Diabetic neuropathy is a loss of
sensory and motor function in the hands and feet of people with
diabetes. While there are several different types of neuropathy
that may occur in diabetics, the most common one effects the
feet first and subsequently the hands. The individual begins
to notice sensory changes such as numbness, pain or tingling
in the toes or fingers. At first these symptoms will come and
go, but then they will become constant. The unpleasant symptoms
may interfere with your going to sleep, or may cause you to
awaken from sleep. Over time, with increasing loss of sensation,
you may not be able to feel how tight your shoes are, know whether
the bath water is hot or cold, or feel any small injuries to
your feet. Changes in muscle strength may also occur. This weakness
may cause you to feel unstable on your feet or to fall and the
arches in your feet may collapse.
Neuropathy is the leading cause of ulcerations (wounds) that
occur on the feet. Neuropathy is the leading cause of infections
in the feet. Neuropathy is the leading cause of loss of toes
and in advanced cases, amputation of the lower leg.
The reason that diabetic's nerves are susceptible to compression
is that the nerves in diabetic's are swollen. Sugar from the
blood enters into the nerve to give the nerve energy; this glucose
is converted into another sugar called sorbitol. Sorbitol's
chemical formula makes it attract water molecules. When water
is drawn into the nerve, the nerves can become swollen. When
nerves become swollen, they can become pinched or compressed
at areas of tight fibrous bands in the lower and upper extremities.
This compression causes the symptoms of neuropathy; such as
carpal tunnel syndrome.
A second reason for the neuropathy is that the transport system
for nutrients for the nerve is slowed in a diabetic. This decrease
in axoplasmic transport means that the nerve cannot repair itself
well, rendering it more likely to remain in trouble from compression
and therefore produce symptoms of neuropathy.
Although good control of blood glucose levels can slow the
development of neuropathy, doctors today still do not have a
medical approach to either prevent or control the progressive
loss of sensory and motor functions. There are medications to
treat the symptoms of neuropathy, but the underlying pathology
is not improved.
Dr. Lee Dellon has developed a noninvasive testing method to
quantitate the degree of sensory nerve loss in both upper and
lower extremities. He has also developed a surgical intervention
to decompress the peripheral nerves of the lower extremities
to help restore sensory and motor function. To date, Dr. Dellon
and those surgeons that he has trained have either decreased
or completely alleviated neuropathic symptoms in 80% of the
diabetics which they have treated. To date, no patient that
has had a peripheral nerve decompression has developed an ulceration
on the lower extremity.
Care Clinic @ AJH
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