Diabetes is a chronic metabolic disorder which occurs due to impaired metabolism of glucose in the body. Considered to be a disease of the developed nations in the past, its prevalence is also rising in the developing parts of the world due to changing lifestyles and increasing stress.

It has several long term complications on the body, but damage to the nervous system starts early and is one of the most common chronic complication.

Damage to the nerves connecting the brain to limbs for feeling sensations and carrying out movements occurs earlier as compared to other complications. This leads to altered or reduced sensation over feet, hands and the limbs. Commonly, the abnormality starts from the feet. One may feel like insects crawling, a sensation of pin prick or coldness. Some persons get burning type of pain in the limbs. If the sensation is reduced, a person fails to perceive any pain and unknowingly may hurt himself leading to wounds or infection, more particularly in the feet.

Apart from the peripheral nerves, sometimes the nerves present in brain can also be affected by diabetes. This results in one or more of the following manifestations like drooping of eyelids, blurred vision, and paralysis of one side of face and or tongue. All this generates much distress and disability.

Involvement of the autonomic nervous system, one influencing involuntary functions of the body also becomes very troublesome for the affected person. Bowel movement can be altered, causing chronic diarrhea or constipation in a person with previously healthy bowel habits. This affects intake and the overall nutritional status of the individual resulting in weakness. Exaggerated, fall in blood pressure while standing or changing position makes a person feel giddy on standing. If severe, it can result in episodes of unconsciousness. Apart from this, an individual can have excess sweating or feeling hot or cold without any obvious cause. Sexual impotence is yet another sequel of damage to the nervous system and it is the most worrying for the sufferer. In men, it can manifest as loss of libido or failure to get an erection, while in women it manifests as frigidity.

In diabetic individuals, the damage to the nervous system occurs due to interruption of the blood supply to the nerves, thus impairing their nutrition. The sickness and disability caused by diabetes is further aggravated by use of alcohol and tobacco, both of which are toxic to the nervous system.

Once these problems start, they are mostly irreversible. Medicines given are mostly to reduce the pain or supplement vitamin B. complex. Therefore, people need to be aware of these problems and take due precautions to prevent it.

Firstly, it is important to keep the diabetes well controlled. This can be achieved by following the dietary restrictions, being physically active and taking prescribed medicines regularly.

Intake of whole grains, cereals and nuts ensures adequate amount of vitamin B complex in the body, thus keeping the nerves in a good state and minimising damage by diabetes. High fiber in the diet will minimise chances of constipation and help overcoming it. Quitting alcohol helps in reducing the effect on the nervous system.

A person with reduced sensation should be very careful about his feet. They should always be kept clean and dry and regularly examined for cuts or any injury. Footwear used should be comfortable and of good fitting.

Those suffering from dizziness can use well-fitting elastic stockings while standing or walking. This helps in ensuring return of adequate amount of blood to the heart, thus preventing dizziness. Sex therapy, psychotherapy, intracavernous devices are some of the measures used for sexual impotence. If a diabetic individual can prevent neuropathy, it is ideal; otherwise one should try to adopt measures to minimise the suffering.

Dr. Rachna Pande specialist, Internal Medicine, Ruhengeri Hospital

rachna212002@yahoo.co.uk