Ms X, a 60-year-old woman, was very active and cheerful. However, she then began to experience numbness and a burning sensation in her feet. Initially, she ignored it, but as it increased, she consulted a physician. Simple blood tests revealed that she had diabetes and neuropathy. Diabetes has several long-term complications in the body, but damage to the nervous system starts early and is one of the most common chronic complications. Damage to the nerves connecting the brain to the limbs for feeling sensations and carrying out movements occurs earlier than other complications. This leads to altered or reduced sensations in the feet, hands, and limbs. Commonly, the abnormality starts in the feet. One may feel sensations of insects crawling, pinpricks, coldness, or a burning type of pain in the limbs. If sensations are reduced, a person may fail to perceive any pain and unknowingly hurt themselves, leading to wounds and infection, particularly in the feet. Apart from the peripheral nerves, sometimes the nerves present in the brain can also be affected by diabetes. This results in one or more of the following manifestations, such as drooping of eyelids, blurred vision, and paralysis of one side of the face or tongue. All of this generates much distress and disability. The involvement of the autonomic nervous system, which influences involuntary functions of the body, also becomes very troublesome for the affected person. Bowel movements can be altered, causing chronic diarrhea or constipation in a person who previously had healthy bowel habits. This affects their intake and overall nutritional status, resulting in weakness. Exaggerated falls in blood pressure while standing or changing position can make a person feel giddy upon standing. If severe, it can result in episodes of unconsciousness. Apart from this, an individual can have excessive sweating or feeling hot or cold without any obvious cause. Sexual impotence is yet another consequence of damage to the nervous system and it is most worrying for the sufferer. In men, it can manifest as a loss of libido and/or failure of erection, while in women, it manifests as frigidity. In individuals with diabetes, damage to the nervous system occurs due to an interruption of the blood supply to the nerves, thus impairing their nutrition. The sickness and disability caused by diabetes are further exacerbated by the 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 pain or supplement a vitamin B complex. Therefore, people need to be aware of these problems and take due precautions to prevent them. Firstly, it is important to keep diabetes well-controlled. This can be achieved by following dietary restrictions, being physically active, and taking prescribed medications regularly. Consumption of whole grains, cereals, and nuts ensures an adequate amount of vitamin B complex in the body, thus keeping the nerves in a good functioning state and minimising damage caused by diabetes. High fibre in the diet will minimise the chances of constipation and help in overcoming it. Quitting alcohol helps in reducing the effect on the nervous system. A person with reduced sensation should be very careful about their feet. They should always keep them clean and dry and regularly examine them for cuts or any injuries. The footwear used should be comfortable and of a good fit. Those suffering from dizziness can use well-fitting elastic stockings while standing or walking, which helps ensure an adequate amount of blood returns to the heart, thus preventing dizziness. Sex therapy, psychotherapy, and 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 minimize the suffering. Dr Rachna Pande is a specialist in internal medicine
