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Neuropathy -continued- The reach of neuropathy extends well beyond hands and feet.
Asking patients about their digestion to screen for symptoms at every encounter is important. Keep an eye out for symptoms that may be paired with poor glycemic control after meals, lingering high BGs despite increases in insulin dosage, sudden low or target BGs 1-2 hours post meal followed by BG elevations or patients frequently needing to delay insulin or medication dosage to after meals, or making high use of extended boluses regardless of glycemic index of the meal.
Neuropathy impacting the autonomic or central nervous system can lead to a host of hard to manage and even harder to live with, potentially life threatening symptoms.
Dysautonomia Cardiovascular Autonomic Neuropathy can cause arythmias, unstable blood pressure. Postural Orthostatis Tachycardia Syndrome Orthostatis Hypotension can both greatly increase risks of falls.And all of these can make exercising (an important piece of wellness and diabetes management) very difficult to do safely.
Neuropathy can also damage the nerves in the bladder. This results in the loss of sensation when one needs to urinate, and the inability to fully void. These can both increase our risks of bladder and kidney infections, bladder cancer, and other renal function problems. Alternately this neuropathy can cause discomfort or painful voiding as well as over active bladders or incontinence. When Neuropathy affects the blood vessels and nerves of the genitals the result can be sexual dysfunction. Erectile dysfunction is one of the most common long-term complications experienced by men with diabetes, but goes largely unreported. When the nerves and blood vessels that supply the genitals are not able to function properly due to neuropathy achieving and maintaining arousal becomes difficult. For women this may result in reduced arousal and reduced lubrication. This often leads to a reduced sex drive, emotional distress and relational strain. It is important to be open about sexual changes with your patients, these changes are not a “normal part of aging” and there are options to help improve symptoms.
Be sure to consider needs of Transgender, intersex or non gender identifying persons. Sexual wellness can be more complicated in the presence of hormones, gender affirmation surgery, gender dysphoria and other challenges. Being open and non judgemental with all patients is key to diagnosing and treating all diabetes complications effectively.
Preventing Neuropathy Preventing Neuropathy, much like nephropathy begins with: Maintaining blood sugars as close as possible to Without the excess glucose to cause irritation of microvascular tissues your risk of injury goes way down! Healthy weight reduces the stress on the peripheral nervous system as well as excess stress on the digestive and urinary organs Healthy blood pressures in the capillary structures, is key to keeping those vessels healthy and getting needed oxygen to the nerves Routine physical activity also promotes capillary growth and dilation, perfusion and increases oxygenation in the blood stream Quitting smoking is particularly important to reduce risks of neuropathy as smoking constricts blood vessels and directly causes neuropathy.
Don’t assume all symptoms lead back to diabetes! Electromylogram can trace the extent and area of origin of nerve related problems. Writing off tingling hands or feet, or voiding issues or any neuropathy, as a “Diabetes complication” could be very damaging. Neuropathy is largely untreatable with therapies being limited. We have no verified treatments to return nerve function once damage is done. . But there is also every chance that the cause of the symptoms is nerve impingement from orthopedic injury, arthritis, a tumor, or even an alternative auto immune disease all of which can be treated very effectively. Be sure to rule out other possible causes before settling on the irreversible diagnosis. |
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