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Diabetes & Neurological Problems
Patients with diabetes are prone to neurological Problems. Diabetes can damage even the smallest nerves in the body. As the duration of the disease advances, they are prone to more and more complications.
Diabetes patients can have:
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Altered Sensorium
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High sugar & low sugar both can produce altered sensorium, decreased consciousness level, and seizures. An entity called hyperosmolar coma can happen in diabetic patients with high blood sugar. (This condition is precipitated by even minor infections in the body.
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Low sugar can produce coma & fits. Changes produced in the brain are reversible if corrected early. If not corrected early, it can produce irreversible damage to the brain.
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Cranial Neuropathy
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Diabetic Patients irrespective of this sugar control can have various cranial neuropathy. It can produce diplopia (double vision) by the involvement of nerves supplying the ocular muscles.
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It can produce visual disturbances by the involvement of the retina (diabetic retinopathy), premature cataract, and involvement of the optic nerves/macular(optic neuritis & maculopathy).
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It can produce facial paralysis & lower cranial nerve Palsy (i.e hoarseness of voice & difficulties in swallowing).
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Diabetics and Stroke
Patients with diabetes have accelerated atherosclerosis & carotid stenosis, which can give rise to stroke. Diabetes can predispose the patient to have cardiac & renal problems, which itself is a risk factor for the development of future strokes.
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Diabetes and peripheral neuropathy
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It can produce both small and large fiber Neuropathy. Patients with small fiber neuropathy will have severe burning and pricking sensations. Patients with large fiber neuropathy will have numbness, a cotton wool-like sensation ( as if walking on sand).
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Patients with small fibre neuropathy may or may not have weakness in the limbs. Patients with large fiber neuropathy have complaints of slipping of slippers without knowledge.
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Diabetic patients are prone to various mono neuropathies & entrapment neuropathy. Diabetic patients can have foot drop, hand weakness. (ulnar neuropathies).
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Diabetic patients can have chronic neuropathies in addition to what can be caused by diabetes, an entity called “CIDP (chronic inflammatory demyelinating polyneuropathy).
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IN CIDP, the patient will have weakness and wasting of all 4 limbs, with neck muscle weakness, with sensory symptoms; symptoms can range from a week to months. This disease requires aggressive treatment with proper evaluation. Any patient with Diabetes having weakness of limbs that is rapidly progressing would need evaluation for “CIDP”.
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Some patients with diabetes will have some weakness and wasting in one leg associated with severe pain. An entity called diabetic amyotrophy (Diabetic Lumbo. radiculo-plexopathy).
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Diabetic patients can have autonomic neuropathies, i.e patients will have bloating sensations in the abdomen after having a small quantity of food. Unexplained diarrhoea, frequent constipation, erectile dysfunction, passing urine without awareness, urinary incontinence/skin changes(dryness of feet).
So in brief, diabetes can affect the entire brain to the distal-most nerves in the body. Aggressive sugar control and proper evaluation of neurological symptoms by experts in time can prevent the progression of symptoms. Consult with the best neurologist in Mangalore today.
Investigation to rule out: Neurological complications
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Carotid vertebral Doppler to rule out carotid disease and prevent strokes.
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Nerve conduction studies with SSR (To detect diabetic peripheral neuropathies & Autonomic nerve involvement)
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Ophthalmological evaluation
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In cases of CIDP/certain atypical neuropathy, when in doubt, would require nerve biopsy.
Book an appointment with the best neurologist in Mangalore if you or someone else requires treatment for Diabetes-related Neurological issues.
How to treat diabetic Neuropathy?
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Patients with diabetic neuropathies will have severe burning symptoms which can be treated with medicines like a) Pregabalin b) Amitryptlini c) Tegretal d) Gabapentin e) Local applications, cream like capsaicin cream.
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Some patients with diabetic neuropathy who are having CIDP will require Aggressive Immunosuppressants, high-dose steroids & azathioprine.
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Autonomic Neuropathy is difficult to treat, especially in patients with bladder problems and diabetic diarrhoea. Gastroparesis can be treated with prokinetic drugs.
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Autonomic postural hypotension is treated with drugs like fludrocortisone, Midodrine, and elastic stockings for both lower limbs.
In Nutshell
Diabetic patients are prone to various neurological problems. More the duration of diabetes, the more complications of the disease. Timely evaluation and proper treatment can prevent the progression of the disease.
Manipal Hospital is the best neurology hospital in Mangalore having neurologists in Mangalore trained in diagnosing and treating people with epilepsy, aneurysms, spinal Bifida, movement disorders, dementia, stroke, brain tumors, multiple sclerosis, headache, neuromuscular diseases, peripheral nerve tumors, paralysis, nerve pain, sleep disorders, speech disorders, and many other conditions.
MD, DM-Neurology
