Diabetic neuropathy is caused by damage to nerve cells by high levels of blood sugar, or glucose. In this article we’ll explore the four basic types of autonomic neuropathy.
Peripheral autonomic neuropathy
Peripheral autonomic neuropathy is often described as having a stocking and glove distribution. It causes numbness, burning pain, and tingling in the arms, hands, legs, and feet. This puts patients in danger of developing foot ulcers because cuts and other injuries to the feet can go unnoticed. This is why patients are cautioned to wear well-fitting shoes at all times and to take good care of their feet.
For peripheral autonomic neuropathy of the feet, patients are urged to walk every day, and pentoxifylline, also known as Trental, may be prescribed. This allows red blood cells to conform more easily to small blood vessels and carry needed oxygen and nutrients to the cells. Feet must be carefully checked for scratches, redness, and blisters, and any lesions should be reported to the patient’s physician or podiatrist. Toenails should be trimmed straight across to prevent ingrown toenails.
Peripheral neuropathy causes pain in the thighs, hips, and buttocks, usually on only one side, and can cause weakness of the leg on that side. Medications for nerve pain include carbamazepine (Tegretol), gabapentin (Neurontin), oxcarbazepine (Oxtellar XR and Trileptal), pregabalin (Lyrica), and topiramate (Topamax).
Focal neuropathy can affect the eyes, one side of the face, chest, or abdomen. The eyes can be painful, and patients can experience double vision. One side of the face can droop and be paralyzed, in a condition known as Bell’s Palsy. Pain in the chest or abdomen can mimic heart attack or appendicitis, or severe back or leg pain can be mistaken for herniated disk. Often the same types of medications used to treat peripheral neuropathies are used to treat focal neuropathies.
Autonomic neuropathy typically affects the digestive system, and is also known to affect the blood vessels and genitourinary system. When the stomach or other digestive organs are affected, patients complain of feelings of fullness after small meals (early satiety), bloating, constipation, diarrhea, nausea, vomiting, and heartburn. When the urinary tract is involved, patients experience difficulty emptying their bladders, urination at night, incontinence, and bloating. When the reproductive system is involved, women may experience dryness and lack of orgasms. Men may be unable to achieve erections or ejaculation. Damage to blood vessels can cause low blood pressure, leading to dizziness and fainting when standing up quickly, fast heartbeat, nausea, and vomiting.
When the stomach is affected by autonomic neuropathy, Reglan (metoclopramide) may be prescribed to help the stomach empty its contents (gastroparesis). Over-the-counter medications can be effective for diarrhea and constipation. Viagra and Cialis are available for men unable to achieve or maintain erections. Women can be treated with vaginal creams containing estrogen. Dizziness caused by low blood pressure can be treated with Florinef (fludrocortisone) or Mestinon (midodrine and pyridostigmine). Beta blockers, such as Inderal (propranolol) can help restore the heart’s normal rhythm.
How can I prevent diabetic neuropathy?
Prevention of diabetic neuropathy consists of keeping blood sugar levels under control with a healthy diet and regular physical activity. Many diabetes specialists recommend keeping HbA1c levels below 7.0%.