Feeling Numb: Understanding Diabetic Neuropathy and Its Impact

Diabetic neuropathy is the most common complication of diabetes mellitus (DM), affecting as many as 50% of patients with type 1 and type 2 DM.

Diabetic peripheral neuropathy involves the presence of symptoms or signs of peripheral nerve dysfunction in people with diabetes after other possible causes have been excluded

In type 1 DM, distal polyneuropathy typically becomes symptomatic after many years of chronic prolonged hyperglycemia, whereas in type 2, it may be apparent after only a few years of known poor glycemic control or even at diagnosis.

Sensory symptoms

Sensory neuropathy usually is insidious in onset and shows a stocking-and-glove distribution in the distal extremities. Sensory symptoms may be negative or positive, diffuse or focal. Negative sensory symptoms include feelings of numbness or deadness, which patients may describe as being akin to wearing gloves or socks. Loss of balance, especially with the eyes closed, and painless injuries due to loss of sensation are common. Positive symptoms may be described as burning, prickling pain, tingling, electric shock–like feelings, aching, tightness, or hypersensitivity to touch.

Motor symptoms

Motor problems may include distal, proximal, or more focal weakness. In the upper extremities, distal motor symptoms may include impaired fine hand coordination and difficulty with tasks such as opening jars or turning keys. Foot slapping and toe scuffing may be early symptoms of foot weakness. Symptoms of proximal limb weakness include difficulty climbing up and down stairs, difficulty getting up from a seated or supine position, falls due to the knees giving way, and difficulty raising the arms above the shoulders.

Autonomic symptoms

Autonomic neuropathy may involve the cardiovascular, gastrointestinal, and genitourinary systems and the sweat glands. Patients with generalized autonomic neuropathies may report ataxia, gait instability, or near syncope/syncope. In addition, autonomic neuropathies have further symptoms that relate to the anatomic site of nerve damage eg:

Gastrointestinal autonomic neuropathy may produce the following symptoms?

• Dysphagia
• Abdominal pain
• Nausea/vomiting
• Malabsorption
• Fecal incontinence
• Diarrhea
• Constipation

Cardiovascular autonomic neuropathy may produce the following symptoms:

• Persistent sinus tachycardia
• Orthostatic hypotension
• Sinus arrhythmia
• Near syncope upon changing positions from recumbent to standing

Bladder neuropathy (which must be differentiated from prostate or spine disorders) may produce the following symptoms:

• Poor urinary stream
• Feeling of incomplete bladder emptying
• Straining to void

Sudomotor neuropathy may produce the following symptoms:

• Heat intolerance
• Heavy sweating of head, neck, and trunk with anhidrosis of lower trunk and extremities
• Gustatory sweating

Diagnosis

?The diagnosis of DPN is mainly based on characteristic symptoms and signs.

?Nerve conduction studies (NCS) is one of the gold standard techniques for diagnosing peripheral neuropathy.?NCS has the characteristics of being quantifiable, objective, and sensitive, but it has the following disadvantages: time-consuming, high cost, poor experience, and the need for professional doctors to operate. It is difficult to implement in large sample screening?

Other causes of peripheral neuropathy must be excluded

Differential Diagnoses

• Alcohol (Ethanol) Related Neuropathy
• Amyloid polyneuropathy
• Chronic Myelogenous Leukemia (CML)
• Nutritional Neuropathy
• Spinal Cord Tumors
• Toxic Neuropathy
• Uremic Neuropathy
• Vasculitic Neuropathy
• Vitamin B-12 deficiency

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Management of diabetic neuropathy

• Foot care, including regular follow-up, patient education, and referral as appropriate
• Tight, stable glycemic control (most important for slowing progression of neuropathy)
• Pain management (e.g., with pregabalin, gabapentin, sodium valproate, dextromethorphan, duloxetine, transdermal lidocaine)
• Treatment of diabetic gastroparesis (e.g., with erythromycin, cisapride, metoclopramide).

As we continue to raise awareness about diabetic neuropathy, it’s essential to highlight the role of healthcare providers in managing this condition. As Salam International Hospital- New Cairo, stands at the forefront of patient care, offering comprehensive support and innovative treatment options, we exemplify the commitment to improving the quality of life for those affected. By prioritizing education, early intervention, and personalized care, we can empower individuals to navigate their health journey with confidence and resilience.