As a diabetic, one of the side effects of this condition is diabetic neuropathy.  Neuropathy occurs when the high blood sugars affect the nerves and their function. But it is important to know that there are many types of diabetic neuropathy.  When we typically refer to diabetic neuropathy in the lower extremity, we think of it as tingling and numbness.  However this is only a small part of diabetic neuropathy.  Those nerves that are affected are sensory nerves.  However nerves control many things in the body, and high blood sugars have an effect on these nerves in different ways.  There are effects on peripheral nerves, and also autonomic nerves that lead to either peripheral neuropathy on the sensory nerves, or autonomic nerve neuropathy affecting body function and muscle balance. There is also mononeuropathy, which focuses on certain nerves being damaged. 

The most common type of neuropathy is peripheral neuropathy. The high blood sugars effect the sensory nerves and can lead to numbness and tingling.  Some patients feel burning sensations in their feet or feel like they are "walking on marbles" and that there is something in their shoe or their sock is balled up, but on examination, it is not the case, it only feels like it.  Patients relate very cold toes and fingers, or very hot and burning skin.  Sometimes they may feel a pins an needles sensation going up and down their legs. The way to control neuropathy is to control the blood glucose levels.  Often patients that have there symptoms find that they decrease when their blood glucose is tightly controlled, and some of these feelings can even go away.  If a patient is controlling their blood sugars but some of these symptoms persist, then there area oral medications available, but many of these have untowardly side effects.  Some of these medications side effects prevent a patient from driving.   Another option is a topical medication.  Our office works with a compounding pharmacy and our doctors can prescribe a topical medication containing topical lidocaine (a numbing medication) and gabapentin (an oral medication use for nerve pain and neuropathy) with an anti inflammatory that may help alleviate symptoms.  Although some patients see great success in reducing their symptoms with topical formulations, these topical medications have to be applied three to four times a day to be potent and they take several days to take effect.  The most successful treatment in our practice is MLS laser.  The MLS laser protocol in our office works to decrease edema and increase blood flow to the affected areas.  MLS laser is a non invasive, non painful treatment that helps neuropathy by releasing endorphins that reduce pain and stimulates the bodies own ability to repair nerves. Our office recommends 2-3 sessions per week, separated by at least 1 day, and a total of 12 sessions for the maximum effect.  There are few contraindications, and little risk, and this treatment is effective to treat the symptoms of peripheral neuropathy in the lower extremity. 

The autonomic nerves in your body control bodily function. So someone who has autonomic neuropathy may have symptoms with their body systems. Sometimes it affects the GI tract, and can lead to gastroparesis (slow emptying of the stomach) and nausea, or loss of appetite and a patient can get constipation or diarrhea. It can cause bladder problems, including increase incidences of urinary tract infections or urinary retention.  Sometimes it affects the muscles of the body and can affect swallowing.  There can be increased or decreased sweating, and controls the sweat glands all over your body but in the foot, there might be increased dryness or increased dampness of the skin.  Again, in order to control the effects on the autonomic nerves, patients must control their blood glucose levels.  With tight blood glucose control, many of these effects will be minimal. 

Sometimes there are specific nerves that are affected.  Neuropathy can cause compression of certain nerves and can be a contributing factor in conditions such as carpal tunnel syndrome in the wrist where the nerves in the wrist are compressed.  This can cause weakness and the inability to grasp small objects, and can affect fine motor skills of the hand.  This is difficult for the patient because it affects every day function, such as holding a pen to write or being able to hold a utensil to cook.  Other patients have certain motor nerves for example in the anterior or front of the shin, affecting certain nerves in the leg.  For some patients this means affecting the nerves that allow function in the legs.  One example is when a diabetic patient has foot drop, or the inability to dorsiflex (flex the foot upwards) during gait.  Footdrop may happen on one side, but is often both legs, and this can impair a patient from being able to walk on their own. They may need a foot and ankle orthosis or custom brace in order for their leg to function in gait, and this may also affect their balance and proprioception causing an increase risk of falling. 

Another type of neuropathy is Charcot neuropathy.  This happens post injury, or sometimes happens post repetitive trauma to the foot. In Charcot, the body has lost sensation and also has lost its ability to navigate the foot muscles and tendons and ligaments.  As a result, the bones of the foot start to collapse at certain joints.  The joints collapse on themselves, causing more trauma and inflammation to the area, which aggravates the condition further.  A person with Charcot does not feel pain the way that someone should, and so the patient continues to walk on the area, causing more deformity.  The foot appears red, hot, and swollen but there is no infection, but is is the body going through the different phases.  The foot must be stabilized and once it is stabilized, the foot can heal.  But often the foot will look very different and the joints may be unstable and dislocated afterwards, and there may be breakdown of the skin in certain high pressure areas that will appear as open wounds, or ulcers, on the  bony prominences. Early detection of Charcot can help avoid bony destruction and improve healing.  It is important for patients to be aware of their feet and if they see increase in redness, swelling, or warmth to touch, to seek immediate medical attention. 

It is important for patients to be educated about different types of neuropathy in diabetes, and with education, patients can find a way for prevention.  But if there are questions, seeking help from a physician earlier rather than later can prevent complications.