Diabetes with neurological complications

Diabetes with neurological complications

Overview

Diabetic neuropathy is a type of nerve injury caused by diabetes. Nerves all over your body might be damaged by high blood sugar (glucose). Nerve damage in the legs and feet is the most common symptom of diabetic neuropathy.







Diabetic neuropathy symptoms can range from discomfort and numbness in your legs and feet to difficulties with your digestive system, urinary tract, blood vessels, and heart, depending on which nerves are impacted. Some people only experience minor signs and symptoms. Diabetic neuropathy, on the other hand, can be extremely unpleasant and devastating for some people.

Diabetic neuropathy is a significant diabetes consequence that affects up to 50% of those who have the disease. However, continuous blood sugar management and a healthy lifestyle can typically avoid or slow the progression of diabetic neuropathy.

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Symptoms and Types

Symptoms include thigh muscle weakness and shrinkage, severe aches in the hip and buttock area, and weight loss.

Diabetic neuropathy is divided into four categories. You can have one type of neuropathy or multiple types.

The kind you have and which nerves are impacted will determine your symptoms. Symptoms usually appear gradually. It’s possible that you won’t notice anything is wrong until significant nerve damage has happened.

  1. Peripheral neuropathy

Peripheral neuropathy is a condition that affects the peripheral nervous system.

Distal symmetric peripheral neuropathy is another term for this form of neuropathy. Diabetic neuropathy in this kind is the most frequent. It first affects the feet and legs, then the hands and arms. Peripheral neuropathy symptoms and signs are generally severe at night, and may include:

  • Numbness or a diminished ability to perceive pain or changes in temperature
  • Sensation of tingling or burning
  • Sharp aches and pains, or cramps
  • Increased sensitivity to touch – even the weight of a bedsheet can be uncomfortable for some people.
  • Ulcers, infections, and bone and joint discomfort are all serious foot issues.
  1. Autonomic neuropathy

Your heart, bladder, stomach, intestines, sex organs, and eyes are all controlled by the autonomic nervous system. Diabetic nerve damage can occur in any of these regions, resulting in:

  • A lack of awareness of low blood sugar levels (hypoglycemia unawareness)
  • Problems with the bladder or bowels
  • Gastroparesis (slow stomach emptying) causes nausea, vomiting, and a loss of appetite.
  • Changes in your eyes’ ability to shift from light to dark
  • Sexual reaction is reduced.
  1. Proximal neuropathy (diabetic polyradiculopathy)

Diabetic amyotrophy is a kind of neuropathy that affects nerves in the thighs, hips, buttocks, and legs. It might also have an impact on the abdomen and chest. The symptoms normally appear on one side of the body, although they can migrate to the other. You could have:


  • Severe pain in the hip, thigh, or buttocks.
  • Thigh muscles that are weak and shrinking.
  • Standing up from a seated position is difficult.
  • Severe stomach pain
  1. Mononeuropathy (focal neuropathy)

Mononeuropathy can be divided into two types: cranial and peripheral. The term “mononeuropathy” refers to injury to a single nerve. Mononeuropathy can also result in the following symptoms:

  • Having trouble focusing or having double vision
  • Aching behind one eye
  • Bell’s palsy occurs when one side of your face is paralyzed.
  • Except for your pinkie, numbness or tingling in your hand or fingers (little finger)
  • Weakness in your hand that may cause you to drop things.

Causes

There is no known etiology for each type of neuropathy. Uncontrolled elevated blood sugar, according to researchers, destroys nerves over time and interferes with their capacity to deliver messages, resulting in diabetic neuropathy. The walls of the small blood arteries (capillaries) that deliver oxygen and nutrients to the nerves are also weakened by high blood sugar.

 

Risk factors

Neuropathy can affect anyone with diabetes. However, the following things increase your chances of developing nerve damage:

  • Blood sugar levels are out of control. You’re at danger for every diabetes problem, including nerve damage, if your blood sugar isn’t under control.
  • Diabetes has a long history. The longer you have diabetes, the more likely you are to develop diabetic neuropathy, especially if your blood sugar isn’t adequately controlled.
  • Kidney disease is a condition that affects many people. The kidneys can be harmed by diabetes. Toxins are released into the bloodstream when the kidneys are damaged, which can cause nerve injury.
  • Being overweight is a problem. A BMI of 25 or more increases your chances of developing diabetic neuropathy.
  • Smoking causes your arteries to constrict and harden, limiting blood flow to your legs and feet. This makes wound healing more difficult and harms the periphery.

Complications

Diabetic neuropathy can lead to a variety of significant problems, including:

    • Unawareness of hypoglycemia. Shakiness, perspiration, and a fast heartbeat are common symptoms of blood sugar levels below 70 milligrams per deciliter (mg/dL). However, if you have autonomic neuropathy, these warning symptoms may go unnoticed.
    • Amputation of a toe, foot, or leg. Because nerve damage can cause you to lose feeling in your feet, even little cuts can quickly grow into sores or ulcers. An infection might spread to the bone or cause tissue death in severe situations. It may be necessary to amputate a toe, foot, or even the lower leg.
    • Infections of the urinary tract and urine incontinence. You may not be able to completely empty your bladder if the nerves that control it are injured. Urinary tract infections are caused by bacteria accumulating in the bladder and kidneys. Nerve injury can impair your capacity to detect the need to urinate or control the muscles that release urine, resulting in urine leakage (incontinence).




  • Blood pressure lowers dramatically. Damage to the nerves that govern blood flow might make it difficult for your body to regulate blood pressure. When you stand up after sitting, your blood pressure drops dramatically, which can cause dizziness and fainting.
  • Problems with digestion. If your digestive tract is affected by nerve injury, you may experience constipation, diarrhea, or both. Gastroparesis is a disorder in which the stomach empties too slowly or not at all, causing bloating and indigestion. It is caused by diabetes-related nerve loss.
  • Sexual dysfunction is a problem that many people face. The nerves that control the genital organs are frequently damaged by autonomic neuropathy. Erectile dysfunction can affect men. Lubrication and arousal may be a problem for women.
  • Sweating may increase or decrease. Nerve injury can cause your sweat glands to malfunction, making it harder for your body to regulate its temperature.

When should you see a doctor?

If you have any of the following symptoms, call your doctor to schedule an appointment:

  • An infected or non-healing cut or sore on your foot
  • Hands or feet burning, tingling, weakness, or pain that interferes with normal tasks or sleep
  • Digestion, urination, or sexual function changes
  • Dizziness and fainting are common side effects.

Screening for diabetic neuropathy should begin immediately after a person is diagnosed with type 2 diabetes, and five years after a person is diagnosed with type 1 diabetes, according to the American Diabetes Association. After then, annual screening is advised.

Treatment

Diabetic neuropathy has no known treatment. The goal of treatment is to slow the disease’s progression.

Controlling blood sugar levels through routine monitoring and blood testing, as well as treating pain symptoms with drugs and injections, are all part of treatment.

Prevention

By closely monitoring your blood sugar and taking appropriate care of your feet, you can prevent or delay diabetic neuropathy and associated effects.

Controlling blood sugar levels

People with diabetes should get an A1C test at least twice a year, according to the American Diabetes Association. The average blood sugar level for the previous two to three months is estimated with this test.

Although A1C targets must be tailored to the person, the American Diabetes Association advises an A1C of fewer than 7% for many adults. If your blood sugar levels are higher than you want them to be, you may need to make some adjustments to your daily routine, such as adding or adjusting medications or changing your diet.

Foot care is important.

Diabetic neuropathy can cause foot problems such as open sores that don’t heal, ulcers, and even amputation. However, having a comprehensive foot inspection at least once a year, having your doctor check your feet at each office visit, and taking proper care of your feet at home will help you avoid many of these issues.

Follow your doctor’s advice for proper foot care. To protect the health of your feet:

    • Check your feet every day. Look for blisters, cuts, bruises, cracked and peeling skin, redness, and swelling. Use a mirror or ask a friend or family member to help examine parts of your feet that are hard to see.
    • Keep your feet clean and dry. Wash your feet every day with lukewarm water and mild soap. Avoid soaking your feet. Dry your feet and between your toes carefully.
    • Moisturize your feet. This helps prevent cracking. But don’t get lotion between your toes, because it might encourage fungal growth.
    • Carefully trim your toenails. Make a straight cut across your toe nails. To avoid sharp edges, file the edges gently.
    • Socks should be fresh and dry. Look for socks with loose bands and thin seams made of cotton or moisture-wicking fibers.
    • Wear well-fitting, cushioned shoes. To protect your feet, always wear shoes or slippers. Make sure your shoes are comfortable and allow you to move your toes. A foot doctor can teach you how to choose shoes that fit properly and how to avoid problems like corns and calluses. If you qualify for Medicare, at least one pair of shoes per year may be covered by your plan.




Coding guidance

Combination codes for diabetes complications are found in CD-10-CM chapter four. The neurological problems code set includes particular information about the type of neuropathy. In order to code to the maximum level of specificity, medical record documentation must provide the same level of detail.

E11.40 Neuropathy, unspecified

E11.41 Mononeuropathy

E11.42 Polyneuropathy

E11.43 Autonomic (poly)neuropathy

E11.44 Amyoptrophy

E11.49 Other neurological complicatio

Diabetes with neurological complications

Diabetes with neurological complications

Diabetes with neurological complications

Diabetes with neurological complications

Diabetes with neurological complications