Once considered a disease exclusive to developed nations, the prevalence of diabetes is now on the rise in developing nations too. This can be attributed to changing lifestyles and escalating stress levels. Diabetes is a chronic metabolic disorder that occurs due to impaired glucose metabolism in the body. It has several long-term complications in the body, but damage to the nervous system is one of the most common chronic complications and occurs earlier as compared to others. Peripheral nerve damage, which primarily affects individuals with long-standing diabetes, refers to the impairment of the nerves that connect the brain to the limbs, responsible for sensing sensations and controlling movements. This results in changed and/or diminished sensations in the feet, hands, and limbs. Typically, the abnormality begins in the feet. One may experience sensations similar to insects crawling, pinpricks, or coldness. Some individuals may feel a burning pain in their limbs. If the sensations become reduced, a person may not feel any pain and unintentionally harm themselves, leading to wounds and infections, especially in the feet. Sometimes the nerves present in the brain can also be affected by diabetes. This results in one or more of the following manifestations like drooping of eyelids, blurred vision, and paralysis of one side of the face and or tongue. All of this causes much distress and disability. The involvement of the autonomic nervous system, which influences involuntary functions of the body, can become very troublesome for the affected person. Bowel movement can be altered causing chronic diarrhoea or constipation in a person with previously healthy bowel habits. This affects intake and the overall nutritional status of the individual resulting in weakness. A significant decrease in blood pressure upon standing or changing positions can lead to dizziness, and in severe cases, it may cause episodes of unconsciousness. In addition, a person may experience excessive sweating or sensations of heat or cold without any apparent reason. Sexual impotence is a further consequence of nervous system damage and is concerning for those affected. In men, it can result in a decrease in sexual desire and/or an inability to achieve an erection, while in women it is characterised by frigidity. In diabetic individuals, the damage to the nervous system occurs due to interruption of the blood supply to the nerves, thus impairing their nutrition. The sickness and disability caused by diabetes is further aggravated by use of alcohol and tobacco, both of which are toxic to the nervous system. Once these problems start, they are mostly irreversible. Medicines given are mostly to reduce the pain or supplement vitamin B. complex. Therefore, people need to be aware of these problems and take due precautions to prevent it. Firstly, it is important to keep the diabetes well controlled. This can be achieved by following the dietary restrictions, being physically active and taking prescribed medicines regularly. Intake of whole grains, cereals and nuts ensures adequate amount of vitamin B. complex in the body thus keeping the nerves in good functioning state and minimising damage by diabetes. High fibre in the diet will minimise chances of constipation and help overcome it. Quitting alcohol and tobacco reduces the impact on the nervous system. A person with diminished sensation should exercise caution when it comes to their feet. It is important to keep them clean and dry, and to regularly inspect them for any cuts or injuries. It is also crucial to wear comfortable and well-fitting footwear. People experiencing dizziness can alleviate their symptoms by wearing properly fitting elastic stockings while standing or walking. This aids in promoting the proper circulation of blood back to the heart, thereby preventing dizziness. Sex therapy, psychotherapy, and intracavernous devices are among the methods used to treat sexual impotence. For diabetics, it is ideal to prevent neuropathy, but if not possible, one should strive to adopt measures that minimize the suffering. Dr Rachna Pande is a specialist in internal medicine.
