The third kind of microvascular complication resulting from poor glucose control involves the nervous system and is called diabetic neuropathy. The tiny blood vessels supplying the nerve tissue are damaged by the mechanisms discussed in the earlier sidebar "The potential causes of microvascular complications." The result is loss of nerve conduction with numbness and tingling in some cases and pain in others.
Neuropathy becomes more severe the longer diabetes remains out of control. It usually takes ten years to develop, so it's not seen in young children who have had diabetes only a few years. Diabetic neuropathy occurs in some form or another in up to 75 percent of patients with T1DM, but this figure is falling. Neuropathy is made worse in adults by the following conditions:
Age: It becomes more common with age.
Height: It's most common in taller individuals who have longer nerve fibers to damage.
Alcohol consumption: Even small quantities of alcohol can make neuropathy worse.
The speed with which a nervous impulse travels down a nerve is called the nerve conduction velocity (NCV). In diabetic neuropathy, the NCV is slowed. At first, the only symptom is an abnormal NCV, which is tested by using needles at the ends of a nerve and detecting how long a stimulus takes to travel from one end to the other. As early minor symptoms like mild loss of sensation develop, the only way to verify the result of any treatment, whether it's better glucose control or some medication, may be repeating the NCV. However, the degree of NCV slowing doesn't always correlate with the severity of symptoms.
Several different kinds of nerve fibers are responsible for different kinds of sensation such as vibration, light touch, and temperature. These fibers can be tested in the following ways:
^ Vibration testing: A tuning fork discloses damage to vibration nerve fibers, which are large. A result of damage to these nerves may be that you have poor balance.
^ Temperature testing: A hot or cold item discloses damage to temperature fibers, which are small and frequently damaged in people with diabetes. The result of damage may be that you get into a very hot bath without realizing that it may burn you.
^ Light touch testing: A filament reflects the large fibers that sense anything that touches the skin. The amount of force needed to bend the filament to a point that you feel it is measured in grams (g). A person who can feel a 10 g filament is able to feel anything that may damage his foot. A person who can't feel a filament requiring 75 g of force is considered to have lost all sensation in the tested area. The consequence of such damage may be that you're unaware of stepping on a nail.
The various disorders of the nervous system in diabetes are broken down into the following categories:
^ Disorders associated with loss of sensation, where the sensory nerves are damaged
^ Disorders associated with loss of motor nerves, which carry impulses to muscles to make them move
^ Disorders due to loss of automatic nerves (also known as autonomic nerves), which control muscles that you don't have to think about, such as the heart, the intestinal muscles, and the bladder muscles
The following sections describe the various conditions associated with these disorders.
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All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.