Bell's Palsy and Diabetes   (January 19, 2014)

I recently saw the following question:

My husband was diagnosed with Bell's Palsy today and he has diabetes. How can I help him? Is Bell's Palsy related to having diabetes?

My reply:

To answer your last question first: yes, Bell's Palsy is related to diabetes. Although it can occur in anyone, and the exact cause is unknown, it's more common in people with diabetes.

Bell's Palsy is another name for nerve damage to one (either the left or right) or both facial nerves (also known as Cranial Nerve 7), which control the muscles of the face. The name "Bell's Palsy" honors Dr. Charles Bell, who was a Scottish physician who first described the condition in the 1800's; the word "palsy" is a rarely-used medical term for paralysis.

The diagnosis of classical Bell's Palsy is based upon the sudden onset of weakness or paralysis of one side of the face. There may be drooping of the face especially visible at the eyelid or corner of the mouth; difficulty closing the eye on the affected side; difficulty eating and drinking; drooling; and problems making facial expressions such as smiling. Other symptoms may occur, including dry eye, headache, lose of the sense of taste, sounds seeming louder (hyperacusis), and twitching of the facial muscles on the affected side.

Usually, no treatment is required, and the condition spontaneously improves over weeks or months. Sometimes, physicians might recommend use of corticosteroids to reduce swelling around the facial nerve, but since your husband has diabetes, the use of steroids should probably be avoided. (See my previous discussion about the use of steroids in PWD.)

Most folks know that diabetes complications can include damage to nerves, called neuropathy. But folks may not be aware that one of the versions of diabetic nerve damage is damage to a single nerve (also called mononeuropathy). The single nerve can be the facial nerve, as in your husband's case, or could be other cranial nerves (such as the nerves controlling the muscles that move the eyes), or other nerves elsewhere in the body. As with Bell's palsy, these nerves often resolve spontaneously over time. The cause is assumed to be related to damage to the blood supply to the affected nerve. Sometimes, especially with extraocular muscle palsies, there may be concern about other causes of the mononeuropathy, and additional evaluation may be warranted. But in Bell's Palsy, it's usually considered safe to "sit on it" without further testing for other causes if the presentation is classic, especially if the patient has diabetes.

Hope this helps!