Nerve Health in Later Life with Type 1 Diabetes

Introduction

Diabetic neuropathy, or nerve damage caused by diabetes, is a common and potentially serious complication for individuals living with Type 1 Diabetes (T1D), particularly as they age.[1, 11] Persistently high blood sugar levels over time can injure nerve fibres throughout the body.[1, 12] This damage can lead to a wide range of symptoms and affect various bodily functions, depending on which nerves are involved.[11]

For older Victorians with T1D, understanding the different types of neuropathy, their symptoms, and management strategies is crucial for maintaining quality of life, preventing further complications (like foot ulcers or falls), and managing pain or discomfort effectively. This section provides an overview of diabetic neuropathy, with more detailed information on specific types available on subsequent pages.

How Diabetes Damages Nerves

The exact mechanisms are complex, but several factors contribute to nerve damage in diabetes:

• High Blood Glucose: Elevated blood sugar levels are a primary cause. Glucose can cause chemical changes in nerves and impair their ability to transmit signals. It can also damage the small blood vessels (capillaries) that supply nerves with oxygen and nutrients.[1, 12]
• Metabolic Factors: Besides high glucose, other metabolic factors like high triglyceride and cholesterol levels, and being overweight, are associated with an increased risk of neuropathy.[12]
• Duration of Diabetes: The longer a person has diabetes, the higher their risk of developing neuropathy.[11]
• Age: Being older (over 40) is also a risk factor.[11]
• Blood Vessel Damage: Impaired blood flow due to damaged blood vessels can reduce the supply of oxygen and nutrients to the nerves, contributing to damage.[10]
• Inflammation and Oxidative Stress: These processes are also thought to play a role in the development of diabetic neuropathy.[10]

Types of Diabetic Neuropathy

Diabetic neuropathy can be broadly categorised based on the types of nerves affected:

1. Peripheral Neuropathy: This is the most common type and primarily affects the nerves in the feet and legs, and sometimes the hands and arms.[11] It can cause symptoms like pain, numbness, tingling, and weakness. (Covered in detail on the “Peripheral Neuropathy” page).
2. Autonomic Neuropathy: This type affects the autonomic nerves, which control involuntary bodily functions such as heart rate, blood pressure, digestion, bladder function, sexual response, and sweat glands.[11, 12] (Covered in detail on the “Other Diabetes Nerve Damage” page).
3. Proximal Neuropathy (Diabetic Amyotrophy): This less common form affects nerves in the thighs, hips, buttocks, or legs, typically on one side of the body. It can cause severe pain and muscle weakness.[11, 12] (Covered in detail on the “Other Diabetes Nerve Damage” page).
4. Focal Neuropathy (Mononeuropathy): This type involves damage to a single, specific nerve, often in the head, torso, hand, or leg.[11, 12] Symptoms appear suddenly and depend on the nerve affected. (Covered in detail on the “Other Diabetes Nerve Damage” page).

It’s possible for an individual to have more than one type of neuropathy.[11]

General Symptoms and Impact

Symptoms of diabetic neuropathy vary widely depending on the type and location of the affected nerves. Common manifestations can include [1, 11, 13]:

• Numbness, tingling (“pins and needles”), burning sensations, or pain, especially in the extremities.
• Loss of sensation, making it difficult to feel injuries.
• Muscle weakness.
• Problems with balance and coordination.
• Digestive issues (nausea, vomiting, diarrhoea, constipation).
• Bladder problems (incontinence, difficulty emptying).
• Sexual dysfunction.
• Dizziness or fainting due to blood pressure changes.
• Changes in sweating.

Diabetic neuropathy can significantly impact daily life, affecting mobility, sleep, mood, and the ability to perform everyday tasks.[10] It is also a major risk factor for foot ulcers and amputations if peripheral neuropathy affects the feet.[1]

Prevention and Management

While nerve damage cannot always be reversed, steps can be taken to prevent it or slow its progression:

• Blood Glucose Control: Consistently managing blood glucose levels within your target range is the most important step.[11, 13]
• Healthy Lifestyle: Maintaining a healthy weight, regular physical activity, a balanced diet, and avoiding smoking can help.[5, 13]
• Regular Check-ups: Annual screening for neuropathy is recommended, including foot exams.[2, 4]
• Managing Coexisting Conditions: Controlling high blood pressure and high cholesterol is also important.[5, 11]
• Pain Management: Various treatments, including medications and physical therapies, can help manage neuropathic pain.[12, 13]

Key Takeaways

• Diabetic neuropathy is nerve damage caused by prolonged high blood sugar and other factors associated with Type 1 Diabetes.[1, 12]
• It can affect various parts of the body, leading to a wide range of symptoms and potential complications.[11]
• The main types include peripheral, autonomic, proximal, and focal neuropathy.[11]
• Good blood glucose control is paramount in preventing or slowing the progression of neuropathy.[11, 13]
• Regular screening and prompt management of symptoms are essential for maintaining quality of life.

Where to Get Help in Victoria

• Your GP (Doctor): For initial assessment, management, and referrals.
• Endocrinologist: Specialist in diabetes care.
• Neurologist: Specialist in nerve disorders, may be consulted for complex cases.
• Podiatrist: For foot-related neuropathy and care.
• Diabetes Educator: For education on self-management and prevention.
• Physiotherapist/Occupational Therapist: For managing pain, improving mobility, and adapting to functional limitations.[13]
• Diabetes Victoria: Provides resources and support.
• National Diabetes Services Scheme (NDSS): For information and support.

References

• [1] Mayo Clinic. (n.d.). Type 1 diabetes.
• [2] Endocrine Society. (n.d.). Diabetes and Older Adults.
• [13] NCBI Bookshelf. (n.d.). Diabetic Peripheral Neuropathy.
• [10] PMC. (2009). Diabetic Neuropathies: An Update.
• [12] Johns Hopkins Medicine. (n.d.). Diabetic Neuropathy (Nerve Problems).
• [11] Centers for Disease Control and Prevention (CDC). (n.d.). Diabetes and Nerve Damage.
• [4] Royal Children’s Hospital Melbourne. (n.d.). Diabetes complications - what does this mean?
• [5] Mayo Clinic. (n.d.). Type 1 diabetes - Diagnosis and treatment.