Diabetic Neuropathy

First of all, what is diabetes?

The name Diabetes Mellitus comes from the Greek word “diabetes” meaning to siphon or pass through and the latin word “mellitus” for honey or sweet. Diabetes was once known as glycosuria, meaning, 'sugar run-out'. Over 3,000 years ago, the ancient Egyptians spoke about a condition that appears to have been type 1 diabetes. It featured excessive urination, thirst, and weight loss. They recommended following a diet of whole grains to reduce the symptoms.

In ancient India, people discovered that they could use ants to test for diabetes by presenting urine to them. If the ants came to the urine, this was a sign that it contained high sugar levels. They called the condition madhumeha, meaning honey urine.

During the third century B.C.E., Apollonius of Memphis mentioned the term “diabetes,” which may have been its earliest reference. In the Middle Ages, people believed that diabetes was a disease of the kidneys, but an English doctor in the late 18th century found that it occurred in people who had an injury to the pancreas.

In 1776, Matthew Dobson confirmed that the urine of people with diabetes could have a sweet taste. According to an article that the journal Medical Observations and Enquiries published, he measured the glucose in urine and found that it was high in people with diabetes. Dobson also noted that diabetes could be fatal in some people but chronic in others, further clarifying the differences between type 1 and type 2. By the early 19th century, there were no statistics about how common diabetes was, there was no effective treatment, and people usually died within weeks to months of first showing symptoms.

According to the World Health Organization, Diabetes is a chronic, metabolic disease characterized by elevated levels of blood glucose (or blood sugar), which leads over time to serious damage to the heart, blood vessels, eyes, kidneys and nerves. Actually, it is a group of conditions where the body cannot produce enough or any insulin (a hormone made by the pancreas that allows your body to use sugar from carbohydrates for energy or to store for future use), cannot properly use the insulin that is produced, or cannot do a combination of either. When any of these things happen, the body is unable to get sugar from the blood into your cells. This can lead to high blood sugar levels. There are two types of diabetes, Type 1 and Type 2.

Type 1 Diabetes can occur at any age but is commonly diagnosed around the age of 30 when insufficient insulin is produced by the pancreas and the body’s immune system destroys insulin-producing cells. In this autoimmune disease, the white corpuscles of the immune system are reprogrammed by the body to specifically attack the pancreatic islets. The pancreatic islets are responsible for producing and releasing insulin and other hormones that help the body maintain healthy blood glucose levels. When the white corpuscles attack the pancreatic islets, they can no longer produce those hormones, causing the blood glucose levels to rise significantly.

Type 2 Diabetes occurs when the body still produces insulin, but it does not produce enough or is not able to use it effectively due to some type of malfunction. Researchers think that high levels of stress hormones might affect insulin-producing cells in the pancreas and reduce the amount of insulin they make. 

What is insulin and what does it do?

Insulin is a hormone that lowers the level of glucose (a type of sugar) in the blood. It's made by the beta cells of the pancreas (which are part of the Islets of Langerhans) and released into the blood when the glucose level goes up, such as after eating. Insulin helps glucose enter the body's cells, where it can be used for energy or stored for future use.

In the beta cells, insulin is created first as a big molecule called “proinsulin.” Proinsulin is broken into two pieces: insulin and C-peptide. C-peptide is important especially when determining treatment because it can be used to measure how much insulin a person is making. The more C-peptide a person has, the more insulin they are making. This can help a provider determine how much insulin to prescribe. In people with type 1 diabetes, the pancreas no longer makes insulin. The beta cells have been destroyed and they need insulin shots to use glucose from meals.

People with type 2 diabetes make insulin, but their bodies don't respond well to it. Some people with type 2 diabetes need diabetes pills or insulin shots to help their bodies use glucose for energy. Insulin cannot be taken as a pill because it would be broken down during digestion just like the protein in food. It must be injected into the fat under your skin for it to get into your blood. 

What are the symptoms of diabetes?

Feeling more thirsty than usual. Feeling irritable or having other mood changes.

Urinating often. Having blurry vision.

Losing weight without trying. Having slow-healing sores.

Presence of ketones in the urine. Getting a lot of infections (gum, skin, vaginal).

Numbness or tingling in the hands or feet. Areas of darkened skin, in the armpits and neck.

How does diabetes harm the body?

Potential complications of diabetes and frequent comorbidities include:

Heart and blood vessel disease. Diabetes is associated with an increased risk of heart disease, stroke, high blood pressure and narrowing of blood vessels (atherosclerosis).

Nerve damage (neuropathy) in limbs. High blood sugar over time can damage or destroy nerves, resulting in tingling, numbness, burning, pain or eventual loss of feeling that usually begins at the tips of the toes or fingers and gradually spreads upward.

Other nerve damage. Damage to nerves of the heart can contribute to irregular heart rhythms. Nerve damage in the digestive system can cause problems with nausea, vomiting, diarrhea or constipation. For men, nerve damage may cause erectile dysfunction.

Kidney disease. Diabetes may lead to chronic kidney disease or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.

Eye damage. Diabetes increases the risk of serious eye diseases, such as cataracts and glaucoma, and may damage the blood vessels of the retina, potentially leading to blindness.

Skin conditions. Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections.

Slow healing. Left untreated, cuts and blisters can become serious infections, which may heal poorly. Severe damage might require toe, foot or leg amputation.

Hearing impairment. Hearing problems are more common in people with diabetes.

Sleep apnea. Obstructive sleep apnea is common in people living with type 2 diabetes. Obesity may be the main contributing factor to both conditions. It's not clear whether treating sleep apnea improves blood sugar control.

Dementia. Type 2 diabetes seems to increase the risk of Alzheimer's disease and other disorders that cause dementia. Poor control of blood sugar levels is linked to more-rapid decline in memory and other thinking skills. 

What is diabetic neuropathy?

Diabetes can harm your nerves and cause pain; that is called diabetic neuropathy. These damaged nerves cannot effectively carry messages between the brain and other parts of the body.

60% to 70% of all people with diabetes may eventually develop peripheral neuropathy, although not all suffer pain. People with diabetes can reduce their risk of developing nerve damage by keeping their blood sugar levels as close to normal as possible.

When blood sugar levels are too high for too long, 4 kinds of neuropathy can arise: 

Peripheral, Autonomic, Proximal, Focal.

Peripheral: affects feet and legs & rarely arms, abdomen and back

Symptoms include tingling, numbness, burning, pain, pins and needles, cold, pinching, buzzing, sharp, deep stabs, cramps, sensitivity to touch often worse at night. Nerve Compression such as carpal tunnel syndrome causes numbness and tingling of and in the hand and sometimes muscle weakness or pain. This means you may not feel heat, cold, or pain in your feet, legs, or hands. If you get a cut or sore on your foot, you may not know it, which is why it's so important to inspect your feet daily. If a shoe doesn't fit properly, you could even develop a foot ulcer and not know it. 

What can you do? Check feet and legs daily; use lotion on feet if they are dry; take care of toenails; and wear shoes that fit well.

Autonomic: affects digestive system, especially stomach and can also affect blood vessels, urinary system and sex organs

Digestive system: 

Symptoms: bloating, diarrhea, constipation, heartburn, nausea, vomiting, full after small meals

What can you do? Eat smaller meals

Blood Vessels:

Symptoms: faster heartbeat, dizziness, low blood pressure, nausea, vomiting, feeling full quickly

What can you do? Avoid standing up too quickly, maybe wear compression stockings

In Men: may not have or keep erections; may have dry or reduced ejaculations

In Women: less vaginal lubrication and fewer or no orgasms

Urinary System: 

Symptoms: trouble emptying bladder, bloating, incontinence, night trips to toilet

What can you do? Self catheterization to release urine

Proximal: 

Symptoms: pain usually on one side of thighs, hips or buttocks; it can lead to weakness in legs

What can you do? Physical therapy

 

Focal: can appear suddenly and affect specific nerves, most often in the head, torso or leg. It causes muscle weakness or pain.

Symptoms: double vision, eye pain, Bell’s palsy - paralysis on one side of the face, severe pain in a certain area such as the lower back or leg (s), chest or belly pain (it is sometimes mistaken for appendicitis or heart attack).

What can you do? Tell the doctor. It can improve over weeks or months.

Are there ways to relieve diabetes nerve pain?

First, it is important to eat a healthy diet that promotes lower blood sugar levels. Include more non-starchy vegetables, such as broccoli, spinach, and green beans. Avoid added sugars and refined grains, such as white bread, rice, and pasta with less than 2 grams of fibre per serving. Focus on nutrient-dense whole foods instead of processed foods. Eat some protein with every meal.

Next, relax your body using techniques such as a warm bath (especially, with sea salt and lavender oil), meditation, hypnosis, acupuncture and other relaxation techniques that you may find. Meditation is a therapy for diabetes and other painful disorders. Research shows that meditation can lower blood pressure and improve heart rate, breathing, and brain wave activity. Some common ways to relax are: 

Rhythmic breathing: Breathe in through your nose and out through your mouth. Take long, slow breaths. Inhale slowly, and then exhale slowly. Count slowly to five as you inhale. Then count slowly to five as you exhale. Pay attention to how your body naturally relaxes.

Deep breathing: Imagine a spot just below your navel. Breathe into that spot, filling the abdomen with air. Let the air fill you from the abdomen up, then let it out, like deflating a balloon.

Visualized breathing: Find a comfortable place where you can close your eyes. Picture relaxation entering your body and tension leaving the body. Breathe deeply, but in a natural rhythm. Visualize the breath coming into your nostrils, going into your lungs. Picture it expanding your chest and abdomen. Then, visualize the breath going out the same way. Each time you exhale, imagine you are getting rid of a little more tension.

Relax to music: Put on some music that lifts your mood and that you find soothing and calming. There are specially designed relaxation audio tapes or CDs that are perfect for this.

Mental imagery relaxation: This is also called guided imagery. It is a form of "mental escape" in which you create calming, peaceful images in your mind. You also identify self-talk -- your thoughts about your illness -- and focus on positive thoughts and emotions instead. Visualize yourself feeling happy with no pain.

Yoga, tai chi or qigong: These stress-relieving practices help your body to relax and balance. 

And then, you can try teaching your body to vary certain factors such as pulse, digestion, temperature and muscle tension through biofeedback (you attach sensors to the areas you want to monitor and change and then you watch the computer to see how you can control those areas using your mind).

Also, you can use affirmations to change your self-talk from complaint to appreciation and gratitude. For example, Before you eat, say “Thank you food, for your healing and loving energy. All is well. Every day, and in every way, I am getting better and better.” As you are able to increase your gratitude and appreciation, positive changes will begin to occur in your life and health.

Whether it is diabetic neuropathy or some other “unwellness” or “dis-ease”, you are able to effect positive changes in your own wellness through taking responsibility and control over your health through your positive attitude, words and actions. Ask your health practitioner for whatever help and support they are able to give you in your quest for better health.