Diabetic neuropathy is the term used to describe the
usually chronic damage to nerves that occurs as a result of untreated, or inadequately treated, high blood sugar. It results from a complex sequence of events that leads to damage and destruction of the minute blood vessels that nourish nerves along their course
to the region of the body they serve after leaving the spinal canal. Each such nerve is a single cell. The longest nerves, much like long chains, are
the most susceptible to
damage. If a peripheral nerve (i.e., a nerve cell not contained in the brain or spinal
column) emerging from the spinal column and traveling to the toes were the thickness of a piece of string, it would be 3 miles in length! At fre- quent
intervals along its length, each peripheral nerve receives nourishment from tiny blood vessels. If any of these tiny blood
vessels are irreversibly damaged, that part of the nerve dies and no signals
are conducted in either direction along it, i.e., the chain fails at
its weak- est link. Although
there are a vast number of individ-
ual nerve fibers serving any one area of the body, when a
sufficiently large number get damaged, symptoms will result. Since the longest nerve fibers serve the parts of the body
that are farthest from the spinal col- umn, it is not surprising that they are the ones
most
frequently damaged. Therefore, diabetic neuropathy is
most
frequently a
problem in the feet, hands, and male genitals. The
symptoms represent a spectrum
from those
due to injury responses of the non-fatally injured nerves, such as pain, burning,
and abnormal sensations
such as bunched socks under the feet, to those due to loss of impulses, such as numbness and
unperceived injury due to loss of protective sensation. This includes inability to perceive heat and sharp pain, lead- ing to burns and puncture wounds. Although
the typi- cal form of diabetic neuropathy causes these symptoms, there are a number of other less common forms that can lead
to sudden pain, weakness, and other unsuspected symptoms in almost every region of the
body. Discussion of the
whole range of these is beyond the scope of this book.
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