Definition
Diabetic neuropathy is a type of nerve damage associated with diabetes. It can result in damage to any nerve in the body. The types of neuropathy include:
- Peripheral neuropathy (most common)—causes pain or loss of feeling in the toes, feet, legs, hands, and arms
-
Autonomic neuropathy causes changes in nerves controlling body function, including:
- Digestion, bowel and bladder function
- Sexual response
- Sweating
- Heart and blood pressure control
- Breathing
- Vision
- Proximal neuropathy—causes pain in the thighs, hips, or buttocks and weakness in the legs
- Focal neuropathy—only affects one nerve or a group of nerves
Causes
Diabetic neuropathy is likely caused by a combination of factors, including:
- Metabolic factors such as elevated blood pressure, high blood glucose, longer duration of diabetes, high cholesterol, and possibly low levels of insulin
- Damage to blood vessels going to nerves
- Autoimmune factors causing inflammation of nerves
- Nerve trauma
- Genetics
- Smoking or alcohol abuse
Risk Factors
This condition is more common in older adults.
Factors that may increase your risk of diabetic neuropathy include:
Symptoms
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
- Blurred or double vision
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
foot ulcers, infection, and limb loss.
Diagnosis
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, especially if you have muscle weakness. 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
Treatment may include:
Blood Glucose Management
It is important to regularly monitor blood glucose levels. Meal planning, exercise, and/or medications can help.
Foot Care
Footcare will be needed to avoid
ulcers. 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 the feet. In addition, always wear well-fitting shoes and thick, soft, seamless socks to help protect your feet from injuries.
Surgery
Nerve decompression surgery may be done to reduce pain.
Other Treatments
Other treatments will depend on symptoms.
-
Medications can be used to relieve pain, burning, tingling, or numbness from
peripheral neuropathy.
-
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.
- Other options include relaxation training, biofeedback, yoga, massage, acupuncture
- Medications and treatment may also be needed to control symptoms from autonomic neuropathy, such as gastrointestinal, heart, or urinary problems
Prevention
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.
