Diabetic Neuropathy: The Latest Facts

What causes diabetic neuropathy?

High blood sugar levels are toxic to nerves and reduce their ability to heal and recover from injuries. Diabetes also damages blood vessels, especially small vessels (microangiopathy). This means that the nerves cannot receive enough oxygen and nutrients to survive. Some people with diabetes will not develop neuropathy even after 20 years. On the other hand, some people with diabetes will develop immediate damage.

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These results suggest that there are independent factors of chronic hyperglycemia in the development of neuropathy. These factors may be genetic and/or related to the environment, especially diet. This would explain a higher prevalence of neuropathy in certain population groups: in India and North Africa, which are more susceptible to nerve damage than others.

What are the factors that could lead to diabetic neuropathy?

Smoking and alcohol consumption can damage small nerves in the hands and feet and exacerbate diabetic peripheral neuropathy.

The same applies to kidney damage, which can occur in diabetes. Some medications can aggravate the neuropathic damage of diabetes.

Age is also a risk factor, and diabetic neuropathy is more common after the age of 65.

The presence of arthritis of the lower limbs is a risk factor, as is vitamin deficiency.

High stature, which is due to longer nerve fibers, is also a risk factor.

What are the complications of diabetic neuropathy?

When nerves are attacked by high blood glucose levels, nerve information circulates poorly and sensitivity decreases. Decreased sensitivity is the most common sign of diabetic neuropathy. It starts at the feet and gradually progresses through the legs.

Because of this decrease in sensitivity, small wounds may go unnoticed and become infected. The skin of the feet also tends to become more fragile, leading to the development of sometimes very deep wounds (plantar puncture wounds).

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At the same time, hyperglycemia weakens the artery walls of the lower limbs, promotes the deposition of cholesterol in the artery walls and contributes to the formation of atheromatous plaque. The accumulation of cholesterol deposits reduces the diameter of the arteries, obstructs the flow of blood and sometimes stops it. The legs and feet are no longer sufficiently supplied with blood, which can lead to pain, but also to wounds such as ulcers that take a long time to heal.

The end result is what doctors call “Charcot foot” a condition that causes weakening of the foot bones which can lead to severe deformities.

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