What is Autonomic Neuropathy?

Autonomic Neuropathy
One of the hallmark conditions that can occur with diabetes is neuropathy, a misfire in the nerves that impacts feeling and function. There are several types that can affect your body in different ways, but one version — autonomic neuropathy — affects the background functions of your body. That makes getting an accurate diagnosis critical.

What is autonomic neuropathy?

Autonomic neuropathy, also called dysautonomia, affects the nerves that control your involuntary bodily functions. When these nerves are damaged it impacts your blood pressure, temperature control, digestion, and bladder function.

The problems occur because the nerve damage makes it harder for your brain to send messages to your organs and parts of the autonomic nervous system, including your blood vessels, heart, and sweat glands.

What symptoms are common?

The symptoms you experience are directly tied to the part of your autonomic nervous system affected by the neuropathy. Pay attention to these symptoms, and talk with your doctor if they appear.

  • Dizziness and fainting when standing
  • Urinary problems, including incontinence, difficulty starting or sensing a full bladder, and an inability to empty your bladder.
  • Digestive problems, including feeling full after only a few bites, loss of appetite, diarrhea, constipation, bloating, nausea, vomiting, and heartburn.
  • Lack of signs of low blood sugar, such as shaking.
  • Sweating too much or too little, making it harder to regulate your body temperature.
  • Difficulty adjusting your eyes from light to dark.

How is autonomic neuropathy treated?

There are several things you can do to treat your symptoms and minimize the impact. Consider these steps:

  • If you experience nausea or feel full after eating small amounts, work with a dietician to plan your meals.
  • Take medications to accelerate your digestion and reduce diarrhea.

Preventive steps

Slowing the progression of autonomic neuropathy is possible, and it can greatly minimize your symptoms. To limit the impact of the condition as much as you can, follow these tips:

  • Control your blood sugar. Keep it between 80-130 mg/dL before eating and under 180 mg/dL after.
  • Avoid alcohol and smoking.
  • Get appropriate treatment for any autoimmune disease.
  • Control your blood pressure, keeping it below 130/80.
  • Maintain a healthy weight.
  • Exercise regularly, shooting for at least 30 minutes of exercise five times weekly. Biking, running, walking, or swimming are good options.

Making a few lifestyle changes can also lead to improvements:

  • Posture changes: Stand up slowly to decrease dizziness. Tense your leg muscles when standing to increase your blood pressure.
  • Elevate the bed: If you have low blood pressure, raise the head of your bed by approximately 4 inches.
  • Digestion: Eat smaller, more frequent meals. Increase fluids. Choose low-fat, high-fiber options, and restrict lactose and gluten.

If you suspect you have autonomic neuropathy, consult your doctor immediately, particularly if your diabetes isn’t well controlled. Even more, you’ll likely be screened for autonomic neuropathy every year after you receive your diagnosis if you have Type 2 Diabetes.

Contact the Amputation Prevention Centers of America if you have any questions.

What is Peripheral Neuropathy?

Peripheral Neuropathy

Do you have numbness, tingling, or constant pain in your feet and legs? It is worse overnight? Is it hard to feel temperature with your feet, but they’re still hyper-sensitive to touch? If you answered yes, you could have peripheral neuropathy.

And, if you have diabetes, it’s critically important to understand this condition.

What Is It Peripheral Neuropathy?

Peripheral neuropathy is loss of feeling mainly in your legs and feet, but it can spread to your arms and hands.

It affects between 60 percent to 70 percent of people with diabetes, according to the National Institutes of Health, and it worsens at night. It impacts people differently, however. Some feel tingling. Others feel pain or numbness. But, overall, changes appear slowly as people age.

Caused by chronically high blood sugar levels (130 mg/dL before eating; >180 mg/dL after eating), peripheral neuropathy damages nerves, making it harder for messages to travel between your brain and your extremities. It can be particularly dangerous because you might not know you’ve developed an ulcer. Left untreated, ulcers can get infected, potentially leading to amputation or death.

Symptoms

Initially, you can develop numbness; tingling; a prickly pins-and-needles feeling; a burning or cold sensation; pinching; buzzing; or sharp, deep stabbing pains. However, as peripheral neuropathy progresses, these signs are also possible:

  • Touch sensitivity: Your toes, feet, legs, and hands can become overly responsive.
  • Muscle weakness: Nerve damage weakens your muscles, making it harder for you to walk or grab things.
  • Balance problems: Numbness in your feet can make you unsteady and uncoordinated.

Peripheral neuropathy can also cause digestive system, urinary tract, blood vessel, and heart problems.

Treatment Options

There’s no cure for peripheral neuropathy, but you can minimize your discomfort. Talk with your doctor about these options.

  • Braces: Hand and foot braces can reduce physical disability and pain. Orthopedic shoes can improve your gait and help prevent foot injuries. Splints can also alleviate carpal tunnel symptoms.
  • Complementary techniques: In some cases, acupuncture, massage, herbal medication, and cognitive or behavioral training can lessen neurological pain.
  • Medication: Some drugs approved for chronic neuropathic pain can provide relief. Discuss effective medications with your doctor.
  • Transcutaneous electrical nerve stimulation: This treatment delivers gentle electrical currents to painful sites via electrodes attached to the skin. Some studies show it improves peripheral neuropathy.

Protecting Your Feet

If you have peripheral neuropathy, take steps to prevent ulcers or sores on your feet. Follow these tips to avoid potentially serious wounds.

  • Check your feet daily for blisters, sores, or ulcers.
  • Keep your feet clean and dry.
  • Trim your toenails carefully. Cut them straight across, filing down sharp edges.
  • Wear clean, dry socks.
  • Wear cushioned shoes with enough space for your toes.

When to See Your Doctor

There will be times you’ll need to consult your doctor. Schedule an appointment if you see any of these changes if:

  • you have any non-healing cut or sore on your foot.
  • burning, itching, tingling, weakness, or the pain in your hands or feet interferes with your daily activities or sleep.
  • you see changes to your digestion, urination, or sexual function.
  • you experience dizziness.

Overall, knowing how to identify and what to expect from peripheral neuropathy can help you manage the condition.

Contact the Amputation Prevention Centers of America for more information.

Why Your Peripheral Neuropathy Feels Worse at Night

Peripheral Neuropathy

The pain, tingling, and burning sensations from diabetic peripheral neuropathy can be debilitating any time of day. But, for some people, these uncomfortable sensations get particularly worse at night, especially when they’re trying to sleep.

If you’re in this category, you might have been told you’re imagining it. But, recent research from the Comprehensive Pain Center at Oregon Health & Sciences University indicates more acute pain at night isn’t in your head. In a study of nearly 650 participants, investigators found patients with diabetic peripheral neuropathy — regardless of age, gender, or other health conditions — reported feeling the most significant pain between 11pm and 8am.

Next time you feel your peripheral neuropathy pain intensifying at night, consider these possible causes. In some cases, you can try to get the discomfort under control.

  1. Fewer distractions: At night, there’s less to take your mind off your pain — no chores, no errands, and no talking as you try to drift off to sleep. That’s when your mind and body become more aware of your surroundings. You notice your pain more, making sleep elusive.

To combat that heightened awareness, try to focus on something you enjoy to take your mind off what you’re feeling.

  1. Cooler temperatures: With peripheral neuropathy, according to Loma Linda University Health, your feet will be far more sensitive to cooler air. As temperatures drop at night, your peripheral nerves can begin to tingle more, and you’ll feel more burning or sharp pains. Your heart rate also slows when you’re colder, slowing your blood and increasing painful sensations.

If you can handle the touch on your feet, wrap up in blankets to warm up.

  1. Stress/Fatigue: Sometimes, physical stress and exertion can increase your nerve pain as your body begins to relax at the end of the day. Vigorous exercise and the soreness that accompanies it can contribute to more night-time nerve pain.

Be sure you alternate your exercise routines so you’re not over-taxing your body, and pay attention to when you need to take a break from exercise and let your body rest.

  1. Medication: Even though your medication might work well during the day, keeping you mostly free from pain, it eventually wears off. This typically happens at night, according to the Innovations Stem Cell Center. When you’ve been comfortable all day, you’ll notice the pain much more when it starts to creep back in.

 

Try these strategies to stay comfortable at night if your have peripheral neuropathy pain:

  • Control your blood sugar. Work to keep your levels between 80-130 mg/dL before eating and under 180 mg/dL after meals.
  • Soak your feet in a warm bath to relax your nerves at night. Be sure to check the water temperature to avoid burning your feet.
  • Exercise regularly. It increases blood flow and oxygen to your feet, reducing pain. Listen to your body, though, and take breaks when needed.

Contact Amputation Prevention Centers of America if you have questions.

Diabetic Amputation & Neuropathy — Is It Inevitable?

Diabetic Amputation
Diabetic neuropathy — nerve damage caused by high blood glucose levels — affects between 60 percent and 70 percent of individuals with diabetes. If you have it, your diabetic amputation risk will be higher. In fact, more than 50 percent of all amputations annually are associated with diabetes.

According to the National Institutes of Health, approximately 86,000 people undergo foot amputations yearly. But, you can reduce your likelihood if you understand the role neuropathy frequently plays in amputations.

How Neuropathy Causes Problems

The nerve damage and reduced sensations in your feet make it far easier for you to sustain injuries and get infections. Because you can’t notice any discomfort, ulcers, infections, and gangrene can develop easily, and poor circulation makes it harder for you to heal.

If the infection can’t be controlled or the wound won’t heal, amputation is a likely outcome to remove dead tissue. Of the roughly 15 percent of all diabetics who develop a foot ulcer, 24 percent will face amputation.

In some cases only toes or parts of the foot are removed to salvage as much healthy tissues as possible. But, if the infection has spread, doctors might have to remove the entire foot or leg. Amputations require several nights in the hospital and up to 8 weeks of recovery time. Prostheses, assistive devices, and home adaptations can help with rehabilitation.

Ways to Reduce Risk for Diabetic Amputation & Neuropathy

You can reduce your chances for developing an injury that ends in amputation.  Following these suggestions can help keep your feet in tact:

  1. Don’t smoke. It constricts the blood vessels, decreasing circulation.
  2. Get routine foot check-ups. Examine your feet daily, using a mirror to see them if needed. Have a medical provider check them regularly, as well.
  3. Control your blood sugar. Keep your levels between 70-130 mg/dL before eating and under 180 mg/dL after meals.
  4. Eat healthy. Choose lean meats, fruits, vegetables, fiber, and whole grains. Avoid sugared juices and sodas.
  5. Get at least 30 minutes daily. Swimming and walking are good options.
  6. Practice good foot care. Wash and dry your feet thoroughly every day, putting cornstarch between your toes to minimize moisture. Keep your toenails trimmed short. Apply a thin layer of petroleum jelly to your feet to reduce cracking. And, wear well-fitting, closed-toe shoes and dry socks without elastic at all times.
  7. Don’t remove warts or callouses with scrapers or scissors. It can leave your feet open to infection.
  8. Keep moving. Wiggle your toes and twist your ankles several times a day.

 

When to Talk With Your Doctor

Even if you follow these tips, problems could still arise. See your doctor if you have any of these issues: fungal infections, splinters, ingrown toenails, corns, bunions, callouses, plantar warts, chilblains, hammertoes, dry skin, gout, and heal pain/spurs.

Although diabetic neuropathy greatly increases your likelihood for foot injury and possible amputation, following these steps can give you the greatest chance for avoiding this surgery.

Contact the Amputation Prevention Centers of America for more information on diabetic amputation and neuropathy.

Inherited Neuropathy — Can Numbness Be Hereditary?

Inherited Neuropathy

Eye color, shoe size, and height all have one thing in common — they’re hereditary. It turns out inherited neuropathy can be, too.

While it’s rare, children who have a parent with heritable neuropathy have a 50 percent chance of developing the condition, as well. It can show up as early as birth, but it’s more frequently diagnosed in middle- and older-age. Type 2 diabetes and obesity are also risk factors.

According to an Annals of Indian Academy of Neurology study, there are more than 30 genes that are linked to inherited neuropathy. A neurologist can diagnose whether you have the condition via nerve conduction studies, nerve biopsies, or genetic testing.

There are two common forms of inherited neuropathies — Charcot-Marie-Tooth (CMT) and Hereditary Neuropathy with Liability to Pressure Palsies (HNPP). Overall, they share many similar symptoms. Individuals experience pain and tingling in their hands and feet, muscle weakness and loss of mass in their feet and lower legs.  They also experience impaired sweating, low blood pressure upon standing up, and physical deformities, such as high foot arches, hammertoes, and curved spine.

What Happens With CMT?

CMT affects approximately 1 in 3,300 people. There are many CMT subtypes, but CMT1A is the most common. It affects 20 percent of people who seek medical attention for undiagnosed peripheral neuropathy.

Patients with CMT have difficulty lifting their feet, weak ankles, drop foot, and have unsteady balance. They also exhibit poor hand coordination, making it harder to hold pencils, button or zip clothes, and turn door knobs. Additionally, they can be hyper-sensitive to cold temperatures. Muscle weakness and poor circulation can turn hands and feet cold, as well as lead to ankle and foot swelling.

Sometimes, individuals with CMT can also lose their knee-jerk reactions and experience hand tremors. This is called Roussy-Levy Syndrome. Additionally, weak breathing and shortness of breath are rare, but they can be life-threatening. If those symptoms appear, a respiratory specialist might recommend a ventilator.

What Occurs With HNPP?

HNPP is even more rare than CMT, appearing in 2-5 individuals per 100,000.

Affected individuals are extremely sensitive to pressure, and they can have difficulty carrying heavy bags, leaning on their elbows, or sitting in chairs. Frequently, they experience tingling, numbness, and loss of sensation in areas impacted by the neuropathy. These symptoms typically strike the hands, arms, feet, and legs.

Often, HNPP episodes last for several months. Long durations can lead to permanent muscle weakness and sensation loss.

Prevention & Treatment

There’s no way to prevent inherited neuropathy, but genetic counseling is available to parents who worry about passing the condition on to their children.

Additionally, there’s no cure, but ongoing management techniques can greatly improve quality of life. For example, pain medications, physical therapy, corrective surgery, therapeutic shoes, braces, and support devices can greatly reduce the impact inherited neuropathy has. A balanced diet and exercise are also beneficial.

Be sure to seek medical attention as soon as symptoms for inherited neuropathy appear. The earlier the diagnosis, the better prognosis and outlook you’ll have.

For more information, contact the Amputation Prevention Centers of America.

Can’t Feel Your Hands or Feet? It Could Be Diabetic Neuropathy

Diabetic Neuropathy

If you have diabetes, you know controlling your blood sugar is important. But it’s not just about monitoring your insulin. Healthy glucose levels help stave off diabetic neuropathy, a painful nerve condition that affects your mobility and quality of life.

What is diabetic neuropathy?

Diabetic neuropathy is feeling loss in your extremities from nerve damage. It typically strikes the legs and feet, but numbness can appear in other parts of your body.

What causes diabetic neuropathy?

Long-term high blood sugar levels (higher than 130 mg/dL before eating; higher than 180 mg/dL after eating) can injure your nerves. Once damaged, it’s harder for them to fire signals throughout your body. Nerve inflammation, genetic factors, smoking and excessive alcohol consumption can also be factors.

Types of diabetic neuropathy

There are four main types. Talk with your doctor about which form you have.

  1. Peripheral: This is most common, impacting up to 50 percent of diabetics, according to the National Institutes of Health (NIH). It starts in the legs and feet, can spread to the arms and hands and worsens at night. Typical symptoms include numbness, reduced temperature sensitivity, tingling, burning and sharp pains, as well as sensitivity to touch, muscle weakness, poor balance and decreased coordination. Because you can’t feel pressure, ulcers and sores are likely to develop on your feet.
  2. Autonomic: This neuropathy, found in up to 30 percent of diabetics, affects your heart, bladder, stomach, intestines, sex organs and eyes. It prevents you from recognizing blood sugar drops, and a sluggish stomach causes nausea, vomiting, bloating and appetite loss. Incontinence and constipation occur frequently, too. Sharp blood pressure drops and racing heart rates are possible, as well as sexual effects — vaginal dryness in women and erectile dysfunction in men.
  3. Radiculoplexus neuropathy: Most common in individuals with Type 2 diabetes and older adults, this type attacks thighs, hips, buttocks and legs. Eventually, your muscles shrink, making it harder to stand from a seated position. You could also experience abdominal swelling and weight loss.
  4. Mononeuropathy: Also called focal neuropathy, it’s most common in older adults. It affects the face, torso and legs, causing severe pain that suddenly strikes the shin, foot, lower back, thigh, chest or abdomen. However, it tends to disappear on its own within a few weeks or months.

 

What increases your risk?

Your risk increases the longer you’ve had diabetes, and improper blood-sugar control raises your likelihood even more. Existing kidney disease also releases toxins into your blood that cause nerve damage. Additionally, a BMI >24 and smoking put you at risk.

Can you prevent or manage it?

According to the NIH, exercise, following your diabetic meal plans, smoking cessation and taking prescribed medications can prevent neuropathy. Also, limit alcohol consumption to one daily drink for women, two for men.

If you have neuropathy, you can limit its impact. Maintain healthy blood sugar, blood pressure, cholesterol and weight ranges. Keep your feet clean and dry, checking them daily for sores, cuts or ulcers.

When should you see your doctor?

Any time you have a lingering cut or sore on your foot, seek medical attention. Discuss dizziness, new burning or tingling sensations or progressive weakness, as well as digestive or sexual function changes with your doctor. These symptoms don’t automatically mean you have diabetic neuropathy, but get them checked to ensure you don’t overlook effective treatment.

If you have any questions, contact the Amputation Prevention Centers of America.

Living with – and Limiting – Diabetic Neuropathy

Diabetic Neuropathy
Diabetic neuropathy is nerve damage that causes numbness in your extremities and it has no cure. The good news is you can limit how much it impacts your body and life. Work with your doctor to secure a proper diagnosis and outline an effective treatment plan.

What will your doctor do if you have diabetic neuropathy?

Your doctor will ask about your symptoms and medical history, as well as check your heart rate, blood pressure and muscle tone. He or she will also check your reflexes, mainly in your ankles. A tuning fork test will determine sensitivity in your feet to vibration and a nylon fiber pinprick tests sensitivity to touch.

What are your treatment options?

Proper treatment can slow progression. There are several things you can do.

  • Medication: Discuss available medications with your doctor, including alternative therapies. Some medications can ease neuropathic pain by 30 percent to 50 percent. In some cases, alternative therapies, such as acupuncture, can alleviate symptoms when combined with medication.
  • Diet: Eating smaller meals improves digestion. Limit fiber and fat, concentrating mainly on fruits, vegetables, low-fat dairy, whole grains and moderate amounts of fish, poultry and nuts. Eat only small amounts of red meat.
  • Blood Sugar: Keeping your blood sugar in a healthy range (lower than 130 mg/dL before eating, lower than 180 mg/dL after eating) and maintaining a hemoglobin A1C of less than 7 percent can reduce nerve damage by up to 60 percent, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
  • Exercise: Strive for 30 minutes of exercise five days a week. Biking, walking, swimming, running and aerobics are good options to improve circulation to your arms, legs, hands and feet.
  • Get warm: Take a warm bath. It can boost your circulation.
  • Vitamins: Vitamin D can protect you against nerve pain. Getting enough on your own is difficult, so add a supplement to reach the 600-800 IU you need daily. Recent research revealed enough Vitamin D reduces neuropathy symptoms within two months. Low B12 also causes nerve damage and low B6 can decrease the chemicals in your body responsible for sending messages. Have your doctor check your levels.
  • Capsaicin cream: Hot peppers might make you think about having a spicy mouth, but the chemical ingredient that causes that sensation — capsaicin — can also alleviate the burning and pain associated with nerve damage. In fact, a study published in the journal Pain showed wearing an 8-percent capsaicin patch reduced pain by 30 percent after two weeks. Only your doctor can prescribe a higher-level cream, but even a 0.1-percent cream can provide up to 11-percent relief.

Contact us

Overall, since there’s no cure, you can’t completely alleviate the symptoms associated with your diabetic neuropathy. But, with proper treatment — and consultation with your doctor — you can significantly reduce how much it impacts your quality of life.

If you have any additional questions about diabetic neuropathy, contact the Amputation Prevention Centers of America.