Diabetes

Robert G. Parker
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Dr. Parker is a podiatrist and surgeon in Houston, TX who has been helping patients for more than 40 years.

Living with diabetesIf you are diabetic you may already be familiar with many of the complications that come with this condition. Among the most common complications of diabetes is neuropathy. Although the symptoms of diabetic neuropathy are very similar to those of regular nerve compression, diabetic neuropathy arises from the nerve's response to abnormally high glucose levels. Unfortunately, even when good blood sugar levels are maintained, there is a 50% chance that neuropathy will occur.

The Relationship between Diabetic Neuropathy and Nerve Compression

Diabetic neuropathy begins with a change in sensation in the hands and feet. Diabetics experience the same numbness and tingling sensation that a person who has regular nerve compression will experience, however it is different in that it is felt in what is known as a "stocking and glove" distribution.

This means that when the neuropathy is in the hand the entire hand is affected, both front and back. The changes can occur in all of the fingers and extend up to the elbow. Likewise, in the feet, both top and bottom of the foot and the toes are affected, and the changes can be present up to the knee. Another way to think of it is that with a diabetic, multiple nerves will be compressed at a number of sites along the path the nerve follows along the arm or leg.

Regular nerve compression, in contrast, usually involves one nerve in the arm or the leg, resulting in just a particular region in the arm or leg having symptoms of numbness. This difference in the pattern of numbness is the main reason why doctors have not previously associated symptoms of diabetic neuropathy with those of nerve compression.

A second difference between diabetic neuropathy and nerve compression is the fact that the Diabetic nerve is compressed due to a metabolic process, making the nerve itself inflamed, and not just due to many anatomically tight regions that are present in many people. So in diabetics, the nerve compression is superimposed upon the underlying progressive neuropathy. And when the neuropathy and nerve compression exist together, the symptoms of numbness, tingling and weakness exist due to the nerves being compressed.

Why are diabetics prone to nerve compression?

Metabolic neuropathy: Diabetic nerve compression is primarily a result of metabolic imbalances in the nerve, and the tightness of the surrounding anatomy produces symptoms secondary to the original neuropathy. Consequently, one of the main reason's why a diabetic's nerves are susceptible to compression is because the nerves in a diabetic are swollen.

Sugar from the blood enters the nerve, just like it enters other cells, to give it energy. This sugar, glucose, is converted to another sugar called sorbitol. Sorbitol’s chemical nature makes it highly attractive to water molecules, and so water is drawn into the nerve causing it to swell. If the nerve swells in a place that is already tight, like the anatomic regions described previously, then the nerve becomes pinched or compressed, resulting in symptoms of numbness and tingling.

Transport Mechanisms: The second reason for swelling is related to the transport systems within the diabetic nerve. The nerve is filled with a substance that allows important chemical messengers to move along it, enabling the one end of the nerve to know what is happening at the other end.

If the nerve becomes damaged, by compression, for example, its cell membranes need to be rebuilt. The building proteins are transported inside the nerve along tracks called tubulin. This mechanism, called the "slow anterograde component of axoplasmic transport" does not function normally in Diabetics. This means that the nerve is unable to repair itself properly, rendering it more likely to remain in trouble from compression.

What benefits does surgery have?

The surgery to decompress the nerve does not change the basic underlying metabolic (diabetic) neuropathy that makes the nerve susceptible to compression in the first place. When the surgical decompression is done early in the course of nerve compression, restoration of blood flow to the nerve will stop the numbness and tingling, and allow the nerve to recover. When decompression is done later in the course of nerve compression, and there have been extended periods of symptoms, then nerve fibers have begun to die; decompression will facilitate regrowth of the diabetic nerve.

While it is not fully understood as to how to prevent neuropathy from occurring, there are methods available to slow the natural course or history of diabetic neuropathy. This is done by removing the compression, or tight areas along the course of the nerve that are causing the symptoms of numbness and tingling you may feel in your hands and feet. For more specific information on the surgery relevant to the area in which you are experiencing discomfort, please call our Houston office at (281) 497-2850 to schedule a time to speak to Dr. Parker, or make an online appointment.