Diabetic Neuropathy

Presentation is dependent on the type of neuropathy being dealt with [6].

Peripheral neuropathy

• Numbness or reduced ability to feel pain or changes in temperature, especially in the feet and toes
• A tingling or burning sensation
• Sharp, jabbing pain that often worsens at night
• Pain when walking
• Extreme sensitivity to the lightest touch 
• Muscle weakness and difficulty walking
• Serious foot problems, such as ulcers, infections, deformities, and bone and joint pain

Autonomic neuropathy

• A lack of awareness that blood sugar levels are low (hypoglycemia unawareness)
• Bladder problems, including frequent urinary tract infections or urinary incontinence
• Constipation, uncontrolled diarrhea or a combination of the two
• Slow stomach emptying (gastroparesis), leading to nausea, vomiting and loss of appetite
• Difficulty swallowing
• Erectile dysfunction in men
• Vaginal dryness and other sexual difficulties in women
• Increased or decreased sweating
• Inability of the body to adjust blood pressure and heart rate, leading to sharp drops in blood pressure following rise from sitting or lying down (orthostatic hypotension). This may cause the feeling of lightheaded and even fainting in some cases. 
• Problems regulating body temperature
• Changes in the way eyes adjust from light to dark
• Increased heart rate when at rest

Radiculoplexus neuropathy

• Sudden, severe pain in hip and thigh or buttock
• Eventual weak and atrophied thigh muscles
• Difficulty rising from a sitting position
• Abdominal swelling, if the abdomen is affected
• Weight loss

Mononeuropathy

• Difficulty focusing the eyes, double vision or aching behind one eye
• Paralysis on one side of your face (Bell's palsy)
• Pain in the shin or foot
• Pain in the front of the thigh
• Chest or abdominal pain

The condition is diagnosed based on symptoms presented, a physical exam and a medical history [7]. During the exam, the muscle strength and tone is checked, tendon reflexes as well as sensitivity to touch, temperature and vibration are also checked. Other tests that may be conducted include the following:

• Filament test
• Nerve conduction studies
• Electromyography (EMG)
• Quantitative sensory testing
• Autonomic testing

Diabetic neuropathy has no known cure [8] [9]. Treatment and management is mostly focused on slowing of the progression of the disease, relieving of pain, management of complications and restoration of functions.

There are certain risk factors associated with more severe cases of diabetic neuropathy. They include the following [2]:

• Poor glycemic control
• Advanced age
• Hypertension
• Long duration of diabetes mellitus
• Dyslipidemia
• Smoking
• Heavy alcohol intake
• HLA-DR3/4 phenotype
• Tall height

Development of symptoms is however, dependent on a variety of factors such as the total hyperglycemic exposure as well as other risk factors like elevated lipds, blood pressure, smoking, increased height as well as excessive exposure to some other neurotoxic agents like ethanol. Genetic factors have also be considered to have a role.

In the United States, 47% of patients with diabetes show some peripheral neuropathy [3]. Neuropathy is believed to be seen in 7.5% of patients at the time of diagnosis of diabetes with more than half of the cases demonstrating distal symmetric polyneuropathy. Internationally, figures are far lower.

Diabetes mellitus affects men and women with the same frequency. However, male patients with type 2 diabetes may develop polyneuropathy much earlier than their female counterparts. Diabetic neuropathy can be seen at any age but it is most common with increasing age, severity and duration of the diabetes.

The major factors responsible for the development of diabetic neuropathy remains incompletely understood [4]. However, multiple hypotheses have been brought forward. It is generally believed that the condition is a multifactorial process.

Development of symptoms is dependent on several factors such as total hyperglycemic exposure and other risk factors like elevated lipids, blood pressure, smoking, increased height, as well as high exposure to other potentially neurotoxic agents like ethanol. Genetic factors can also play a role.

Important contributing biochemical mechanisms in the development of the more commonly known symmetrical forms of diabetic polyneuropathy may include the following: polyol pathway, advanced glycation end products as well as oxidative stress.

Diabetic neuropathies refer to any of the neuropathic disorders that are commonly associated with diabetes mellitus [1]. These conditions are believed to arise mostly from diabetic microvascular injuries which often involve the small blood vessels responsible for supplying nerves as well as macrovascular conditions that may end up in diabetic neuropathy. There are 4 major types of neuropathy: Peripheral neuropathy, autonomic neuropathy, radiculoplexus neuropathy or diabetic amyotrophy and mononeuropathy.

Diabetic neuropath refers to a type of nerve damage which can occur in people with diabetes. High blood sugar may bring about injury to the nerve fibres around the body but diabetic neuropathy is focused on the legs and feet.

Depending on the affected nerves, symptoms of diabetic neuropathy can range from pain, to numbness in the extremities as well as problems in the urinary tract, digestive tract, blood vessels and the heart. For some people, these symptoms are often mild while for others, diabetic neuropathy can be fatal, painful or disabling.

Diabetic neuropathy is common but serious complication of diabetes that can only be controlled by sticking to prescribed blood sugar controls and living a healthy lifestyle.