the word â€œneuropathyâ€ is a general term that simply means something is â€œwrongâ€ with the nerves. Itâ€™s not well understood and can be frustrating to both doctors and patients alike.
There are three different types of nerves in our bodies, and diabetes can affect each:
the first kind of nerve
are sensory nerves. These nerves carry impulses from a location toward the brain, and let us know about the presence of a stimulus. When sensory nerves are affected by diabetes, there is some kind of change in sensation. Sometimes this means decreased or even absent sensation (the story of the diabetic who steps on a nail and walks around all day without knowing it and finds blood in his sock when he goes home and takes his shoe off), or some sort of altered sensation, like burning, tingling
, pain, numbness
The second kind of nerve are motor nerves. Motor nerves send impulses from the brain to a muscle and when fired, results in some kind of muscle motion. When motor nerves are affected by diabetes, it usually is only one nerve, not a general weakness like what's found in ms or other degenerative diseases. The surrounding (unaffected) muscles try to compensate for the weakness, and become a bit "too" strong. This leads to a muscle imbalance, which can produce various deformities, like hammertoes or bunions, etc. Where a weak muscle group is lying next to a strong muscle group that's trying to make up for the weaker group.
The third kind of nerve are autonomic nerves. Autonomic nerves control things we donâ€™t have direct control over: how fast our hearts beat, sphincter control, â€œgoose bumps, â€ orgasms, how our pupils dilate, the rate by which our intestines digest food, etc. What autonomic nerves control in the foot are the smooth muscles that surround the arteries. More often than not, when there is an autonomic neuropathy
, the larger blood vessels dilate, causing â€œtoo muchâ€ blood to flow in the foot, while the tiny capillaries just under the skin constrict, leading to dry skin
. Whatâ€™s so bad about â€œtoo muchâ€ blood? When there is a large flow of blood through one particular area, it can "wash out" the minerals
from our bones and lead to osteoporosis
, which predisposes that bone to fracture with even minor trauma.
Diabetics with all three types of neuropathy have the "perfect storm:" the motor neuropathy leads to deformities, lumps and bumps and such. In the presence of a sensory neuropathy, the patient doesn't feel any irritation from rubbing on the bump, and an autonomic neuropathy will cause the bone underneath the bump to become brittle. Unfelt pressure from the bump can cause the underlying bone to fracture, and in the presence of a sensory neuropathy, there is little or no pain, so the patient merrily walks on the fracture until they notice swelling or even an ulcer.
This is why diabetics with neuropathy must look at their feet at least once a day, run their hands over them, and check for things that may be going on that your nerves aren't telling you.
Now, the kind of pain you're having is from a sensory neuropathy. Our cells require glucose
for energy. Type 2 diabetics, who have a resistance to insulin
, can't get the glucose into the cell (the function of insulin). Nerve cells are special, though, because they're so important. Nerves have the ability to use other energy sources besides glucose, but when they do, they don't function the way they're supposed to, and the result is pain, burning, numbness, etc... In short: "neuropathy."
there are many drugs and treatments for neuropathy, but it's very frustrating. In general, the single most important thing you can do is make certain your diabetes is as controlled as possible. Usually, when the glucose levels are well controlled, neuropathy symptoms abate. Certain antidepressant medication can help (elavil
I hope this helped.