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• Nearly 70 percent of people with diabetes will experience some degree of neuropathy, but only an estimated 10-25 percent of those people will experience serious symptoms. Therefore, if a person is diagnosed with neuropathy, the odds of having only mild symptoms are good.
• The longer a person has diabetes, the greater the chance of developing neuropathy.
• Evidence suggests that if serious neuropathy is going to develop, it will do so within the first few years after the appearance of neuropathic symptoms.
• People with diabetic neuropathy are at an increased risk of stroke or heart attack.
• Neuropathy occurs most often in people whose diabetes is not well controlled, and in people who have had diabetes for a long time.

Lowering Your Risk Factor
The development of neuropathy appears to be directly related to the duration of a person's diabetes and the level of control he or shee keeps over blood sugar. The first line of defense against neuropathy is to bring blood sugar levels under the best control possible.

Once neuropathy has been diagnosed, the damage cannot be reversed. However, good control can slow the process, and possibly stop further damage. Ideally, good control should begin from the time a person is diagnosed with diabetes. Other factors that increase the risk of neuropathy are smoking and drinking alcohol.

Peripheral Neuropathy
Peripheral neuropathy affects the peripheral nervous syste, which links the legs, arms and outer trunk with the brain. This system of nerves allows you to feel sensations, telling you, for instance, to move your hand if you touch a hot iron. It allows you to walk, grasp objects, type a letter.

The most common type is called distal symmetrical polyneuropathy.

Distal Symmetrical Polyneuropathy

• This type of neuropathy is usually mild.
• It usually affects the legs, feet or hands and occurs equally on both sides of the body (symmetrically).
• Symptoms include tingling, burning, "pins and needles," numbness, aching, itching, the feeling of constantly wearing gloves, and other abnormal sensations.
• This type of neuropathy usually develops gradually, although it can happen suddenly, too.
• Sometimes a newly diagnosed diabetic will experience this neuropathy right after insulin therapy is initiated. When this happens, the symptoms usually subside or disappear with continued use of insulin.

NOTE: Although distal symmetrical polyneuropathy does not cause much discomfort, the inability to feel pain can cause other serious problems. As the disease progresses, a minor injury to the foot can go unnoticed and become infected and ulcerated.

Mononeuropathy
Mononeuropathy attacks a single nerve. Symptoms vary depending upon which nerve is affected, but mononeuropathy is usually acute and extremely painful. However, symptoms generally clear up in three months.

Cranial Mononeuropathy

• Eye paralysis is the most frequent type of cranial mononeuopathy.
• The first sign is pain on one side of the face, followed by paralysis of the eye muscle. Double vision and a drooping eyelid are the result.
• Cranial mononeuropathy usually strikes people over the age of 50.

Truncal Mononeuropathy

• Affects a nerve leading to the chest or abdomen.
• Symptoms can mimic heart diease, acute appendicities or kidney stones.
• A clue to diagnosing truncal mononeuropathy, rather than other ailments, is that the pain is usually greater at night. A physician can determine neuropathy by conducting simple tests.

Proximal Motor Neuropathy

• This type of neuropathy affects the thigh muscles. Because motor nerves are damaged, the thigh muscles become weak and shrink.
• The severity is varied--one or both legs can be affected, pain can be mild or intense, progress can be fast or slow. Some people experience severe weight loss--up to 40 pounds. Recovery usually takes 6 to 18 months. Onces the pain recedes, the muscles buildup again.

Proximal Motor Neuropathy
This type of neuropathy affects the automatic nervous system, the nerves which control a whole range of bodily functions, including the action of the stomach, instestine, esophagus, bladder, genitals, sweat glands and even the heart. These are all nerves which work independently of conscious control. Symptoms vary considerably, depending on the organs affected.

Gastrointestinal Tract
The gastrointestinal tract is one continuous tube running from the mouth, to the stomach, to the intestines to the anus.

• When the esophagus--(from mouth to stomach) is affected, it may become sluggish and fail to move food along normally--resulting in heartburn.
• When the stomach is affected, its movement can be impaired, and so can the secretion of digestive juices. If food is not digested properly or moved along to the small intestine, symptoms can include: vomiting, nausea or bloating, belching, or a full feeling after a few bites of food. Since food is not absorbed as quickly as it should be, severe hypoglycemic episodes can occur after meals. Hyperglycemia may occur at night when the meal finally does move into the intestine.
• When the small intestine is affected, diarrhea is the result. Dirrhea is caused either by over-stimulation of the small intestine (when the stomach suddenly empties a lot of food into it), or by food staying too long in the small intestine. Diabetic diarrhea may come and go. It may only occur at night, and can be mild or severe.
• When the large intestine is affected, constipation is the result. This is caused by a loss of movement in the large intestine, so that the stool remains in the intestine too long and too much water is absorbed from it.
• The rectum and anus retain the stool until a person is ready to pass it. Severe diabetic neuropathy can cause fecal incontinence.

This system controls blood pressure, especially when a person stands up. Normally, nerves tell blood vessels to constrict when a person is standing so that a sufficient amount of blood will remain in the upper body and brain, instead of flowing with gravity to the feet. When the sympathetic nervous system fails, the blood vessels may not constrict quickly enough and too much blood will flow to the legs, depriving the brain of adequate circulation. The result--dizziness or fainting spells.

Sexual Dysfunction

• Fifty to sixty percent of all men with diabetes will experience transient impotence.
• Nerve damage can disrupt the flow of signals which tell the arteries in the penis to dilate so that blood can flow in and make it rigid. This causes impotence--a condition which rarely occurs during the first 15 years of diabetes.
• Impotence may be temporary and reversible, or permanent.
• A sudden onset of impotence will generally be temporary, while gradual and progressive symptoms usually signal the development of permanent impotence.
• In some cases, temporary impotence may be caused by extreme high or low blood sugar levels. Anyone with diabetes who experiences episodes of impotence should test blood sugar levels. Improved blood sugar control can help.
• Impotence in diabetic men is not always caused by diabetic neuropathy. Psychological factors and anxiety about possible diabetic complicatons may be a factor.

See Your Doctor
Because neuropathies take so many different forms, it is essential that your physician be aware of your diabetes, even if it's mild. It is far better to be overly cautious and mention even the least of symptoms you may have to your doctor. By making sure you know and understand the facts about neuropathy, you improve your chances of preventing some of the progression and serious consequences.

Maintaining tight blood sugar control is the key to eliminating many of the symptoms of diabetic neuropathy. Other treatment options are available depending upon the specific type of neuropathy you may be experiencing. You should see your physician to obtain information about treatment.