One of the most common complications of diabetes is diabetic neuropathy. This damage to the nerves, causing pain or on the contrary insensitivity, can itself be the cause of other serious complications, hence the importance of detecting it.
One of the most common complications of diabetes, whether type 1 or type 2, is diabetic neuropathy. It corresponds to an attack on the nerves of the body which will alter the sensitivity to pain in particular: the patient can walk on a nail and not feel anything (hypoaesthesia), or on the contrary experience severe pain in contact with a simple sheet . The disease can also lead to motor disturbances.
Specific risk factors
This complication is linked to the chronic excess of sugar in the blood
“A nerve is like an electric wire”
There is the conductor and a protective sheath around the nerve. In diabetic neuropathy, there will be an accumulation of sorbitol in the sheaths of the nerves, which will cause abnormalities at this level. At the European Diabetes Congress, we also spoke of alterations in the microscopic blood vessels; vascular lesions would therefore also be responsible for this condition “.
If in general the complications of diabetes “occur after 10 to 15 years of unbalanced diabetes”, one of the peculiarities of diabetic neuropathy is that it can “occur early, with diabetes which is not necessarily very unbalanced. Sometimes, it is even a circumstance of discovery of diabetes “.
Other contributing factors have been identified, namely a large size (probably because of the longer nerve fibers and therefore more fragile), age (over 65 years), the presence of arteritis of the lower limbs, deficiencies in nutrition, smoking, or alcohol.
What are the symptoms?
Depending on the nerves affected, signs may appear. There would thus not be a diabetic neuropathy, but diabetic neuropathies, namely:
- Peripheral neuropathy (the most frequent attack), which affects the longest and most fragile nerves and which causes loss of sensation (tingling, tingling, numbness) or pain, particularly in the lower limbs;
- Vegetative or autonomic neuropathy, which affects the vagus nerve and the nerves of the sympathetic system and which causes disorders in the various organs. We speak in particular of cardiovascular neuropathy (tachycardia, orthostatic hypotension), digestive neuropathy (diarrhea, constipation, etc.), bladder neuropathy (hypoactive or overactive bladder), genital neuropathy (decrease in vaginal secretions and anorgasmia in women, dysfunction erectile and retrograde ejaculation in men) or even sweating disorders (hyperhidrosis in the upper part of the body and hypohidrosis in the lower limbs).
How is diabetic neuropathy diagnosed?
“Hence the importance of regular screening.”
The diagnosis of diabetic neuropathy is based on a simple clinical examination carried out by the attending physician, “in particular the examination (sensitivity, pain in the lower limbs), but also on functional complaints such as transit disorders or erectile dysfunction”, explains the French Society of Endocrinology (SFE).
However, most often, the disease is silent: the disturbances of sensitivity caused can indeed make certain symptoms imperceptible.
Examination of the feet is also routine. To check for a possible loss of sensitivity, the doctor has several tools, including the reflex hammer to search for a reduction or even disappearance of Achilles reflexes and monofilament, a rigid nylon thread applied under the foot to assess whether the patient feels the pressure or not.
The importance of preventing diabetic neuropathy
The prevention of diabetic neuropathy is through blood sugar control. It is also necessary to avoid the contributing factors, that is to say to moderate its consumption of alcohol, to stop smoking, and to make sure to have a varied and balanced diet.
Besides the fact that diabetic neuropathy can alter a patient’s quality of life, it can itself be the cause of “much more serious” complications. In the first line, the plantar perforating disease: “Because the soles of the feet are completely insensitive to trauma and the skin becomes very fragile, a hole will appear and become worse by becoming infected more easily, which can lead to gangrene and amputation “.
Another major complication: Charcot’s foot. “The bones are innervated and vascularized. However, diabetic neuropathy corresponds to disorders of the nerves: if the bones do not receive electrical tone very regularly, they almost become dead. Multiple and painless fractures will then occur spontaneously.”
Treatment of diabetic neuropathy
To date, there is no cure for diabetic neuropathy. Only the balance of diabetes, which requires a healthy lifestyle and good therapeutic adherence, can stabilize it. Depending on the related symptoms, medications may be prescribed to relieve them: analgesics, antiepileptics or antidepressants in the event of sensitivity disorders; moisturizers and pedicure treatments for dry skin; drugs or injections to promote erection, etc.
Prevention of complications of diabetic neuropathy
Therapeutic education remains the only way to avoid complications of the plantar and Charcot’s foot perforator type.
Doctors teach the patient to choose a good pair of shoes that will not hurt his feet, we teach him to have hygiene reflexes and in particular to look at his feet daily, he is also asked to go to the chiropodist very regularly.
There is also part of the cost of the consultation which is covered by Social Security for this reason.