The nervous system is a common target, and is likely to be damaged by diabetes. In spite of good diabetic control, it can occur. Only the intensity of symptoms would vary with the diabetic control, that is, if one has well controlled glucose symptoms, it may be less severe and with poor control, more severe.

Any type of nervous system can be affected. Involvement of the peripheral nerves (nerves which carry sensations from the body to the brain) is the most common manifestation of long standing diabetes. There may be tingling, numbness, burning sensation, diminished sensations, sense of insects crawling mostly in the hands and feet. Initially these may be mild and intermittent. But gradually, they may progress and worsen. Result of this is loss of efficient functioning of the hands and feet. It is one of the reasons for "diabetic foot”, another complication of diabetes, leading to foot amputation.

Muscle pains are common. Associated affection of the nerves which are concerned with the execution of movements can lead to wasting and paralysis of hands and feet. Reflexes and coordination of the hands and feet are lost, thus leading to loss of efficiency.

The thigh muscles are affected, causing difficulty in climbing. Deformities of joints may also develop in chronic cases. Smoking and alcoholism can aggravate this problem further.

Autonomic nervous system (system which is not under voluntary control and regulates basic body functions) distress causes problems for the diabetic. Change in bowel habit, that is, constipation or diarrhea becomes troublesome. Another problem that can commence is postural hypotension.

With change in posture, like standing up from a sitting or lying position, the blood pressure falls, causing giddiness. Excess sweating or nocturnal sweating is yet another distressful symptom that requires investigation for possible infectious diseases.

Diabetic autonomic neuropathy can cause a "silent heart attack”. Because of blunting of sensations and diminished response to sympathetic activity, a person may develop a heart attack without the warning symptom of chest pain. As a result, there is delayed diagnosis of the myocardial infarction, causing death. Autonomic neuropathy is one of the most common causes for sexual impotence in men. There may be urinary retention and or incontinence in an individual. Urinary retention, incontinence, repeated urinary tract infections make life uncomfortable and increase vulnerability to kidney damage and subsequent failure. Due to various reasons, susceptibility to stroke is increased. Sudden blindness may occur due to damage to the nerve responsible for vision.

Neuropathy occurs in diabetics because of reduced blood supply to the nerves. Many times, diabetes is diagnosed when the person presents signs of neuropathy. Nerve conduction studies and electromyography can be done to confirm and assess the damage to nerves and muscles.

In the early stages of neuropathy, tight diabetic control may help in preventing the progression of neuropathy and minimising the symptoms. Drugs may provide only marginal relief. High fibre diet with adequate amount of water moves the bowels regularly. Pain killers and anti-inflammatory drugs are used for muscle pains. Regular exercises and physiotherapy can help. Surgery can be carried out in persons having joint deformities if feasible. Special care is needed to prevent the "diabetic foot”. Sexual impotence can be helped with some drugs and penile implants.

There is no reason why a diabetic having neuropathy cannot lead a normal life. With good control of diabetes by means of a diabetic diet, exercise and medication, the neuropathy can be retarded or kept to minimum.

Dr Rachna Pande, Specialist, internal medicine rachna212002@yahoo.co.uk