Neuropathy - Diffuse Neuropathy


Neuropathy (or diffuse neuropathy) is a nerve disorder of which there are 2 types - peripheral and autonomic.

Diabetic neuropathy is a nerve disorder caused by either type 1 or type 2 diabetes.

Types of neuropathy

Diabetic neuropathy may be categorised as follows:

  • Sensory neuropathy occurs when nerves which detect touch and temperature are damaged.
  • Motor neuropathy results from damage to the nerves affecting muscle movement.
  • Autonomic neuropathy follows if the nerves which control involuntary actions, such as digestion or heart rate are affected.

Over time, diabetics who do not strictly control their condition, may develop damage to the nerves around the body.

Incidences are more common in patients with poor control, overweight, have higher levels of blood fat and blood pressure, and are over the age of 40.

The longer a person has diabetes, the greater the risk of developing neuropathies.

  • Neuropathy may affect up to 50% of people with diabetes.

Symptoms of neuropathy will often first manifest as numbness or pain in the hands, feet, arms or legs (distal symmetric neuropathy).

However, they may also affect the organs, including the heart and sex organs.

What exactly causes diffuse neuropathy amongst people with diabetes?

The exact effect of glucose on the nervous system is still not known.

However, prolonged exposure to higher than normal glucose levels certainly damages the nerves, causing neuropathy.

A combination of factors contributes:

  • Lifestyle: Depending on diet and exercise, smoking and alcohol use
  • Metabolic: High blood pressure, low insulin levels, abnormal blood fat concentration
  • Neurovascular: Damage of the blood vessels carrying oxygen and nutrients to the nerves
  • Autoimmune: Inflammation of the nerves
  • Inherited: Preconditions that increase vulnerability to nerve disease

What are the symptoms of diabetic neuropathy?

The symptoms of diabetic neuropathy will depend entirely on the form of neuropathy present, and which nerves are being affected. In some people, no symptoms will manifest themselves.
Common symptoms of neuropathy include:

  • Numbness
  • Tingling
  • Pain

These may be minor at first, and therefore may remain unnoticed as the condition develops gradually. However, in some types of diabetic neuropathy, the onset of the pain will be sudden and severe.

Further symptoms may include:

  • Wasting of muscles in feet or hands
  • Indigestion, nausea and vomiting,
  • Diarrhoea/constipation
  • Urinary problems
  • Impotence or vaginal dryness
  • Faintness or dizziness
  • Weakness of the limbs

What types of diabetic neuropathy could I be at risk from?

The different types of diabetic neuropathy are detailed below:

Peripheral neuropathy

Peripheral neuropathy is associated with the peripheral regions of the body. These include the toes, feet, lower and upper legs, the hands and the arms.

Symptoms may include:

  • Tingling
  • Insensitivity
  • A burning sensation
  • Pains and cramps and eventually
  • A loss of balance.

Peripheral neuropathy can easily develop into ulcers, which when untreated can lead to amputation.

Autonomic neuropathy

Autonomic neuropathy is less obvious, and affects the functioning of the bowel and the bladder, the digestion, perspiration and sexual response.

If left untreated, it can affect the awareness of the body to hypoglycemia.

This can be incredibly dangerous for diabetics. When the heart or circulatory system is affected by autonomic neuropathy, the body’s ability to adjust blood pressure and heart rate may be affected.

How is neuropathy diagnosed?

Diagnosis will occur on the basis of your individual symptoms and a physical exam. The doctor may test your blood pressure, heart rate, strength, reflexes and sensitivity. Foot examinations are recommended for all diabetics.

Other tests may be applied, such as:

  • Nerve conduction studies
  • MG (electromyography) and
  • QST (quantitative sensory testing)

Doctors should screen for neuropathy amongst diabetic patients at least once per annum. Tests may include ultrasound, nerve studies and biopsies, or referral to a specialist neuropathy consultant who may conduct further tests.

How is diffuse neuropathy treated?

Diffuse neuropathy is treated by bringing blood glucose levels under control. This can help to prevent problems from this diabetic complication.

Diet, exercise or medication may be adjusted to reach these goals. Exercise can be particularly effective, helping the patient to improve circulation, strengthen muscle and lose weight.

Smoking should be stopped and the amount of alcohol consumed should be reduced. Taking regular care of your feet and skin is essential.

Nerve damage

Nerve damage in the digestive system can lead to constipation, and sometimes diabetic gastroparesis.

The oesophagus may become affected, making the swallowing of food difficult. The urinary tract may also be affected, and at the worst stages this can cause urinary incontinence.

Also, neuropathy can decrease sexual response in both men and women. The sweat glands may also be affected, and the body may not be able to control temperature properly. Furthermore, the eyes can suffer problems leaving them less sensitive to changes in light.

Proximal neuropathy

Proximal neuropathy affects the hips, buttocks and thighs, and results in weakness of the legs. This type of neuropathy occurs more regularly in type 2 diabetics and in older people. It can weaken the legs, sometimes to the extent of limiting mobility.

Focal neuropathy

Focal neuropathy is manifested in the rapid weakness of a nerve, or group of nerves, leaving the muscles weak and/or in pain.

Focal neuropathy can affect any nerve in the body, but usually occurs in the torso, leg or head. It can cause a variety of complications, including inability to focus, double vision, aching behind the eye, paralysis, lower back pain, pain in various places throughout the body. It is both unpredictable and painful, and usually affects the elderly.

How do I prevent diabetic neuropathy?

Maintaining consistently normal blood glucose levels is the best way to prevent diabetic neuropathy. Keeping levels stable protects the nerves.

How is diabetic neuropathy treated?

Bringing blood glucose levels within normal range is essential. Strictly managing diabetes is the first stage in treating the condition.

Diet and exercise will almost certainly play a role in treating the condition.

Specific types of neuropathy and their resultant complications may all be treated in specific ways.

These may include:

  • Cranial neuropathy
  • Autonomic neuropathy
  • Compression mononeuropathy
  • Femoral neuropathy
  • Thoracic neuropathy

Why is footcare so important?

Peripheral neuropathy makes the foot incredibly vulnerable - hence foot care, and general skin care is very important. One of the symptoms of neuropathy is a loss of feeling.

Feet should be checked daily for cuts, sores, blisters, bruises and cracked or dry skin. If there is anything unusual - get to your doctor as soon as possible.