Diabetic neuropathy (polyneuropathy)

Nervous diseases as a result of diabetes - symptoms and treatment

Diabetic neuropathy or nerve damage is a typical, chronic sequelial disease of diabetes mellitus, which usually damages peripheral nervous system nerves and gradually dying. The most common form is diabetic polyneuropathy (peripheral sensorimotor polyneuropathy), initially recognizable by sensations on the feet. A dreaded complication that can accompany this damage to the nerves is the diabetic foot. Since the treatment options are limited and a complete cure can not be expected, an early detection is the main course to slow down the course of the disease and to prevent further possible sequelae.

contents

• Nervous diseases as a result of diabetes - symptoms and treatment
• A short overview
• definition
• symptoms
• causes
• diagnosis
• treatment
• Naturopathic treatment

A short overview

People who suffer from diabetes should be especially vigilant when it comes to their health, because of the increased risk of a number of sequelae due to diabetes. Early warning signs should be taken seriously and those affected should seek medical advice immediately. Afterwards, you will first find a brief overview with the most important information on neuropathy, before a detailed description of the complaint picture follows.

How to recognize sensomotoric diabetic polyneuropathy?

Early warning signs are sensory disturbances and pain, especially in the feet and legs:

• Skin tingling ("running ants") and feelings of fuzziness,
• Sensitivity disorders for pressure and temperature,
• strong, burning pain (often at night).

What is a diabetic foot??

In the case of this serious complication, increased corneal formation and skin tears on the sole of the foot are often the first to show up. Due to sensory disturbances painful injuries on the feet go unnoticed and it comes, due to circulatory disorders, to poorly healing and inflamed wounds. Deep tissue layers are affected and death is the result. In the worst case, it can lead to amputation.

What are other common complications of diabetes?

• Diabetic macroangiopathy (damage to the large arteries) and microangiopathy (damage to small blood vessels),
• arteriosclerosis,
• Diabetic nephropathy (kidney damage),
• Diabetic cardiomyopathy (heart disease),
• Coronary heart disease,
• High blood pressure with complications such as stroke or heart attack,
• eye damage,
• Fat metabolism and wound healing disorders.

definition

The collective term diabetic neuropathy includes various nerve damage, which usually affects the peripheral nervous system (nerves outside the brain and spinal cord) and are caused by diabetes. Basically, a distinction is made whether only a single nerve is affected (diabetic mononeuropathy) or simultaneous damage to many peripheral nerves occur. The latter also characterizes the most common manifestation: sensorimotor diabetic polyneuropathy. Of the many symptoms, it is especially common to experience sensations of discomfort and pain in the feet and legs. Typically, this condition leads to a diabetic foot in the further course.

A serious consequence of nerve damage and discomfort in polyneuropathy can be diabetic footing. (Image: kirov1969 / fotolia.com)

Nerves of the so-called autonomic (vegetative) nervous system are also less often affected, in this case one speaks of an autonomous diabetic neuropathy.

These diseases, known as long-term consequences of diabetes mellitus, are relatively common. Thus, in about ten to twenty percent of those affected by type 2 diabetes today neuropathy is detected very early. The sequelae also occur in type 1 diabetes. The incidence continues to increase with the duration of diabetes and reaches almost half of those affected after about 25 years.

symptoms

A variety of symptoms may be associated with diabetic neuropathy, depending on which nerve tracts are affected. In the most common form, sensorimotor polyneuropathy, early signs of discomfort, sensory disturbances, and pain are usually on the feet and legs or, less commonly, on the hands and arms:

• Skin tingling ("running ants") and feelings of fuzziness,
• Sensitivity disorders for pressure and temperature,
• strong, burning pain (often at night).

It also links to Burning Feet Syndrome (Burning Feet) and Restless Legs Syndrome (Restless Legs). In addition, the diabetic foot syndrome is a serious complication, which often results from a polyneuropathy. First, often unnoticed signs are increased corneal formation and skin tears on the sole of the foot. The reason for this are incorrect stress due to sensory disturbances on the foot. By reducing the sensation of pain, injuries to the feet often go unnoticed. Mostly favored by circulatory disturbances, poorly healing and inflamed wounds penetrate into deep layers of tissue and can cause dying. In the worst case even threatens an amputation.

In advanced stages of polyneuropathy, it can also cause piercing, spasmodic or permanent pain in legs and arms. As well as to numbness or hypersensitivity. For example, even touching the legs with duvet and mattress while sleeping can cause severe pain. In the further course also motor failures can develop up to paralysis phenomena.

The symptoms of diabetic neuropathy are especially common in disorders of the peripheral nervous system, less often the autonomic nervous system is affected. (Image: heilpraxisnet.de/Original: Normaals / fotolia.com)

If also the autonomic nervous system is affected, which controls the autonomous functions of the body, arrhythmia, circulatory disturbances, dizziness, nausea, vomiting, incontinence, diarrhea or even constipation can be associated with the disease. In addition, abnormal perspiration and sexual dysfunction are possible.

causes

The factors that are responsible for the development of diabetic neuropathy have not yet been clearly researched and proven. According to experts, however, there is a connection between a not optimally adjusted blood sugar (increased blood sugar levels) and the damage of nerves. Central risk factor seems to be a high blood glucose value over a longer period of time (hyperglycemia).

The increased blood sugar levels can cause breakdown and deposition of substances that affect the functions and metabolic processes of nerve cells. In addition, a deposition of sugar molecules ("saccharification") to endogenous fats and proteins (proteins) may be the result, which are important building blocks for the nerves. It comes to clogged blood vessels and thickened vessel walls. Consequently, the blood can no longer flow so easily through the narrow capillaries, which hinders the supply of the nerves. A resulting lack of oxygen and nutrients additionally damages the nerves. The progression of these symptoms gradually leads to the death of the nerve tissue.

diagnosis

Because there is limited therapeutic options for a pronounced clinical picture of polyneuropathy, prevention and early detection are of particular importance. People with a diabetes diagnosis should always have their nerves examined regularly, whether or not they already have neuropathic pain or other symptoms. This is also called a neuropathy screening to prevent complications or to detect early. People with type 2 diabetes are advised to have a screening done at the time of diagnosis. People with type 1 diabetes should do so at the latest after five years. If no neuropathy is detected, screening should be done once a year.

Neuropathy is a very common sequelae of diabetes, especially with high blood sugar levels. (Image: Dmitry Lobanov / fotolia.com)

In order to determine sensorimotor diabetic polyneuropathy, a home-based or specialist medical examination will first be followed by a patient survey (anamnesis) in order to record possible symptoms, the medical history and the existing diabetes illness as precisely as possible. For further diagnosis, both legs and feet are examined and compared, and shoes and stockings are considered for possible foot deformities. The motor skills and possible limitations are checked.

Furthermore, neurological examinations will take place, often using very simple methods to test mainly the following sensations and reflexes:

• pain,
• Pressure and touch perception,
• temperature sensation,
• vibration sense,
• Tendon reflexes.

All results together should shed light on the possible presence of polyneuropathy and also on the current severity of any existing nerve damage. If the diagnosis is not clear and there is further need for clarification, other specific procedures may be used. In most cases, a precise neurological examination of the nerves takes place in these cases. This usually focuses on pain diagnostics and nerve conduction velocity. In addition, a comprehensive blood test can provide further evidence and in rare cases, a skin biopsy (tissue sampling).

The diagnosis of autonomic diabetic neuropathy is often more difficult. The patient's information on the medical history and possible complaints may then require various examinations. These will focus on possible dysfunctions of the cardiovascular system, the gastrointestinal tract and the urinary and genital tract, as consequential damage is common in these areas.

By means of an electrocardiogram (ECG), irregularities in the heart rate can be made visible. Blood pressure measurements repeated lying and standing, or even over 24 hours, to determine whether there is a sharp fall in blood pressure and dizziness when standing in the context of neuropathy (neurogenic orthostatic hypotension).

In polyneuropathy nerves and nerve tracts are damaged and die gradually without appropriate therapy. (Image: Sagittaria / fotolia.com)

An autonomic neuropathy, which affects the gastrointestinal tract, is difficult to determine, because gastrointestinal complaints may have many other causes. Therefore, it is important to exclude other possible causes. Ultrasound or examinations with an endoscope as well as various functional tests are often used. If other causes are excluded, further evidence may help diagnose diabetic nerve damage, such as prolonged diabetes with poor blood sugar control and metabolic abnormalities.

It may be necessary to measure urine flow during bladder emptying and possible residual urine. In men, the prostate is also scanned. For erectile dysfunction, the testosterone level and other laboratory values ​​and test methods are used.

treatment

So far there is no way to completely cure the diabetic neuropathy. Therefore, treatment is primarily about slowing the progression of the disease, relieving pain, and treating possible sequelae. There are a variety of treatment options available.

The most important therapeutic measure is a permanently constant and optimal adjustment of the blood sugar level. The optimal blood sugar value depends on many factors and must be determined individually for each patient. In addition, blood lipid and blood pressure should be well adjusted.

Patients are advised not only to regularly check their own blood sugar levels, but also to pay attention to their weight and a healthy lifestyle, with a balanced diet and physical activity. In general, alcohol and smoking should be avoided, as this can cause additional nerve damage.

The first treatment for polyneuropathy is the optimal adjustment of blood sugar levels. (Image: Henrik Dolle / fotolia.com)

In pain therapy, a reduced perception of pain is sought. This can be achieved via pharmaceuticals such as antiepileptic drugs (anticonvulsants) and antidepressants. For very severe pain also by means of opioids. In any case, these drugs are prescription. Whether it makes sense to take a dose should be decided by means of a pain analysis taking into account individual factors. In addition, the therapy in the further course requires medical supervision. Side effects are possible with all mentioned remedies. In particular, opioids should be warned against a development of tolerance and subsequent dose increases or dependence. Commercially available analgesics (for example ibuprofen, diclophenac or acetylsalicylic acid) should not be used in neuropathic pain. Only rarely is paracetamol used for a limited time for a therapeutic trial.

Specific therapeutic measures in autonomic neuropathy depend on the nature of the nerve damage and the associated symptoms. It is advisable to seek specialized medical advice according to the symptoms.

Naturopathic treatment

In addition to the already mentioned consideration of a healthy diet and lifestyle, which is considered indispensable in any naturopathic treatment, the regular medical pedicure plays an important role. This can in particular prevent the development of a diabetic foot. The feet should also be extensively examined, bathed and creamed every day. Also an appropriate footwear belongs to the preventive measures.

Furthermore, especially for pain relief, various measures from the field of naturopathy promise success. Naturopathic therapies can be used as support for traditional medical therapy or even offer alternative treatment options.

Physical therapies

For the treatment of pain in polyneuropathy, various physical treatments can be applied such as physiotherapy, cold-heat treatments, alternating and movement baths or electrical treatments of paralyzed muscles. In addition to pain relief, these therapies also aim to improve blood circulation, strengthen weakened muscles and increase and maintain mobility.

For the prevention of a diabetic foot, a regular medical pedicure is particularly important. (Image: Jennewein Photo / fotolia.com)

Electrotherapeutic procedures

A special alternative treatment method is provided by electrotherapeutic procedures such as transcutaneous electrical nerve stimulation (TENS) or high-toning therapy, in which pain is fought with electricity. The patients are thereby electrodes stuck to the painful skin region, transmit the current pulses of a stimulation current device to the body or on the nerves. Through the generated stimulus, the electrical signals are transmitted via the nerve tracts into the spinal cord, where the actual effect of the TENS takes place. When using high frequencies (over 80 hertz), the signal transmission to the brain and thus the perception of pain is inhibited or interrupted. Low frequencies in turn should release chemical substances in the brain and thereby lead to a reduced perception of pain. High-Tone therapy uses alternating electrical fields in the frequency range of approximately 4 to 30 kilohertz. In this way, the energy should penetrate deeper into the tissue, influence the cell metabolism and thus lead to a healing effect and pain relief. However, these methods are not proven in their effectiveness.

Traditional Chinese Medicine (TCM)

In Chinese medicine, a so-called "tan" is the central cause of polyneuropathy. This means substances that can no longer be excreted and thus cause inflammation. About the drug therapy, which is adapted individually for each patient, it should be possible to dissolve these substances and excrete. In addition, the acupuncture is said to have a supporting effect.

Other alternative agents and methods

Various alternative active ingredients from naturopathy offer in addition to the drug-based pain therapy other ways to relieve discomfort. To combat pain, a preparation of chilli can be used externally (capsicum patch or cream, capsaicin ointment) on intact skin. The alpha-lipoic acid protects against damage to the nerve fibers by antioxidant properties. Evening primrose oil, hemp oil and pomegranate seed oil are also suitable for a treatment, since the contained gamma-linolenic acid can improve nerve functions. Unfortunately, these drugs can have unpleasant side effects, especially in the digestive system. A general therapy recommendation for the mentioned active substances is not given.

In addition to other naturopathic treatments, electrotherapy can help alleviate neuropathic pain. (Image: Werner / fotolia.com)

Further measures from the naturopathy, which can be helpful according to experience particularly with beginning symptomatology, are the Dark field microscopy, Milieutherapie and the (classical) homeopathy. An oxygen therapy can also improve the blood circulation of the tissue and thus minimize consequential damage. The psyche also plays a crucial role in coping with pain. Affected persons can also help with psychotherapy or pain management training to relieve the symptoms. (jvs, cs; updated July 27, 2018)

To read more:
Abstract of the guideline: National Guideline on Neuropathy in Diabetes in Adulthood
Patient Guideline "Nerve damage in diabetes"