But unlike the other organs which get affected, for example, when the eye gets affected, there are very specific lesions. It can affect the, can lead to bleeding of the eyes inside the eyes or it can lead to some leaking of the blood vessels in the eye. Similarly, when the kidney is affected, the first thing that happens is that some protein starts leaking in the urine, small quantities of albumen which we call micro albuminuria.

Neuropathy types and sensory system involvement

So, it’s very predictable, the eye changes and the kidney changes are very predictable, but neuropathy is a very big subject. It is not of one type at all. For example, sometimes neuropathy can just affect the sensation. So that is the commonest, in fact, we call it as peripheral neuropathy which is affecting the sensory system.

Sensory neuropathy mainly change the feet

So, what happens when the sensory system is damaged? It can affect you anywhere, but mainly it affects the feet. When the feet are affected, slowly the sensation in the feet go away. So, when the sensation goes away, as you can see in this picture here, this person is stamping on a nail and he does not even know that he is stamping on a nail.

Risk of diabetic foot ulcers from unnoticed sore

Expect there is a pin on the road and you unintentionally step on it, what will happen? You’ll immediately withdraw your leg, won’t it? But when you have neuropathy, and especially if the neuropathy is very severe, what happens is like you saw there, he is now putting his leg on this nail, it has gone right inside because he stamped on that nail.

Importance of neuropathy in diabetes

So, what started off as a very simple decrease in the sensation of the foot can even end in an amputation and that is why neuropathy is very important. I told you there are different types of neuropathy. Sometimes instead of affecting the sensation, it can affect what is called as the motor system. In other words, it affects the muscles.

Motor neuropathy and muscle complications

When it affects the muscles or the motor system, it can lead to many complications. For example, you can get what is called as a foot drop; the foot falls off like that because one nerve has got affected and the muscles are affected. It can lead to that, it can lead to what is called as claw foot.

Severe neuropathy effects on foot shape

It can lead to a total damage of the foot itself; the shape of the foot itself may be altered. But don’t worry, all these happen only in very severe cases of neuropathy, and if you look after your diabetes well, don’t get frightened by these pictures that you saw.

Neuropathy prevention with good diabetes control

You need not develop any of these complications of diabetes. But neuropathy is not just when your foot gets affected. There are many places in the body where neuropathy can occur.

Cranial nerve involvement in neuropathy

For example, in the eye, there are many muscles of the eye and each of these muscles are controlled by one nerve. We call them as cranial nerves and you can have the third cranial nerve or the fourth cranial nerve or the sixth cranial nerve.

Facial nerve and posits explained

Even the seventh cranial nerve or the facial nerve is also there. If that particular nerve gets affected, the third nerve gets affected, you get a condition called as ptosis. What is ptosis? One eyelid closes.

Posits and recovery possibilities

If you look at this particular picture here, you can see that this is a person who has ptosis and so one eye they are not able to open at all. Of course, if you do exercise and take treatment and get the sugar under control, it may recover the third nerve paralysis or the cranial neuropathy, what we call as, can recover completely.

Recovery from facial nerve paralysis

Now again, it is quite common, but if you control your diabetes you need not get it and if you treat it properly, it may completely recover also.

Autonomic neuropathy and blood pressure changes

Apart from peripheral neuropathy, there is another type of neuropathy which is called as autonomic neuropathy. And if you have autonomic neuropathy, what happens is that there can be a sudden drop in the blood pressure when you stand.

Lack of hypoglycemic symptoms in severe autonomic neuropathy

In severe autonomic neuropathy, the patient will not have any symptoms of low sugar. You know that when somebody gets low sugar, they feel very hungry, their heart starts palpitating, there is tremors of the fingers, sweating.

Symptoms of low sugar and response

These are all symptoms of low sugar, so you immediately go and eat something and then it becomes okay.

Severe autonomic neuropathy and risk of low sugar coma

What if you have autonomic neuropathy which is very severe? The blood sugar will drop from 100, 70, 60, 50, 40, 30 and still the patient is not having any symptoms. Suddenly the blood sugar will go to 20 and then the patient faints or goes into a low sugar coma.

Managing severe autonomic neuropathy to prevent low sugar

This can happen in people who have very severe autonomic neuropathy. So, in such patients, what do we do? We don’t allow the sugar to go down at all, and we’ll tell the patient you keep your sugar at 130 or 140 or 150, that is enough because I don’t want you to go into low sugar.

Advances in glucose monitoring

Of course, today it’s much easier. 10 years ago we were worried a lot. Today, we have the small patches you can put, the small sensor on your hand which will continuously give you a glucose reading.

Continuous glucose monitoring benefits

As you can see in this particular graph, if you see this graph, you can see that there is a continuous glucose monitoring tracing. What is the advantage of doing this? We call it as ambulatory glucose profile or continuous glucose monitoring or CGM.

How continuous glucose monitoring works

Just a small patch like a coin, like a caramel coin, you wear on your hand and you can read your blood sugars throughout the day and throughout the night, hundred times in a day.

Detecting low sugar during sleep with CGM

Now what is the advantage of doing that? When you are sleeping, then the blood sugars, suppose they are dropping, you may not know, but the next morning when you look at the graph, you will know, oh my god, it has gone so low in the night and I did not even know.

Preventing low sugar with CGM data

So, you can reduce your medication, either the tablet or the insulin, you can reduce and prevent the low sugar from occurring and you can prevent yourself from going into hypoglycemic coma or low sugar coma.

Hypoglycemic unawareness in autonomic neuropathy

So, this is one of the, ah, you know, the disadvantages of having autonomic neuropathy because you may not have hypoglycemic awareness. We call it as hypoglycemic unawareness. You are not aware of it at all.

Erectile dysfunction as a neuropathy complication

Some of the other things that happen when you have severe neuropathy in men, you can get impotence, so erectile dysfunction. We also call it as ED for short.

Preventing and treating erectile dysfunction

If you have unchecked diabetes for a long time, you are not able to get a welding at all, therefore they cannot have sex at all because of this elevated dysfunction.

Of course, this also can be prevented by good control of diabetes. Today we have got medicines to treat the ED or the erectile dysfunction, but you must be careful and keep your sugars under control so that you do not develop erectile dysfunction.

Neuropathy effects on bladder function

So, as you can see, neuropathy is a mixed syndrome where it change the muscles, it affects the nerves, can change  the genital system, can change the bladder.

So, when it disturbs the vesicle, what happens? Normally, the vesicle emotion is there. When your vesicle  is half full or three-fourth full, you feel like running to the toilet.

When the vesicle nerves are damaged, you do not feel the emotion at all. The vesicle becomes so full, suddenly the urine may come out, incontinence we call it until then the patient does not even know the bladder is full. These are, of course, in extreme cases.

Silent heart attacks due to neuropathy

There is one other thing about neuropathy which you should know, and that is silent heart attacks. Suppose the nerves to the chest are affected due to neuropathy.

When you get a heart attack, what happens is you say that I am having pain and that’s what makes you go to the doctor. Suppose those nerves are affected, you have a heart attack inside and you don’t even know about it.

True story of silent heart attack case

In fact, I’d like to tell you a story of a true story which happened in my hospital. Patient came and we had asked history routinely.

When we asked in history, we do ask do you get nature’s pain? Do you get the thing? Have you had any heart problem? And he said no, no, no.

So, we sent him to the, uh, to the next floor. In fact, he walked up one floor to get the ECG done.

So, when the ECG was done, the ECG technician came running to me and he said sir, sir, see this, he’s got acute heart attack.

So when I saw he had features of an acute heart attack, he probably had it the previous day or that morning and he has not known about it at all.

Now I rushed up to the ECG room to the technician where the technician then the patient is happily lying down without any problem.

So I issued him sir, are you all good? No, I’m all good. Why? Why? No sir, there is small problem. What problem? No, no, there is a small problem in your ECG.

What problem in my ECG? He thought I am simply saying something. So I said no, no, it looks as if you have had a small heart attack.

You started laughing. Heart attack? Come on doctor, I have not had any pain, I have not had breathlessness, not had anything and you’re telling me that I got a heart attack.

How can it be? You know, then I told them no, if you don’t believe me I will get a cardiologist now. Let him come and see.

So I got the cardiologist when he came and said, he said straight into the ICU you have to go.

Patient still would not believe until more tests were done and it was proven and then finally one day after he got discharged he came to thank me and he said doc, had you not found out that heart attack, I would have gone off like that somewhere, I could have died isn’t it?

I said yes, but good thing God is great we found out the heart attack.

Then he asked me why is that I didn’t have any symptoms doctor I should have had some symptoms.

Now I said unfortunately, you have neuropathy and because you have this neuropathy you are not getting any symptoms.

Common neuropathy symptoms reported by patients

Those are extreme cases which I told you.

Some of the common symptoms which people say when I am walking even my chapels fall off I do not know that they have fallen off. That is a common symptom which people tell me.

Ok then, another thing which people tell me is I am walking but I am walking on a hard surface it looks as if I am walking on cotton wool, as if I am walking on a mattress.

It looks like so that is a lack of sensation is not able to feel the hard ground and therefore he or she feels that they are walking on a mattress. A very common symptom.

Paresthesia and altered sensations

There is another symptom which is called deadness. What is deadness? Paresthesia means corrected emotion.

One of the ex-governors of Tamil Nadu whom I was treating actually told me this and it’s quite common.

He said doctor when I walk it looks as if there is water under my foot.

I’ll take my foot and see there is no water at all. I will see the ground there is no water at all but I am sure there is water there.

See what is happening is the sensation which is supposed to go from that nerve slowly to the spinal cord and from there to the brain that is got altered because some damage occurred and the rewiring which took place of the nerves took place in a wrong manner.

So some altered sensation is going.

So when there is no water the brain is getting a message there is water there.

This is called as paresthesia.

Checking for neuropathy and importance of control

I am sure some of you long term diabetes would have had these symptoms.

So what do you do to find out whether you got neuropathy or not?

Every year when you go to the diabetic center insist that the tests for neuropathy are done.

Look at your feet, look at the other tests that are there for neuropathy and see whether you got it.

More importantly, see that your sugars are kept under good control.

If your HbA1c, the three months control test is kept below seven percent, the chances of you getting neuropathy is very very small and even if it is there it may even be reversible.

So you do not have to get worried about neuropathy but focus on good diabetes control.

Regular health checkups and early detection

See that you visit the diabetic center at least three times, if not four times in a year and once in a year please get your entire systems checked, your heart, your kidney, your nerves, your eyes and all the organs because we never know when these complications can sit in.

It can be very silent as I told you like the silent heart attack.

It can be very very silent and therefore it is your duty to remind the doctor and say my annual checkup is due doctor I better come and do everything.

A stitch in time saves nine they say.

So if you are able to detect these complications early we can totally reverse it.

Future article and closing remarks

In future videos I will be talking about the, I in greater detail about the kidney and the heart and other complications.

Please do share your feedback with me and if you like any other aspects of neuropathy that you would like to hear about or any other suggestions please feel free to write in the comments section what that what you would like me to speak on and I would be happy to interact with you and provide you that knowledge that you are looking for.