Diabetes and the nerves

Diabetic neuropathy, a possible complication of diabetes, involves damage to the nerves.

The most common form is a polyneuropathy, which causes diminished sensation in the hands, feet and legs, where it's usually most marked.

Diabetic neuropathy is often symptomless, but may be associated with numbness, tingling, and pins and needles in the hands and feet. It’s also less commonly associated with debilitating, severe, deep-seated pain and increased sensitivity to touch. Ankle jerks, which are elicited by the doctor with a small hammer during an examination of the nervous system, are decreased or absent.

Symptoms and signs of polyneuropathy can be present at diagnosis in patients with type 2 diabetes, but it's not usually found in people with recently diagnosed type 1 diabetes.

Older diabetics can suffer from acute and painful so-called mononeuropathies affecting the nerves of the head and neck (the cranial nerves). These symptoms may resolve spontaneously over a period of weeks to months.

Autonomic neuropathy occurs mainly in those diabetics who have polyneuropathy. This affects the part of the nervous system responsible for the control of bodily functions that are not consciously controlled. This includes regular beating of the heart, intestinal movements, sweating and salivation.

Diabetic neuropathy can cause postural hypotension, in which blood pressure falls when a person stands up suddenly. It can also cause disordered sweating; erectile dysfunction and retrograde ejaculation in men; impaired bladder function; delayed emptying of the gut; problems with swallowing; constipation and diarrhoea. Diarrhoea at night is very characteristic.
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