Diabetic Neuropathies and Managed Care

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Diabetic Neuropathies and Managed Care: One area that many individuals diagnosed with diabetes may not readily consider is the potential for long-term nerve damage as a complication of their disease.

According to the National Diabetes Information Clearinghouse, “Diabetic neuropathies are a family of nerve disorders caused by diabetes. People with diabetes can, over time, develop nerve damage throughout the body. Some people with nerve damage have no symptoms. Others may have symptoms such as pain, tingling, or numbness—loss of feeling—in the hands, arms, feet, and legs. Nerve problems can occur in every organ system.”

It is believed that as many as 70% of those with diabetes will deal with diabetic neuropathies.

Doctors will likely test periodically for potential nerve damage as part of a normal diabetic checkup.

Diabetic Neuropathy Types

  • Peripheral neuropathy, the most common type of diabetic neuropathy, causes pain or loss of feeling in the toes, feet, legs, hands, and arms.
  • Autonomic neuropathy causes changes in digestion, bowel and bladder function, sexual response, and perspiration. It can also affect the nerves that serve the heart and control blood pressure, as well as nerves in the lungs and eyes. Autonomic neuropathy can also cause hypoglycemia unawareness, a condition in which people no longer experience the warning symptoms of low blood glucose levels.
  • Proximal neuropathy causes pain in the thighs, hips, or buttocks and leads to weakness in the legs.
  • Focal neuropathy results in the sudden weakness of one nerve or a group of nerves, causing muscle weakness or pain. Any nerve in the body can be affected. (Source: National Diabetes Information Clearinghouse)

These various neuropathic dysfunctions can affect virtually every area of your life, which is why regular monitoring of neurological function is important to the managed care of diabetes.

The patient cannot detect some diabetic neuropathies. They settle in without detection and the body simply accommodates the lack of feeling until detected by a health care provider. Other neuropathies can be very painful and require pain management.

One of the primary reasons health care providers urge diabetics not to smoke has to do with the impact smoking has on neurological function. Many who do choose to smoke are at a much greater risk for lower limb amputation due to nerve damage and foot ulcers.

The American Diabetes Association (ADA) provides some suggestions for those who have already been diagnosed with diabetic neuropathies.

  • Use a blood glucose meter to help you make decisions about day-to-day care.
  • Get an A1C test (a lab test) at least twice a year.
  • Report all possible signs of diabetic neuropathy.
  • If you have problems, get treatment right away. Early treatment can help prevent more problems later on.
  • Take good care of your feet. Check your feet every day. If you no longer can feel pain in your feet, you might not notice a foot injury. Instead, use your eyes to look for problems.
  • Protect your feet. If your feet are dry, use a lotion on your skin but not between your toes. Wear shoes and socks that fit well and wear them all the time.
  • Get special shoes if needed. If you have foot problems, Medicare may pay for shoes.
  • Be careful with exercising. Some physical activities are not safe for people with neuropathy. Talk with a diabetes clinical exercise expert who can guide you.

Often the reason for foot problems stems from the fact that diabetics may not be able to detect injuries or ulcers without visual inspection. If they can’t feel the pain they may not recognize the problem until it is well advanced and difficult to treat. Foot care remains an important consideration for those who may be suffering with diabetic neuropathies.

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