diabetic neuropathy

http://www.telegraphindia.com/1140915/jsp/knowhow/story_18835166.jsp#.VBbuZ5SSya8 The slow killer

Your Health DR GITA MATHAI

Most senior citizens in India have diabetes. Unfortunately, many do not take this disease seriously. They cheat on their diet, add “a little sugar” to their tea and miss their daily dose of pills. They coast along, as complications take a long time to set in. Uncontrolled sugars damage the nerves, causing “diabetic neuropathy”. High blood sugars slow down conduction signals in nerves and the blood vessels, which supply essential nutrients to the nerves, are also compromised. Smoking and consumption of alcohol aggravate diabetic neuropathy. The symptoms are many. Tingling, numbness, sudden shooting pains can occur along the peripheral nerves, which supply the limbs. The pain of an injury may not be felt as the sensation in the distal parts of the limbs is affected. So injuries that go unnoticed can lead to an infection and eventual amputation. Muscles become weak and flabby, resulting in loss of power and balance. If the autonomic nervous system is affected, the heart rate can be inappropriately rapid at all times instead of fluctuating with activity. This interferes with the body’s ability to maintain blood pressure. Giddiness may appear or consciousness may be lost on suddenly standing up. The movement of the gastrointestinal tract can be affected. It may become difficult to swallow as the esophagus does not contract properly. The stomach may become lax and distended causing belching, a feeling of fullness, nausea and vomiting. The slow movement of food through the intestine can cause constipation. In others the neuropathy may cause uncontrollable watery diarrhoea, worse at night. Damage to the bladder nerves prevents the person from sensing whether the bladder is full or empty, leading to incontinence. Sex organs can become affected. In men, this can cause impotence and erectile dysfunction. In women vaginal lubrication may decrease and there may be failure to achieve orgasm. The muscles responsible for proper focus in the eyes can malfunction. There is blurring of vision. The treatment of diabetic neuropathy begins with proper control of blood sugars. The blood sugar should be in the target range of 80-130mg dL on an empty stomach and 180mg dL two hours after food. A judicious combination of diet and exercise needs to be followed. Between 1500 -2000 calories can be eaten a day. Avoid processed food, sugar and honey. Walk, jog, cycle or swim for at least 30 minutes a day. Weight training exercises help maintain muscle mass and strength. Twenty to thirty repetitions of standard drills with dumbbells weighing 1-2kg will maintain muscle mass without adding bulk. Blood sugar can be controlled with insulin injections or medications that increase the body’s insulin output. In addition, specific medicine can be taken for the symptoms of neuropathy. The pain of neuropathy responds to external applications of a capsaicin-containing ointment and also to acupuncture. If these do not work, effective drugs are pregabalin and carbamazepine, which belong to the seizure medication group. Antidepressants like amitriptyline, nortriptyline, desipramine and duloxetine are effective in some people. Avoid codeine-based painkillers as they can become addictive. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in