Nearly 70% of persons with diabetes experience some degree of nerve damage or neuropathy. Neuropathy occurs in people with Type I and Type II diabetes, due to metabolic changes associated with diabetes. Constant high blood sugar destroys both nerve fiber (axon) and the fatty insulation that surrounds it (myelin ). Damaged nerves do not transmit proper signals, resulting in a loss of sensation, hypersensation, or pain.

Peripheral neuropathy is the most common form. Varying from mild to severe, it causes changes in sensation that begin in the toes move up to the feet and legs. One may experience numbness, tingling, burning, dull ache, or stabbing pain and cramping, which is worse at night. The skin can become so sensitive that pressure from clothes is painful. Severe neuropathy may cause weakness and unbalanced walking. The greatest danger is foot ulcers, which result when lack of sensation causes people to continuing walking on injured feet.

Many treatments are available for peripheral neuropathy, including medications and topical creams. Not all are effective for everyone. Better diabetic control helps some patients. A painful neuropathy may change to a numb feeling after a while. And neuropathies sometimes disappear on their own. Autonomic neuropathy involves the nerve supply to small blood vessels and sweat glands of the skin, the stomach, the bowls, the bladder, the heart, and the nervous system. It is most often associated with long-term diabetes, poor control, and elevated blood sugar. Symptoms vary, depending on the affected area, and may include:

• Abnormal sweating after eating

• Inappropriate response to temperature changes, such as constricting blood vessels in warm temperatures

• Nausea and early fullness when eating, delayed emptying stomach, or vomiting

• Watery diarrhea, often at night and without warning

• Incomplete emptying of bladder, leading to urinary tract infections

• Sexual disfunction, including impotence and delayed vaginal lubrication

• Drop in blood pressure upon sitting or standing

• Rapid heart beat

• Loss of warning signs of hypoglycemia

Various medications may be prescribed to control nausea, vomiting, diarrhea, sudden drops in blood pressure, and recurrent urinary tract infections. Penile implants and vacuum systems are useful in treating impotence.

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