Neuropathy is a complication that is bothersome and not very often addressed or treated properly. This complication gradually develops over a period of time and is not always due to diabetes mellitus. This can be due to smoking or excessive alcohol intake as well. However, longer the duration of diabetes, chances of developing a neuropathy are higher. Neuropathy can be aggravated by insulin and some medicines. Rapid control of sugar is known to cause neuropathy for some people. Classically the neuropathy first affects the feet and toes and may gradually ascend.
There are four major types of neuropathy
- Peripheral neuropathy- this is the commonest form which affects the feet and hands. This can present in many forms. There may be numbness of the digits and reduced ability to feel changes in temperature or pain. Patients may complain of tingling or burning, feeling of insects crawling on the body, sharp pains at night, and some may experience extreme sensitivity to even the lightest of touches. Some may experience difficulty in walking or can have ulcers or deformity of the feet.
- Autonomic neuropathy: This part of the nervous system controls the functioning of the eyes, heart, lungs, stomach,intestines and sex organs. Thus, a dysfunction of this part of the nervous system may cause either of the following: urinary bladder problems ( too much urine or lack of control in holding the urine), constipation or diarrhoea, slow emptying of the stomach leading to fullness, difficulty swallowing, dryness of vagina, erectile dysfunction in males, reduced sweating, problems regulating body temperature, difficulty in eyes adjusting to a dark room when coming from a bright room. Some people have variations in blood pressure while getting up from lying down posture leading to imbalance.
- Radiculoplexus neuropathy- affects bigger nerves and hence the numbness can affect the thighs, buttocks, hip and legs. Characterestically patients complain of difficulty getting from sitting position. Some may complain of abdominal swelling and weak muscles.
- Mononeuropathy- this is the type of neuropathy affecting one single nerve. This may disappear over a period of time. No long term complications associated with this type. There maybe difficulty in focusing of the eyes, paralysis of one side of the face with deviation of angle of mouth, carpal tunnel syndrome where there is numbness of one part of the palm with weakness of muscles or loss of sensation. This can be corrected by a small surgery.
For details on how to test for neuropathy, please refer to the blog on feet.
If eyes are the window to the soul, then the smile offers a look into the health of the pancreas. Diabetes can affect the kidneys, feet, heart and eyes just as much as it could affect the oral health. Oral hygiene has often been the most neglected even among those without diabetes.
A smile is fat free, sugar free, reduces blood pressure, can relieve pain and depression, requires no battery and is free of cost.
There are about 500 micro organisms in the mouth which make a human bite quite dangerous ( more dangerous than an animal bite). Some of the micro organisms are helpful and some are harmful. There have some studies which tried studying the organisms in the mouth and predicting the heart health as these organisms could travel by blood stream and get deposited in the coronary vessels.
The oral cavity contains teeth, the gums which hold the teeth together, the bones on which the teeth rests, the tongue, saliva which bathes the mouth and the pink mucosa lining the mouth inside.
Those with diabetes are more prone for developing gum disease and it progresses twice faster than those without diabetes. Serious gum disease could worsen the sugar control and will need an intensification of treatment. The ability to fight the bacteria is affected in those with diabetes. Further , the diabetes is also a good medium for the organisms to thrive.
A look into your mouth:
Gingivitis is a mild form of gum disease, periodontitis is a more serious form of the same. Pockets form between the gums and the teeth which get filled with organisms, pus and then deepen. This can lead to destruction of bone around the teeth, leading to loosening of the teeth and subsequent falling off. The habit of using tobacco rolls or tobacco containing sweetened “paans” can cause a small burn on the insides of the pink mucosa which can later lead on to cancer.
Dry mouth can be due to snoring, poor sugar control, use of too much of alcohol based mouthwashes, some medicines, and also due to kidney diseases. Low salivary production can be a sign of diabetic neuropathy ( autonomic neuropathy) . Saliva helps in digestion of the food while chewing, protects the gums and teeth against the plaques and acid deposition which can damage the teeth and cause decay.
Thrush is a type of fungal infection common among those with diabetes.
• Soda, energy drinks, carbonated sweetened beverages and lemon water can damage the enamel which is the protective outer coating of the teeth. For people who have recurrent episodes of low sugar, they consume a lot of sweets which could damage the teeth. Speak with the health care provider on ways to prevent low sugar spells and thereby reduce the intake of sweets, thus protecting the oral hygiene.
Technique of brushing teeth
• Brushing the teeth effectively is to dislodge the plaques which build up at the gum line.
• The tooth brush must meet at the outer and inner surfaces of the teeth at an angle of 45 degrees.
• Move the toothbrush in short strokes, vibrating it back and forth across gum line, gums and tooth surfaces. This involves up and down movements, movements across and also movements to clean the inner sides of the teeth. For brushing the chewing surface, hold the brush horizontally and brush. For cleaning the inner side of the teeth, hold the brush vertically and move it up and down.
• Stiff brushes will not help remove plaques
• Brushing too hard can do more harm and even damage the protective enamel.
• Use a brush size that fits inside your mouth comfortably. A soft bristle brush is good for the gums and also to brush for at least 2 minutes.
• Those with arthritis or braces of the teeth can use an electric brush instead. The electric brush is effective and some of them have a 3000 rpm.
• There are so many tooth pastes which have flooded the market. Generally the fluoride containing tooth pastes are better.
• Sensitive teeth are due to the damage of the enamel. There are so many toothpastes available for that as well.
• The junk food culture and consumption of processed food items have damaged the teeth enamel more than the yesteryears.
• Use of turmeric is good for those with gingivitis ( diseases of the gums). Use of clove in those with dental aches is another well known home remedy. These have also been incorporated in some of the tooth pastes.
Dental floss is a string which helps dislodge food between the teeth. Measure an arms length of floss, roll around the index finger of one hand and roll the other free end around the index finger of the other hand. Slide the floss gently between the teeth, keeping the floss taut across the thumbs and floss up and down in a shoe shine manner following the curve of the teeth. Sometimes blood may come while flossing. Do not floss too hard.
Clean the tongue using the under surface of the toothbrush head. The use of metallic cleaners and too vigorous cleaning is to be discouraged to avoid damage to the taste buds on the tongue surface.
Water is a good mouth wash after any meal. However, there are breath fresheners which make the mouth feel, smell and taste fresh after any meal. There are treatment rinses containing fluoride which help prevent plaque deposition and decay of teeth.
Avoid alcohol containing rinses to avoid dry mouth.
Ask the dentist whether these are needed.
Meet with the dentist at least twice a year to make sure all is well. It is safer and lighter on the purse to have the problem sorted out earlier.
Change your tooth brush at least once in 3 months are if bristles have splayed earlier to that.