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Understanding Diabetes Mellitus: A Growing Global Concern
Diabetes Mellitus is a complex metabolic disorder that affects millions of people worldwide. It’s characterized by chronic high blood sugar levels, either due to a lack of insulin (the hormone that helps regulate blood sugar) or the body’s inability to respond properly to insulin.
The Prevalence of Diabetes: A Global Challenge
In 2022, an estimated 830 million people worldwide were living with diabetes. This condition is becoming increasingly common, with the highest prevalence found in low and middle-income countries. Unfortunately, many people living with diabetes aren’t getting the care they need—over half of those with the condition did not take the necessary medication in 2022, according to the World Health Organization (WHO).
Why Is Diabetes on the Rise?
The rising rates of diabetes are linked to factors such as unhealthy diets, sedentary lifestyles, and an aging global population. It’s important to understand the impact diabetes has on overall health, as uncontrolled diabetes can lead to serious complications like heart disease, kidney failure, nerve problems and even blindness.
How Diabetes Damage your Nerves – Diabetic Neuropathy
High blood sugar levels can affect any nerve in your body in various ways. Some forms of nerve damage may be reversible, while others may not. We can categorize this nerve damage into five groups, depending on their mechanism and symptoms.
- Symmetrical distal polyneuropathy
- Acute painful neuropathy
- Mononeuritis and mononeuritis multiplex (multiple mononeuropathy)
- Diabetic amyotrophy
- Autonomic neuropathy
Symmetrical Distal Polyneuropathy
This condition typically affects the nerves in the feet and lower legs. Early signs include a loss of the ability to feel vibrations, pain, and changes in temperature in the feet. In later stages, it can cause difficulty with balance, especially when washing your face or walking in the dark. This happens because of impaired proprioception, which is the sense that helps you know where your body parts are without looking. Additionally, the condition can involve motor nerves, leading to muscle wasting. You may notice small muscles in your hands or the spaces between your fingers becoming weaker, and there can be a noticeable loss of muscle in the hands as well.
Acute Painful Neuropathy
This is a less common but painful form of neuropathy. People with this condition often experience burning or crawling sensations in the feet, shins, and the front of their thighs. These feelings can be worse at night, and even the light pressure of bedclothes can become intolerable. Sometimes, this condition occurs at the time of diabetes diagnosis or after there’s a sudden improvement in blood sugar control, such as when insulin treatment is started. The good news is that acute painful neuropathy often improves on its own within 3 to 12 months if blood sugar levels are well managed. However, the chronic form of this condition doesn’t respond to treatments.
Mononeuritis and Mononeuritis Multiplex
Mononeuritis refers to damage to a single nerve, while mononeuritis multiplex involves multiple nerves. Any nerve in the body can be affected by this condition, and the onset is usually sudden and sometimes painful. Radiculopathy, which involves nerve root problems, may also occur. Commonly, this condition affects cranial nerves 3 and 6, causing isolated palsies (weakness or paralysis). The good news is that full recovery can occur in 3 to 6 months, often without long-term effects.
Diabetic Amyotrophy
Diabetic amyotrophy is more common in older men and involves painful muscle wasting, particularly in the quadriceps (thigh muscles), which typically occurs on one side of the body (asymmetrical). This condition is often associated with periods of more severe high blood sugar (hyperglycemia). The muscle wasting is accompanied by diminished or absent knee reflexes. However, with good blood sugar control, this condition is reversible.
Autonomic Neuropathy
Autonomic neuropathy, which affects the autonomic nervous system, is rare but can cause a variety of symptoms. It affects both the sympathetic and parasympathetic systems, which control involuntary functions like heart rate, digestion, and blood pressure.
When it affects to your heart and blood vessels, you may feel rapid heart rate, loss of normal heart rhythm pattern (sinus arrhythmia), and drop in blood pressure when standing up leading to dizziness.
Diabetes can damage your tummy in following ways. it slows down the movement of food through the tummy and may lead to symptoms like intractable vomiting. It’s often asymptomatic but can cause discomfort. Sometimes it lead to symptoms like difficulty swallowing (dysphagia), indigestion (dyspepsia), abdominal pain, constipation, diarrhea, and fecal incontinence (involuntary passing of stools).
When it affects to your bladder, may not empty fully, leading to urine retention and an increased risk of urinary tract infections (UTIs).
Most of the diabetic patients experience sexual issues like incomplete erection or retrograde ejaculation (where sperm goes into the bladder instead of out of the penis).
How to Identify Nerve Damage
If you experience any of the symptoms mentioned above, it’s important to consult your healthcare provider. Many cases can be diagnosed through a proper history and physical examination. However, some individuals may not notice symptoms until the later stages of the condition. Therefore, it is strongly recommended to have regular check-ups to identify neuropathy early through a physical examination.
During an exam, your healthcare provider will likely check your sensations to pain, touch, temperature, and vibration. They may also assess your tendon reflexes and overall muscle strength to identify any issues. Afterward, your provider may order specific tests to help diagnose the condition, such as a filament test, nerve conduction test, or electromyography.
Are There Any Treatments for Diabetic Nerve Damage?
Currently, there is no specific treatment to cure nerve damage caused by diabetes. The goal of treatment is to slow down the progression of the disease, alleviate pain, and manage complications. The most important aspect of treatment is maintaining good blood sugar control.
According to the American Diabetes Association (ADA), the target blood sugar levels should be:
- Before meals: 80-130 mg/dl
- Two hours after meals: less than 180 mg/dl
However, blood sugar control should be individualized based on age and other underlying health conditions. For older adults with additional comorbidities, slightly higher fasting blood sugar levels may be recommended.
Pain Management
For individuals with painful polyneuropathy, pain management medications may be prescribed. Commonly used medications include:
- Duloxetine
- Gabapentin
- Pregablin
These medications help alleviate discomfort and manage nerve pain.
Managing Autonomic Neuropathy
In cases of autonomic neuropathy, there are several strategies to manage complications. For bladder issues, patients may be trained in timed urination schedules, self-catheterization, or, in some cases, permanent catheterization.
Lifestyle changes are essential for managing tummy and heart problems associated with autonomic neuropathy. These include:
- Eating smaller, more frequent meals
- Modifying the diet to address constipation and diarrhea
- Drinking plenty of water
- Avoiding alcohol
- Changing positions slowly
Managing Sexual Dysfunction
If sexual dysfunction occurs, your healthcare provider may prescribe medications like Sildenafil or Tadalafil after a thorough evaluation. These medications can help manage erectile dysfunction.
In conclusion, while diabetic nerve damage cannot be cured, proper management of blood sugar levels and addressing symptoms with medications and lifestyle changes can significantly improve quality of life. Always consult your healthcare provider to create a personalized treatment plan that works best for your individual needs.
References
- Kumar and Clerk clinical medicine
- World Health Organization
- American Diabetes Association
