Diabetic Neuropathy

Written by Carmella Wint | Published on June 14, 2012
Medically Reviewed by Peggy Pletcher, MS, RD, LD, CDE on April 29, 2014

What Is Diabetic Neuropathy?

Diabetic neuropathy is a common complication of type 1 and type 2 diabetes due to uncontrolled high blood sugar levels that result in damage to the nerves. According to the American Diabetes Association (ADA), between 60 and 70 percent of diabetics have some form of neuropathy. (ADA)

In cases of severe or prolonged neuropathy, patients may suffer injuries or infections in their extremities or soft tissue damage that requires amputation. If you have diabetes and are experiencing numbness, tingling, pain, or weakness of your hands or feet, you must see your doctor. These are the early symptoms neuropathy.

Types of Diabetic Neuropathy

There are four main types of neuropathy seen in people with diabetes. The most common form is peripheral neuropathy, or damage to the nerves that reach out from the brain and spine to all the parts of the body.

The nerve endings in your legs and arms are the most commonly affected. Peripheral neuropathy can cause numbness, tingling, and pain in your extremities.

People with peripheral neuropathy of the lower body may not feel an injury to one of their feet, or may not feel a sore, which can become infected.

The second most common type of neuropathy in people with diabetes is autonomic neuropathy.

The autonomic nervous system runs the involuntary systems of the body, the systems that we have no conscious control over. Many body organs and muscles are controlled by this system. For instance, the autonomic system controls important organs, including the heart, bladder, and lungs. Autonomic neuropathy, therefore, can cause problems with your digestive and urinary tracts, as well as with your eyes and sex organs. A common complaint of men with diabetic neuropathy is impotence or erectile dysfunction. Cardiovascular autonomic neuropathy, which affects the heart, is a leading risk factor for death.

A less common form of neuropathy is proximal neuropathy, also known as diabetic amyotrophy. This form of neuropathy is more commonly seen in older people with type 2 diabetes. It most commonly affects the hips, thighs, and legs. Diabetic amyotrophy usually affects only one side of the body.

The final type of neuropathy is focal neuropathy, or mononeuropathy, which occurs when there is damage to one specific nerve or group of nerves, causing weakness in the affected area.  The pain of mononeuropathy can be extreme, but it tends to resolve itself over time and usually does not lead to long-term complications.

It is important for you to talk to your doctor if you feel you are experiencing neuropathy. A common medicine used in diabetes, metformin, can lead to lower B12 levels, which can cause a type of neuropathy. Your doctor and healthcare team can help diagnose and treat any nerve problems you may be experiencing.

What Causes Diabetic Neuropathy?

Diabetic neuropathy is caused by nerve damage, most likely due to a number of factors such as:

  • high blood sugar levels over long periods of time
  • damage to the blood vessels, such as damage done by high cholesterol levels
  • mechanical injury, such as injuries caused by carpal tunnel syndrome
  • lifestyle factors such as smoking or alcohol use

What Are the Symptoms of Diabetic Neuropathy?

It’s common for symptoms of neuropathy to appear gradually. In most cases, the first sign is a feeling of “pins and needles” in your feet.

Other common signs and symptoms of diabetic neuropathy include:

How Is Diabetic Neuropathy Diagnosed?

Your doctor will ask about your symptoms and medical history and conduct a physical examination. During the physical exam your doctor will check your reflexes and level of sensitivity to vibration, temperature, and touch, as well as your heart rate, blood pressure, muscle tone, and so on.

To test the feeling in your feet, the doctor may do a simple filament test, using a nylon fiber to check your limbs for loss of sensation. A tuning fork may be used to test your vibration threshold. The doctor may also test your ankle reflexes.  .

How Is Diabetic Neuropathy Treated?

There is no cure for diabetic neuropathy, but treatment can slow the progression of your condition. Treatment can also help you manage symptoms, such as pain and indigestion.

Slowing the Disease’s Progress

Keeping your blood sugar levels within a healthy range can slow the progress of the disease. It can also lead to some symptom relief. Quitting smoking and exercising regularly can also be parts of a comprehensive treatment plan.

Always have a discussion with your doctor or healthcare team before beginning a new exercise or fitness routine.

Pain Management

Medications are used to treat pain caused by diabetic neuropathy. Talk to your doctor about the medications available and their side effects. You may also want to consider alternative therapies, such as acupuncture. Some people do find that alternative therapies provide a measure of relief when used in conjunction with medication.

Managing Complications

If you have problems with digestion as a result of your neuropathy, your doctor may suggest that you eat smaller meals more often and limit the amount of fiber you eat. If you’re a female experiencing vaginal dryness, your doctor may give you lubricants. If you’re a male with erectile dysfunction, medication may be prescribed to address that.

Diabetes is the leading cause of amputation in the United States.  People with peripheral neuropathy need to take special care of their feet. Make sure to check your feet often for any cuts or blisters, because you may not feel them forming. Keep your feet clean and dry, and make sure that your toenails are trimmed and filed properly. Talk to your healthcare team about proper foot care. If you have signs and symptoms of diabetic neuropathy, be sure to have your healthcare provider check your feet at every visit.

How Is Diabetic Neuropathy Prevented?

Diabetic neuropathy is preventable if you manage your blood sugar levels properly. Be consistent in monitoring your blood glucose levels, taking you oral medications, and using your insulin (if it has been prescribed). Keeping your diabetes in check is the best way to prevent diabetic neuropathy.

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