physical examination and order blood tests to exclude other causes of neuropathies that may mimic diabetic neuropathies. An electromyogram may be performed to objectively test the function of the nerves and the muscles.
Sensory loss in the feet may lead to ulcers that go unnoticed and can subsequently lead to tissue death and bone infections.
Diabetic neuropathy is irreversible once it has begun, so prevention is crucial. That often means getting blood sugar under control even before a diabetes diagnosis.
"Borderline diabetics are at risk of developing nerve damage as well," Malik says. "In fact, in some people the symptoms of neuropathy may be the first sign of diabetes."
For those already diagnosed, maintaining tight control of blood sugar (at a daily level around 100 mg/dL) is critical to slowing neuropathy’s progression: Neuropathy generally appears after blood sugar has been poorly controlled for some time and worsens when levels remain too high.
Malik and her fellow neurologists use a number of strategies — sometimes in combination — to help patients manage diabetic neuropathy:
Diabetic patients should also check their feet everyday, and wear shoes that fit well, have appropriate support and cushioning to protect their feet.
But by far the most powerful way to address diabetic neuropathy is to improve overall health, control blood sugar and have a thorough understanding of the consequences of uncontrolled diabetes.
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