Nerve Damage From Diabetes (Part 2)
By Hope Warshaw
Having diabetes puts you at risk for nerve damage that can affect digestion, breathing, or even blood pressure – a condition known as autonomic neuropathy. Here are steps you can take to maintain the health of your nervous system, as recommended in the latest ADA Standards of Care.
The nervous system acts as your body’s command center – it controls movement, pain, digestion, breathing, sexual response, and even your heartbeat. If you have diabetes, you may be at a higher risk for different types of nerve damage, also known as neuropathy.
This article breaks down one of the common types of nerve damage people with diabetes can experience – autonomic neuropathy – and how to keep nerves healthy based on guidance from the American Diabetes Association’s Standards of Care.
*Another common form of nerve damage, known as peripheral neuropathy, affects nerves in the hands and feet. For more information, read: Nerve Damage in Your Hands and Feet From Diabetes.
Autonomic neuropathy affects the nerves in your autonomic nervous system, or the part of your nervous system that controls muscles in the body’s organs, such as the heart, blood vessels, lungs, GI and urinary tract, sex organs, and sweat glands.
Autonomic neuropathy encompasses a diverse group of signs and symptoms and can cause a wide array of health problems. These include dizziness, dry eyes, mouth or skin, rapidly feeling full after eating (gastroparesis), bladder disorders, and sexual function disorders. It’s estimated that around a third of people with diabetes will experience autonomic neuropathy.
High blood glucose levels over time can damage small blood vessels that bring nutrients and oxygen to the nerves. Consistently high blood pressure and abnormal levels of blood lipids, like LDL-cholesterol and triglycerides, may also contribute to neuropathy. Diabetes-related neuropathy is also more likely if you have excess weight or obesity, advanced-stage chronic kidney disease, or you smoke.
Hypoglycemia unawareness occurs when someone doesn’t experience or perceive the symptoms of hypoglycemia. Due to lack of recognition of early signs and symptoms, this may put you at risk of dangerously low glucose levels if you are taking a glucose-lowering medicine that can cause hypoglycemia, such as insulin or a sulfonylurea.
Treatment may involve raising glucose and A1C targets and making changes in the types and doses of glucose lowering medications you take. Anyone with hypoglycemia unawareness should be prepared with a source of carbohydrate to treat low glucose and assure that loved ones, co-workers and others are aware of where glucagon is stored and how to use it.
Treatment for heart-related issues focuses on minimizing symptoms through medication and lifestyle changes. Heart-related issues can include:
Tachycardia: a racing heart while at rest
Orthostatic hypotension, also called postural hypotension: experiencing low blood pressure when standing up. Symptoms can include dizziness or lightheadedness and fainting.
Increased or decreased amount of sweating
Issues may involve any portion of the gastrointestinal (GI) tract, from the esophagus all the way down to the bowels. You may hear the general term “gastroparesis.” Gastroparesis refers to slow emptying of the stomach and can cause early satiety (or “fullness”), bloating, nausea and vomiting.
A telltale sign of gastroparesis is difficult-to-manage glucose levels and upper GI symptoms like abdominal pain, nausea and vomiting with no other cause. The diagnosis can be made by measuring how quickly food empties from the stomach.
Treatment for gastroparesis can be challenging. Medications can be tried to improve stomach emptying and control nausea and vomiting. People can also make changes to their diet by choosing foods that are low in fiber and fat, eating small frequent meals and chewing food thoroughly before swallowing.
Other GI problems include constipation, diarrhea, or inability to control bowel movements (fecal incontinence).
Genital/urinary tract issues
In men, this may include erectile dysfunction, which is the inability to maintain an erection for sexual intercourse. Treatment can include use of one of the medications that enables the maintenance of an erection, or a vacuum device or penile prosthesis.
In women, it may include decreased sexual desire and arousal, pain during intercourse and inadequate lubrication.
In both men and women, bladder dysfunction can include incontinence, urgency, and frequency .
In general, management of an autonomic neuropathy focuses on reducing symptoms and improving quality of life. However, these interventions often don’t change the underlying problem.
Getting and keeping glucose levels in the target range is, as always, an important part of treatment.
How To Prevent or Delay Diabetes-Related Nerve Problems
As is true for the prevention or delay of most diabetes-related problems, there are actions to take daily, like keeping your glucose, blood pressure and lipids at safe levels, and actions to take annually or more frequently to detect a problem.
Get and keep glucose in a desired target range. Good glucose management over time can help prevent or delay neuropathies. Glucose management is extremely important because there are few specific treatments for diabetes-related nerve damage that completely resolve the problem. Work with your healthcare providers to set glucose management targets that are best for you. These may need to change over the years. There’s also benefit in getting and keeping your blood pressure and blood lipids in target ranges. Set these goals with your healthcare providers as well.
Put a plan in place to live a healthy lifestyle and practice regular diabetes self-care. This includes regular physical activity, choosing and eating healthy foods, maintaining healthy eating habits, quitting or not smoking, consuming no more than one alcoholic drink per day for women and two for men, and taking medications as prescribed.
Annual or as needed actions
Advocate for yourself. Be proactive. Make sure your healthcare provider completes the annual checks and tests mentioned in this article. In addition, advocate for yourself and be proactive.
Report any new signs or symptoms of a nerve-related problem to a healthcare provider when they occur or shortly thereafter. Schedule a visit if need be. If you have a problem that requires further testing and evaluation, put together an action plan with your provider for treatment and follow up.
If you are told you have an indication of any diabetes-related neuropathies, take the recommended treatment and management steps as soon as possible. Remember, early detection and action is key to slowing the progression of diabetes-related neuropathy.
About this series:
Each year the American Diabetes Association (ADA) updates their Standards of Medical Care in Diabetes. The Standards of Care or Standards, are updated annually by the ADA’s Professional Practice Committee (PPC). ADA publishes their revised Standards each January as a supplement in one of their journals as well as online. ADA also maintains, “Living Standards.” These interim updates are published during the year as necessary based on new science. This series of articles translate the what’s and how to’s on diabetes complications based on the ADA Standards.