The purpose of this chapter is to provide you with information that brings optimism for patients with diabetes. By having a yearly measurement made of the sensibility in your feet, the earliest stages of neuropathy can be identified and appropriate changes in diabetes management can be made. In certain circumstances, it may be found that areas are present in your legs that cause compression of your nerves. These sites of pressure on your nerves can be treated with surgery in order to restore sensation to your feet.
Nerves begin in the spinal cord and extend into the fingers and toes. Along this path, them are anatomic areas of narrowing. These exist in everyone and many are already known to you, such as your "funny bone" at the elbow and the carpal tunnel at the wrist. In the leg, there are similar tight places at the outside of your knee and inside of your ankle, called the tarsal tunnel. Although some people may have been born with structures that would make the tunnels more narrow and the nerves more likely to become pinched, like a smaller ankle or extra muscles that go through one of these tunnels, the diabetic has two unique reasons that make nerves susceptible to compression.
The first reason is that the nerves in a diabetic am swollen. Sugar from the blood enters into the nerve to give the nerve energy. This sugar, glucose, is converted into another sugar, called sorbitol. Sorbitol's chemical formula makes it attract water molecules, and so water is drawn Moo the nerve, causing the nerves in a diabetic to become swollen. It is Dr. Dellon's hypothesis that if a nerve swells in a place that is already tight, like those anatomic areas described above, then the nerve becomes pinched ar compressed, causing symptoms.
The second reason is related to the transport of systems within the diabetic nerve. The nerve is filled with a substance that lets important chemical messengers move along the nerve, carrying messages that let the nerve's central part know what is happening at its other end. If the nerve becomes damaged, by compression, for example, and its cell membranes need to be rebuilt, these building proteins are transported downstream inside the cell along tracks called tubulin. This mechanism, called the slow anterograde component of axoplasmic transport, does not work normally in diabetics. Dr. Delano hypothesis is that the decrease in axoplasmic transport means that the nerve cannot repair itself well, rendering it more likely to remain in trouble from compression, and therefore produce symptoms.
If someone were squeezing your neck, choking you, you would be yelling and screaming, struggling to get air into your lungs. If your nerve gets choked, or pinched, it also does not get enough oxygen. The nerve makes you aware of this lack of oxygen by sending you a warning message. You will feel buzzing, tingling or numbness in the areas that are supplied by that nerve.