Persons who keep their blood sugar as close to normal as possible have a 60% reduced risk of nerve damage.

Without early attention and vigilant control of blood sugar, these problems can eventually lead to serious effects.

Cynthia often noticed numbness and pins and needles in her feet during the day and sometimes burning pain in bed at night. The pain was never so bad that she couldn’t manage it, but since she had been diabetic for eight years, she reported her symptoms. Her doctor confirmed that they were indeed related to her diabetes and required prompt attention before the symptoms got worse.

Cynthia was suffering from diabetic neuropathy, a nerve disorder that is a common complication of both type 1 and type 2 diabetes. Symptoms can range from numbness, tingling and burning to sharp, jolting pains, cramps and sensitivity to even light touch such as rubbing against the bed clothes. If early symptoms are ignored, they may get worse until the discomfort is great enough to keep the person awake at night and make it difficult to walk or perform daily chores.

About 60 percent of diabetics suffer from nerve problems associated with their disease. Problems are more common among diabetics who have been diagnosed for a number of years, smokers, heavy drinkers and those who have not been good about controlling their blood sugar, cholesterol and blood pressure.

Without early attention, these nerve problems can eventually lead to serious consequences such as kidney failure, gastrointestinal problems and limb amputation.

What Cynthia was suffering from is by far the most common type of diabetic nerve problem–distal symmetrical polyneuropathy. It affects the feet and, to a lesser degree, the hands on both sides of the body and progresses in a pattern known as “stocking and glove.”

Feet Are Vulnerable
Taking the weight of the entire body with every step, the feet are particularly vulnerable to damage of many kinds. Changes in the forces put on the foot, combined with osteoporosis and arthritis, frequently damage the structure of a diabetic patient’s foot. The foot may become shorter and wider and develop deformities such as bunions and hammer toes. Changes in gait can greatly increase the risk of falls and of further damage to the skin and soft tissue of the feet.

Perhaps even more dangerous is the loss of normal sensation that comes with diabetic neuropathy. Any bruise, cut, ulcer or infection in the foot, as a result, may go unnoticed, eventually putting the patient at risk of severe complications, including gangrene. The situation is compounded by the fact that the person may also have reduced immune function and blood flow to the feet as a result of diabetes. About half of all amputations in this country are a direct result of diabetic foot infections.

Another common type of nerve damage, affecting at least 30 percent of diabetics, is autonomic neuropathy. The autonomic nervous system controls all those functions of the human body that we take for granted–the beating of the heart, the working of the gastrointestinal system, kidneys, bladder, sweat glands and even the pupils of the eyes.

Autonomic neuropathy can progress gradually and produce symptoms that are hard to pin down. A patient’s feet may remain overly dry, for example, while sweat pours from her face and body. Diarrhea and bladder dysfunction are common. She may feel abnormally nauseous and bloated after meals. If this leads to vomiting or poor eating habits, it can have an effect on blood sugar control and nutrition.

Men frequently suffer erectile dysfunction as a result of autonomic neuropathy. For women, sexual problems include vaginal dryness and pain during intercourse.

Probably the most dangerous consequence of autonomic neuropathy is the effect on the heart and cardiovascular system, which depend on a fluctuating heart rate to meet the demands of daily life.

Autonomic nerve dysfunction can be detected through simple tests to determine how much the patient’s heart rate varies in response to physical activity, breathing and changes in position. Lack of variability can signal a serious risk of heart problems.

What Can You Do?
Frequently overlooked, diabetic nerve problems are never to be taken lightly. With early detection and constant vigilance, however, the most serious consequences can be avoided.

Whether for prevention or treatment, the most important thing you can do is to maintain tight control of blood sugar. Although scientists do not know for sure why high blood sugar causes nerve problems, large studies such as the Diabetes Control and Complications Trial (DCCT) have demonstrated that persons who keep their blood sugar as close to normal as possible have 60 percent less risk of nerve damage. They are less likely to have initial symptoms and, once they do have symptoms, they have a slower progression of disease.

For those wishing to prevent nerve problems or treat it in the early stages, good blood sugar control can be obtained through regular exercise and a diet that is rich in plant-based foods and low in fats and simple carbohydrates. For more advanced disease, treatment usually includes oral medication or insulin doses designed to keep blood glucose under tight control.

Good foot care is essential. The diabetic must be constantly aware of her feet–examining them regularly and protecting them from trauma, cuts and fungal infections. Any redness, swelling, infection, numbness, tingling or pain is reason for a prompt visit to a doctor.

A foot examination–at least once a year and on every doctor’s visit–should be an essential part of any diabetic’s treatment plan. This examination should test sensation and reflexes and check for sores, cuts, bruises and deformities.

Spotting autonomic neuropathy means paying attention to signs such as blurred vision, intermittent diarrhea, constipation, nausea, dizziness, abnormal sweating or sexual dysfunction. A racing heart while at rest is often the first sign of damage to nerves controlling the heart.

To control pain in the feet or hands, numerous medications can be used, depending on the type of symptoms.

These include simple pain killers such as ibuprofen and acetaminophen, narcotic pain killers, antidepressants and anti-seizure medications. Among promising drugs being investigated to help in the treatment of diabetic neuropathy are aldose reductase inhibitors.

Gastrointestinal problems can sometimes be relieved by eating frequent small low-fat meals rather than three large meals a day.

Compared to other complications, diabetic nerve problems are often overlooked. Except for the pain or numbness in the feet or hands, they often develop silently and then strike with devastating force. Patients and doctors alike must be vigilant about spotting the symptoms and starting early treatment.

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