Diabetes is an inherited lifestyle disease in which blood sugar levels remain consistently high (fasting more than 125 mg/dL, a two-hour PP of 180-200 or a HBA1c of 6.5 per cent or higher). It requires lifestyle modifications, such as maintaining a proper diet and exercising regularly in an attempt to achieve ideal body weight. If these measures do not bring blood sugar under control, medication becomes necessary.

When the body stops producing insulin altogether, insulin injections become essential. In other cases, medications that act at various sites can be used. Some can stimulate the pancreas to release more insulin. Others enhance the body’s sensitivity to insulin, or slow down the breakdown and absorption of food, or increase the kidneys’ excretion of sugar.

Prolonged, uncontrolled high blood sugar levels take a toll on the body. Nerves are particularly vulnerable. High glucose acts as a toxin, damaging the protective sheaths around nerves. The tiny blood vessels supplying these nerves become less efficient, reducing blood flow. In addition, the chemicals responsible for nerve signal transmission are diminished. This type of nerve damage is known as diabetic neuropathy.

The longest nerves in the body are those that supply the hands and feet. These are particularly prone to damage in diabetes, leading to loss of sensation, numbness, tingling, burning, sharp pains, cramps and muscle weakness. There may be clumsiness and difficulty in walking. The symptoms usually affect both sides of the body equally and are worse at night, interfering with sleep.

Sometimes, multiple smaller nerves in the thighs, buttocks, hips, chest wall or abdominal area may be affected. It usually involves only one side of the body. It can cause sharp or unusual pain in the affected areas, which may be mistaken for gallbladder disease or disc problems.

If the autonomic nervous system is affected, several symptoms may occur. There may be a drop in blood pressure when changing position from sitting or lying down to standing, which can cause giddiness, dizziness or even fainting. The heart rate may become rapid. The rate at which the stomach empties may slow down, leading to frequent stomach upsets, vomiting, bloating and discomfort. Sweating may increase.

There may be urinary frequency and incomplete bladder emptying, which can lead to frequent infections. Constipation or diarrhoea may also occur.

Diabetic neuropathy is more likely to develop if you are overweight and have high blood pressure or elevated lipid levels. Smoking and alcohol consumption also damage the nerves and worsen the condition.

The dangerous aspect of diabetic neuropathy is the loss of sensation in the feet. Cuts and injuries may go unnoticed due to reduced sensation and pain perception. Infections can set in and spread rapidly, sometimes leading to the loss of a toe or even the entire foot.

Feet need to be checked every day for blisters, cuts or swelling. Infections can develop through neglected cracks in dry skin. The skin should be kept soft by applying oil or moisturiser, but avoid using it between the toes. Nails should be trimmed carefully, straight across, to prevent injury to the toes. If poor eyesight or limited flexibility makes this difficult, ask a relative or a professional to help.

Never walk barefoot, even indoors, as reduced sensation may prevent you from realising that you have stepped on a sharp object that could cause injury. Always wear well-cushioned footwear, and replace slippers or shoes when the soles wear out.

Keep the blood flow to your feet healthy by elevating them whenever you sit. Every 10 to 15 minutes, consciously wiggle your toes and move your feet up and down to improve circulation.

The writer has a family practice at Vellore and is the author of Staying Healthy in Modern India. If you have any questions on health issues please write to yourhealthgm@yahoo.co.in