Diabetic Neuropathy

(Nerve Damage of Diabetes)

Definition

Diabetic neuropathy is a type of nerve damage associated with diabetes. It results in damage to the nerves in a person’s feet, legs, and eyes, and to the nerves that control bodily functions, such as digestion, blood pressure, and heart rate.

Nerves of the Foot

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Causes    TOP

Diabetic neuropathy is likely caused by a combination of factors, including:

  • Metabolic syndrome—A condition marked by elevated blood pressure, cholesterol, blood glucose, and body weight. Excess weight centered around the midsection is of particular concern
  • Damage to blood vessels
  • Autoimmune factors
  • Genetics

Risk Factors    TOP

This condition is more common in older adults.

Factors that may increase your risk of diabetic neuropathy include:

Symptoms    TOP

Symptoms of diabetic neuropathy may include:

  • Numbness, tingling, or pain in the extremities
  • Weakness in the arms and/or legs
  • Indigestion
  • Nausea or vomiting
  • Diarrhea or constipation
  • Lightheadedness
  • Urination problems
  • Erectile dysfunction or vaginal dryness
  • Weakness of facial muscles resulting in a drooping eyelid, drooping mouth, facial droop, difficulty swallowing
  • Muscle cramps
  • A prolonged feeling of fullness after eating, and/or abdominal pain
  • Decreased ability to sweat normally

If you have diabetic neuropathy, you are at increased risk for developing other types of neuropathies, such as carpal tunnel syndrome.

Diabetic neuropathy can lead to serious complications, including ulcers, infection, and limb loss.

Diagnosis    TOP

You will be asked about your symptoms and medical history. A physical exam will be done. A foot exam will also be done.

Your nerve function may be tested. This can be done with:

  • Nerve conduction studies
  • Electromyography
  • Quantitative sensory testing—the use of stimuli to check for neuropathy
  • Quantitative sudomotor axon reflex test—a test to evaluate the nerve supply of sweat glands

Images may be taken of your bodily structures. This can be done with an ultrasound.

Your nerves may need to be tested. This can be done with a biopsy.

Treatment    TOP

Talk with your doctor about the best treatment plan for you. Treatment options include:

Blood Glucose Management

It is important to regularly monitor blood glucose levels. You can bring them within normal range with meal planning, exercise, and/or medications.

Foot Care

If you have diabetic neuropathy, you will need to take special care of your feet. The nerves in the feet are the ones most often affected by neuropathy. This care will involve regular visits to a foot doctor and careful cleaning, inspection, moisturizing, and grooming of your feet. In addition, always wear well-fitting shoes and thick, soft, seamless socks to help protect your feet from injuries.

Surgery    TOP

If you have painful diabetic neuropathy, nerve decompression surgery may be done to reduce pain. Talk to your doctor about whether this option is right for you.

Other Treatments    TOP

Other treatments will depend on your symptoms. Medications can be used to relieve pain, burning, tingling, or numbness. Often, the medications used to treat these symptoms are the same ones used to treat seizures and depression.

Another option to treat pain is called transcutaneous electrical nerve stimulation (TENS). With TENS, a machine sends painless electrical signals through the skin to the nerves. Your doctor may offer this treatment.

Prevention    TOP

The best way to prevent diabetic neuropathy is to regularly monitor and manage your blood glucose levels. Your doctor can instruct you about how often to check your levels and what the numbers mean.

RESOURCES:

American Diabetes Association
http://www.diabetes.org
National Institute of Diabetes and Digestive and Kidney Diseases
https://www.niddk.nih.gov

CANADIAN RESOURCES:

Canadian Diabetes Association
http://www.diabetes.ca

References:

Diabetic neuropathies: the nerve damage of diabetes. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at:
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Updated November 26, 2013. Accessed September 8, 2015.
Diabetic peripheral neuropathy. EBSCO DynaMed Plus website. Available at:
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Updated February 7, 2017. Accessed September 28, 2016.
England JD, Gronseth GS, et al. Practice Parameter: Evaluation of distal symmetric polyneuropathy: role of laboratory and genetic testing (an evidence-based review). Neurology. 2009;72(2):185-192.
Ogawa K, Sasaki H, et al. Peripheral nerve functions may deteriorate parallel to the progression of microangiopathy in diabetic patients. Nutr Metab Cardiovasc Dis. 2006;16(5):313-321.
Types of peripheral neuropathy: pre-diabetic/diabetic University of Chicago Center for Peripheral Neuropathy website. Available at:
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Accessed September 19, 2014.
Vinik AI, Mehrabyan A. Diabetic neuropathies. Med Clin North Am. 2004;88(4):947-999.
2/4/2010 DynaMed Plus Systematic Literature Surveillance
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Dubinsky RM, Miyasaki J. Assessment: efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2010;74(2):173-176.
6/16/2015 DynaMed Plus Systematic Literature Surveillance
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Macaré van Maurik JF, Oomen RT, et al. The effect of lower extremity nerve decompression on health-related quality of life and perception of pain in patients with painful diabetic polyneuropathy: a prospective randomized trial. Diabet Med. 2015;32(6):803-809.
Last reviewed September 2016 by Kim Carmichael, MD
Last Updated: 9/8/2015

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