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Diabetic Neuropathy

What is diabetic neuropathy ?

Diabetic neuropathy means damage of nerve fibers in people with diabetes. How the nerves are injured is not entirely clear but research suggests that high blood glucose changes the metabolism of nerve cells and causes reduced blood flow to the nerve. There are different types of nerves in the body. These can be grouped as

  • sensory (detect sensation such as heat, cold, pain)
  • motor (contract muscles to control movement)
  • autonomic (regulate functions we cannot control directly, such as heart rate and digestion)

The most common type of diabetic neuropathy affects the nerves in the legs and is usually known as peripheral neuropathy. This is the type of neuropathy that causes foot problems. It affects mainly the sensory nerves although the motor and autonomic nerves can also be involved with important consequences.

What problems can be caused by diabetic neuropathy ?

Neuropathy can result in two sets of what superficially appear to be contradictory problems. Most patients who have neuropathy have one of these problems but some can be affected by both.

  • loss of ability to feel pain and other sensation which leads to neuropathic ulceration.
  • symptoms of pain, burning, pins and needles or numbness which lead to discomfort.

A typical neuropathic ulcer is shown in the figure below. Patients with neuropathy lose their sensation of pain. As a result, they exert a lot of pressure at one spot under the foot when they walk, building up a callus at that site without causing discomfort. The pressure becomes so high that eventually it causes breakdown of tissues and ulceration. The patient hardly notices any pain.

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