Expertise: Stroke, cerebrovascular disease, acupuncture treatment for stroke (currently limited to inpatients), repetitive transcranial magnetic stimulation treatment

      "Doctor, my HbA1c is just slightly above normal, and I feel fine. Why should I take medication?"
      "I'm already taking a lot of medications. My blood sugar is a bit high but I don't feel anything. Please don't prescribe more!"

      Such conversations often occur in clinics. Many patients believe that diabetes is not a big deal, thinking that slightly high blood sugar doesn't hurt or affect their daily life. As a result, they take medications inconsistently or even refuse treatment. However, this mindset leads people to slowly fall into the "sweet trap" of diabetes.

Diabetes is More Than Just High Blood Sugar

       People often underestimate the threat diabetes poses to health. According to the Ministry of Health and Welfare statistics, diabetes ranked fifth among the leading causes of death in Taiwan in 2023. Why is diabetes so serious? Because it is not merely about elevated blood sugar levels — it is a systemic disease that affects the entire body. Diabetes can damage blood vessels, increasing the risk of cardiovascular and cerebrovascular diseases; it can damage the eyes, leading to diabetic retinopathy; it can damage the kidneys, causing diabetic nephropathy; and it can cause diabetic neuropathy, which is the focus of this article.

Common Symptoms of Diabetic Neuropathy

Diabetic Peripheral Neuropathy

       Unnoticed, high blood sugar gradually damages nerves. Peripheral neuropathy often begins at the toes. Initially, patients may notice decreased sensation to pain and temperature, accompanied by numbness. Some may experience abnormal sensations like tingling, burning, and difficulty walking. If sensory nerve damage progresses, patients may feel as though they are walking on cotton, lose balance, and suffer falls. As numbness or abnormal sensations extend upward, the hands can also be affected, giving a sensation like wearing socks or gloves. Over time, muscle weakness and atrophy can occur. Additionally, dulled sensation in the feet means injuries often go unnoticed, and with diabetes impairing wound healing, foot ulcers can easily develop.

Cranial Neuropathy

       Cranial nerves can also be affected. When cranial nerves are damaged, various symptoms may appear. Damage to the oculomotor nerves can cause double vision and blurry vision. Facial nerve damage can cause facial droop. Eyelid drooping may also occur.

Diabetic Lumbosacral Radiculoplexus Neuropathy

       Beyond peripheral nerves, proximal nerves (nerve roots and plexuses) can also be affected, termed diabetic lumbosacral radiculoplexus neuropathy. Although rare, it can cause severe unilateral lower limb weakness and unbearable pain in the waist and leg, significantly impacting quality of life.

 Diabetic Autonomic Neuropathy

      Autonomic nerves refer to the sympathetic and parasympathetic nervous systems, which regulate body functions automatically in response to external changes. Therefore, autonomic neuropathy has widespread effects and presents with various symptoms, most commonly affecting the cardiovascular and digestive systems:

- Cardiovascular symptoms: Orthostatic hypotension. Moving from lying to sitting or sitting to standing results in a drop of over 20 mmHg in systolic pressure or over 10 mmHg in diastolic pressure, leading to dizziness. Other symptoms include resting tachycardia and exercise intolerance (easy fatigue).
- Digestive symptoms: Difficulty swallowing, constipation, diarrhea.

      Additionally, symptoms such as sexual dysfunction, anhidrosis (lack of sweating), and poor heat tolerance may occur.

Treatment

      Since diabetic neuropathy is primarily caused by uncontrolled blood sugar, blood sugar control is crucial. It is vital both after the onset of neuropathy and for prevention and slowing its progression. Symptoms like pain and constipation can be managed with medications. Acupuncture and transcutaneous electrical nerve stimulation (TENS) therapy have shown symptom relief in some patients.

      Understanding the disease process and related complications at the time of diabetes diagnosis is key to reinforcing the importance of blood sugar control.

Conclusion

     Diabetic neuropathy is a significant part of the disease course in diabetes, with wide-ranging impacts that can severely diminish quality of life. Actively managing blood sugar can delay the progression and severity of neuropathy. If symptoms of neuropathy appear, medications and lifestyle modifications can help alleviate discomfort.

      Don't let diabetes quietly steal your health—taking blood sugar control seriously now is taking your future seriously.