DEAR DOCTOR K: I have diabetes. Lately I've had some new, unpleasant symptoms. My doctor says they're due to diabetic neuropathy. What is this? And what can I do about it?
DEAR READER: Diabetic neuropathy is nerve damage that results from diabetes. The most common symptoms of neuropathy are tingling, burning, other unpleasant sensations or a loss of sensation.
The most common type of nerve damage from diabetes is peripheral neuropathy. It affects the peripheral nerves that extend from your spine to your arms and legs. This condition lowers your sensitivity to touch and pain, especially in your feet. It increases your risk of serious foot injury because if you develop sores on your feet, you may not feel any pain.
Pain is a warning sign. Without it, you may not notice the sore, and as a result it may get worse. People with diabetes have a hard time healing sores because their circulation is poor. With diabetic neuropathy, a simple cut or blister on the bottom of the foot can become so severely infected that it won't heal. If the sore won't heal on its own, the only solution may be an amputation.
That's why it is so important for people with diabetes to take care of their feet. You must carefully check your feet every day and treat any foot injury immediately. See your doctor about any wound that doesn't heal.
People with diabetes also can suffer from neuropathy in parts of the body other than the feet. Nerve damage can lead to problems with digestive, bladder, bowel or sexual function. This is from damage to the autonomic nerves, which control such things as heart rate, blood pressure, digestion, sweating and erections. Such damage can cause a variety of unpleasant effects:
- BOWEL DISTURBANCES. Eating more fiber may correct bowel disturbances. If your stomach empties too slowly, a medication such as metoclopramide (Reglan) may help. For diarrhea, try an antidiarrheal drug such as loperamide (Imodium).
- ERECTILE DYSFUNCTION. Drugs such as sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra) may help. Vacuum devices or surgical implants are also options.
- BLADDER PROBLEMS. Go to the bathroom every few hours rather than waiting until you feel the urge. If this doesn't help, ask your doctor about drugs or surgery.
- DIZZINESS. If standing up quickly brings on lightheadedness, take more time to change positions. Cutting out alcohol, wearing support stockings and increasing your dietary salt intake may also help.
- TINGLING, BURNING, UNPLEASANT SENSATIONS. Several types of medicine can greatly reduce these symptoms, including tricyclic drugs and certain anticonvulsants. Most of my patients with diabetic neuropathy have gotten good relief from them.