Diabetic Neuropathy: Loss of Voluntary Movement Nerves and Automatic Nerves

Neuropathy can affect the muscles that you move voluntarily and the muscles that move automatically like the heart, diaphragm and intestines.  The signs and symptoms will depend on which nerves are involved.

Disorders of Movement: Mononeuropathy

Mononeuropathy means loss of movement of the muscle activated by a single nerve.  The cause is believed to be the sudden closing of the blood vessel supply to that nerve.  If, for example, the nerve to one of the eye muscles is affected, the patient will be unable to turn his eye to the side that the muscle is on.  If it is the nerve to a muscle to the mouth, he may not be able to smile on that side of his face.  There can be trouble with vision or hearing on the affected side.  The patient may not be able to focus his eye.

There is no specific treatment for mononeuropathy, but it tends to improve and disappear after several months.

Disorders of Autonomic  (Automatic) Nerves

Your body contains an entire system of nerves devoted to movement of automatic muscles.  As you read this, your heart is automatically pumping your blood, your diaphragm is automatically pulling air into your lungs, your intestines are automatically pushing that large lunch you ate down from your mouth to your esophagus to your stomach to your small intestine and large intestine.  40 percent of people with diabetes have been found to have some form of autonomic neuropathy using sensitive tests.

Here are some of the different conditions that result from loss of autonomic nerves:

  • Bladder abnormalities: the patient can’t tell when his bladder is full and he does not urinate regularly.  Urinary tract infections occur.  Treatment involves remembering to urinate every four hours and/or taking a drug that improves the force of contraction of the bladder muscles.
  • Abnormalities of sexual function: in 50 percent of males and 30 percent of females.  The males have loss of erections and the females have loss of sensation and lubrication.
  • Gastrointestinal abnormalities: The most common problem is constipation.  There is also delayed emptying of the stomach so that the food is not being absorbed while the insulin injection is active, resulting in brittle diabetes.
  • Failure of the gall bladder to empty resulting in gall stone formation.
  • Diabetic diarrhea and multiple (as many as 10) daily bowel movements.
  • Heart rhythm abnormalities so that the heart fails to speed up with exercise or the heart rate may be very fast and fixed, not slowing with rest.
  • Sweating problems, especially in the feet.  The body compensates from loss of sweating in the feet by sweating excessively in the face, arms and chest.

Key Advice

None of these disorders need ever occur if you keep your blood glucose in the normal range and maintain a hemoglobin A1c level of 7 percent or less.

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