Physiotherapy for diabetic neuropathy

Diabetic neuropathy is the most common complication of Diabetes Mellitus (DM). According to International Diabetes Federation's Diabetes Atlas, there are 415 million people with diabetes in the world. Bangladesh has a disproportionately high diabetes population with more than 10 million according to research published in the World Health Organisation (WHO) bulletin in 2013. In Bangladesh 19.7% patients with diabetes have been suffering from peripheral neuropathy.

Physiotherapy helps to reduce the symptoms of peripheral neuropathy and helps the people to lead a physically active life.

What is diabetic neuropathy?

It is a type of nerve damage caused by uncontrolled diabetes that leads to numbness and sometimes pain and weakness in the hands, arms, feet and legs. Diabetic neuropathy can affect the digestive tract, heart and genitalia. The longer a person has diabetes, the greater the risk of neuropathy.

What are the symptoms and signs of diabetic neuropathy?

The symptoms and signs of diabetic neuropathy depend upon the type of neuropathy that is present. There are four types of diabetic neuropathy.

Peripheral neuropathy:

♦ The most common, cause  pain, tingling or burning sensation or loss of feeling in the hands, arms, feet, and legs

♦ Increased sensitivity to touch

♦ Muscle weakness

♦ Loss of balance and coordination

♦ Serious foot problems, such as ulcers, infections and deformities.

Autonomic neuropathy: The autonomic nervous system controls heart, bladder, lungs, stomach, intestines, sex organs and eyes. Diabetes can affect the nerves in any of these areas, possibly causing:

♦ Lack of awareness that blood sugar levels are low

♦ Bladder problems, including urinary tract infections or incontinence

♦ Constipation, uncontrolled diarrhoea or a combination of the two and loss of appetite

♦ Erectile dysfunction in men, vaginal dryness and other sexual difficulties in women

♦ Increased or decreased sweating, problems of regulating body temperature

♦ Inability of body to adjust blood pressure and heart rate, leading to sharp drops in blood pressure after sitting or standing

♦ Difficulty of eyes to adjust from light to dark.

Proximal neuropathy:

♦ Sudden, severe pain in thighs, hips or buttock

♦ Weak and atrophied thigh muscles

♦ Difficulty rising from a sitting position

♦ Abdominal swelling, if the abdomen is affected

♦ Weight loss.

Mononeuropathy:

Signs and symptoms depend on which nerve is involved and may include:

♦ Difficulty focusing your eyes, double vision or aching behind one eye

♦ Paralysis on one side of your face (Bell's palsy)

♦ Pain in your shin or foot, lower back or pelvis, front of thigh. Sometimes chest or abdomen.

Importance of physiotherapy for diabetic neuropathy

Physiotherapy has a significant role in the treatment and prevention of diabetic neuropathy. Specific exercise programme including range of motion, muscle strengthens and gait training can improve gait pattern or walking in patients with diabetic neuropathy. Evidence shows that resistant strengthening exercises lower blood glucose level. A proper physiotherapy intervention will help to alleviate from the symptoms of diabetic neuropathy and also improve overall quality of life.

How to prevent diabetic neuropathy?

Keeping diabetes under control is the best way to prevent or stop the progression of diabetic neuropathy and other complications of diabetes. Monitoring your blood glucose levels, avoiding smoking, getting aerobic exercises, strengthening exercises, balance training, taking your medications as prescribed, proper foot care and being active is the best way to prevent it.

The writer is a neurodynamic specialist and clinical physiotherapist at BRB Hospital Ltd.

Email: ranacrpphysio@gmail.com