how Physiotherapy can Help in diabetic neuropathy?

A severe and common complication of type 1 and type 2 diabetes is diabetic neuropathy. It's a kind of nerve damage caused by high blood sugar levels in the long term. 

The condition usually develops slowly, occasionally over several decades. Incidences are more common in poorly controlled, overweight patients, have higher levels of blood fat and blood pressure, and are over 40.

You should see your doctor if you have diabetes and you notice numbness, tingling, pain, or weakness in your hands or feet. These are early Peripheral Neuropathy symptoms. 

Usually, the danger is when you can't feel pain and an ulcer on your foot develops. You may be vulnerable to injuries or infections when experiencing severe or prolonged peripheral neuropathy. Poor wound healing or infection can cause amputation in serious cases.

Diabetic neuropathy has different types that affect different areas of your body, causing a variety of symptoms. If you have diabetes, it's important to check your blood glucose levels regularly and contact your doctor if you have any neuropathic symptoms.

What are Diabetic Neuropathy Symptoms?

Gradually, it is common for neuropathy symptoms to appear. In many cases, the nerves of the feet are involved in the first type of nerve damage to occur. This can lead to the symptom, in your feet, of sometimes painful "pins and needles."

Symptoms vary according to the area affected. Common symptoms and signs of the various types of diabetic neuropathy include:

• sensitivity to touch
• loss of sense of touch
• difficulty with coordination when walking
• numbness or pain in your hands or feet
• burning sensation in feet, especially at night
• muscle weakness or wasting
• bloating or fullness
• nausea, indigestion, or vomiting
• diarrhea or constipation
• dizziness when you stand up
• excessive or decreased sweating
• bladder problems, such as incomplete bladder emptying
• vaginal dryness
• erectile dysfunction
• inability to sense low blood glucose
• vision trouble, such as double vision
• increased heart rate

What are Diabetic Neuropathy types?

The term neuropathy is used to describe various types of damage to nerves. There are four main types of Neuropathy in people with diabetes.

1.  Peripheral neuropathy

Peripheral neuropathy is the most common form of Neuropathy. Peripheral neuropathy usually affects the feet and legs, but may affect the arms or hands as well. Symptoms vary and may be mild to severe. They cover:

• numbness
• tingling or burning sensations
• extreme sensitivity to touch
• insensitivity to hot and cold temperatures
• sharp pain or cramping
• muscle weakness
• loss of balance or coordination
• Some people experience symptoms more often at night.

If you have peripheral neuropathy, you might not feel a foot injury or sore. People with diabetes often have poor circulation which makes healing of wounds more difficult. This combination heightens the risk of infection. In extreme cases, the infection may provoke amputation.

2. Autonomic neuropathy

The second most common type of neuropathy in people with diabetes is autonomic neuropathy.

The autonomic nervous system runs other systems in your body over which you have no conscious control. Many organs and muscles are controlled by it, including your:

• digestive system
• sweat glands
• sex organs and bladder
• cardiovascular system
• Digestion problems

Nerve damage to the digestive system may cause:

• constipation
• diarrhea
• swallowing trouble
• gastroparesis, which causes the stomach to empty too slowly into the small intestines
• Gastroparesis causes a delay in indigestion, which can worsen over time, leading to frequent nausea and vomiting. You’ll typically feel full too quickly and be unable to finish a meal.

Delayed digestion often makes it more difficult to control blood glucose levels, too, with frequently alternating high and low readings. Also, symptoms of hypoglycemia, such as sweating and heart palpitations, can go undetected in people with autonomic neuropathy. This can mean not noticing when you have low blood sugar, increasing the risk for a hypoglycemic emergency.

Bladder and sexual problems

Autonomic neuropathy can also cause sexual problems, such as erectile dysfunction, vaginal dryness, or orgasm difficulty. Bladder neuropathy can cause incontinence, or make emptying your bladder completely difficult.

The Cardiovascular Issues

Damage to the nerves that control your heart rate and blood pressure may cause them to react slower. You may experience a drop in blood pressure and feel lightheaded or dizzy when standing up after sitting down or lying down, or when exercising. Also, autonomic neuropathy can cause an abnormally fast heart rate.

Autonomic neuropathy can complicate the identification of some of the symptoms of a heart attack. When your heart is not getting enough oxygen, you may not feel any chest pain. If you have autonomic neuropathy you should be aware of the other heart attack warning signs, including:

• Profuse sweating
• Arms, back, neck, jaw or stomach pain
• Breathlessness
• Boredom
• Lightheadedness

Patients with diabetic neuropathy should be monitored regularly by a primary care practitioner. Patients should be monitored every 4 weeks to 3 months to see if therapy works to decrease pain or nausea or vomiting, as well as to decrease drugs for painful peripheral neuropathy.

3. Proximal neuropathy

Proximal neuropathy, also known as diabetic amyotrophy, is a rare form of Neuropathy. In adults over 50 years of age with fairly well-controlled type 2 diabetes, and more often in men, this form of neuropathy is seen more commonly.

4. Focal neuropathy

Focal neuropathy, or mononeuropathy, occurs when one particular nerve or group of nerves is damaged, causing weakness in the area affected. This most often happens in your hand, head, torso, or leg. It suddenly appears and is generally very painful.

Most focal neuropathies, like proximal neuropathy, go away in a few weeks or months and leave no lasting damage. Carpal tunnel syndrome is the most prevalent type.

Although most do not feel the symptoms of carpal tunnel syndrome, there is some degree of nerve compression at the wrist in about 25 percent of people with diabetes. Symptoms of focal neuropathy include:

• pain, numbness, tingling in fingers
• an inability to focus
• double vision
• aching behind the eyes
• Bell’s palsy
• pain in isolated areas, such as the front of the thigh, lower back, pelvic region, chest, stomach, inside the foot, outside the lower leg, or weakness in the big toe.

What causes diabetic neuropathy?

Diabetic neuropathy is caused by high blood sugar levels that are sustained for a long time. Other factors could cause damage to the nerves, such as:

1. Cholesterol-induced damage to blood vessels
2. Mechanical lesions such as carpal tunnel syndrome injuries
3. Lifestyle factors, such as alcohol use or smoking
4. Low vitamin B-12 levels can lead to neuropathy, too. Metformin, a common drug used to manage diabetes, may decrease vitamin B-12 levels. To identify any vitamin deficiencies you may ask your doctor for a simple blood test.

How do you diagnose diabetic neuropathy?

A doctor will determine if you have neuropathy or not, starting with inquiring about your symptoms and medical history. Also, you will have a physical exam. They will monitor your temperature and touch sensitivity level, your heart rate, blood pressure, and muscle tone.

Your doctor may do a filament test to check your feet for sensitivity. For this, they are going to use a nylon fiber to check your limbs for any sensation loss. Test your vibration threshold using a tuning fork. Your doctor may also test reflexes in your ankle.

How to treat diabetic neuropathy?

Diabetic neuropathy is not cured but you can slow its progression. The best way to decrease the likelihood of developing diabetic neuropathy or slow its progression is to keep your blood sugar levels within a healthy range. It can ease some symptoms, too.

A comprehensive treatment plan also includes quitting smoking and regular exercise. Always talk to your physician or health care team before you start a new fitness routine. Also, you can ask your doctor about complementary neuropathy treatments or supplements.

• Pain management

Pain caused by diabetic neuropathy may be treated with medications. Talk to your doctor about the medication available and its possible side effects. Several medicines have been shown to aid in symptoms. Also, you might want to consider alternative therapies, like acupuncture. 

• Managing complications

Depending on your type of neuropathy, your doctor can suggest medications, therapies, or lifestyle changes that may help deal with symptoms and ward off complications.

• Physiotherapy and its management.

Physical therapy can be a useful adjunct to other therapy, particularly when muscle pain and weakness are a manifestation of neuropathy for the patient. The physical therapist may instruct the patient to maintain his or her mobility and strength in a general exercise program. An aquatic therapist may be helpful, too.

How Physiotherapy can help in diabetic neuropathy?

Research has shown that strength training can moderately improve muscle function in people with peripheral neuropathy (PN). Regular exercise can also help reduce neuropathic pain and help control blood sugar levels. Diabetic clients must tightly monitor their blood sugar levels during exercise to prevent major fluctuations. This may involve educating clients and monitoring blood sugars, ideally through a multi-disciplined approach in rehabilitation.

Specific exercise programs should include

• Flexibility (progressive stretching and self stretches)
• Muscle strengthening ( using a variety of modes as appropriate eg isometric, graded weight progression, open and close chain)
• Aerobic activity ( aiming for 30 minutes 4 times a week)
• Balance ( for falls prevention and stability)
• Gait (can improve gait pattern or walk-in patients with diabetic neuropathy) 
• Physiotherapy may also involve splinting for mononeuropathies eg. carpal tunnel or for muscle weakness eg Ankle foot orthoses.
• The Diabetic Foot. (Podiatry)
• The Diabetic Amputee.

Besides exercise, to assist with pain control, the patient should also be educated on independent pain management and relaxation strategies. For patients with neuropathic pain, transcutaneous electrical nerve stimulation (TENS) may be a recommended method, and the physical therapist may be helpful in teaching and monitoring the patient's use.

Can I Prevent diabetic neuropathy?

Diabetic neuropathy is often avoidable if you carefully manage your blood glucose. For this to happen, be consistent in:

• Monitor your blood sugar levels
• Taking medicines according to prescription
• Governing your diet
• Active Being
• Work closely with your doctor if you develop diabetic neuropathy and follow their recommendations to slow its progression. You can reduce the damage to your nerves with proper care, and avoid complications.