The Nerve Damage of Diabetes
Sitting or standing slowly may help prevent
light-headedness, dizziness, or fainting, which are symptoms that may be
associated with some forms of autonomic neuropathy. Raising the head of the bed
and wearing elastic stockings may also help. Increased salt in the diet and
treatment with salt-retaining hormones such as fludrocortisone are other
possible approaches. In certain patients, drugs used to treat hypertension can
instead raise blood pressure, although predicting which patients will have this
paradoxical reaction is difficult.
Muscle weakness or loss of coordination
caused by diabetic neuropathy can often be helped by physical
Urinary and Sexual Problems
Nerve and circulatory problems of diabetes
can disrupt normal male sexual function, resulting in impotence. After ruling
out a hormonal cause of impotence, the doctor can provide information about
methods available to treat impotence caused by neuropathy. Short-term solutions
involve using a mechanical vacuum device or injecting a drug called a
vasodilator into the penis before sex. Both methods raise blood flow to the
penis, making it easier to have and maintain an erection. Surgical procedures,
in which an inflatable or semirigid device is implanted in the penis, offer a
more permanent solution. For some people, counseling may help relieve the
stress caused by neuropathy and thereby help restore sexual
In women who feel their sexual life is not
satisfactory, the role of diabetic neuropathy is less clear. Illness, vaginal
or urinary tract infections, and anxiety about pregnancy complicated by
diabetes can interfere with a woman's ability to enjoy intimacy. Infections can
be reduced by good blood glucose control. Counseling may also help a woman
identify and cope with sexual concerns.
Why Is Good Foot Care Important for People with Diabetic Neuropathy?
People with diabetes need to take special
care of their feet. Neuropathy and blood vessel disease both increase the risk
of foot ulcers. The nerves to the feet are the longest in the body, and are
most often affected by neuropathy. Because of the loss of sensation caused by
neuropathy, sores or injuries to the feet may not be noticed and may become
At least 15 percent of all people with
diabetes eventually have a foot ulcer, and 6 out of every 1,000 people with
diabetes have an amputation. However, doctors estimate that nearly three
quarters of all amputations caused by neuropathy and poor circulation could be
prevented with careful foot care.
To prevent foot problems from developing,
people with diabetes should follow these rules for foot care:
- Check your feet and toes daily for any cuts, sores, bruises,
bumps, or infections--using a mirror if necessary.
- Wash your feet daily, using warm (not hot) water and a mild
soap. If you have neuropathy, you should test the water temperature with your
wrist before putting your feet in the water. Doctors do not advise soaking your
feet for long periods, since you may lose protective calluses. Dry your feet
carefully with a soft towel, especially between the toes.
- Cover your feet (except for the skin between the toes) with
petroleum jelly, a lotion containing lanolin, or cold cream before putting on
shoes and socks. In people with diabetes, the feet tend to sweat less than
normal. Using a moisturizer helps prevent dry, cracked skin.
- Wear thick, soft socks and avoid wearing slippery stockings,
mended stockings, or stockings with seams.
- Wear shoes that fit your feet well and allow your toes to
move. Break in new shoes gradually, wearing them for only an hour at a time at
first. After years of neuropathy, as reflexes are lost, the feet are likely to
become wider and flatter. If you have difficulty finding shoes that fit, ask
your doctor to refer you to a specialist, called a pedorthist, who can provide
you with corrective shoes or inserts.
- Examine your shoes before putting them on to make sure they
have no tears, sharp edges, or objects in them that might injure your
- Never go barefoot, especially on the beach, hot sand, or
- Cut your toenails straight across, but be careful not to
leave any sharp corners that could cut the next toe.
- Use an emery board or pumice stone to file away dead skin,
but do not remove calluses, which act as protective padding. Do not try to cut
off any growths yourself, and avoid using harsh chemicals such as wart remover
on your feet.
- Test the water temperature with your elbow before stepping
in a bath.
- If your feet are cold at night wear socks. (Do not use
heating pads or hot water bottles.)
- Avoid sitting with your legs crossed. Crossing your legs can
reduce the flow of blood to the feet.
- Ask your doctor to check your feet at every visit, and call
your doctor if you notice that a sore is not healing well.
- If you are not able to take care of your own feet, ask your
doctor to recommend a podiatrist (specialist in the care and treatment of feet)
who can help.