Diabetic Neuropathy

What is Diabetic Neuropathy

Diabetic neuropathy refers to nerve damage that is caused by diabetes (diabetes mellitus). Over time, people with diabetes can develop nerve damage throughout the body. There are several types of diabetic neuropathy:

• Peripheral neuropathy. This is the most common type of diabetic neuropathy. It causes damage to nerves that carry signals between the spinal cord and other parts of the body (peripheral nerves). This usually affects nerves in the feet and legs first, and may eventually affect the hands and arms. The damage affects the ability to sense touch or temperature.
• Autonomic neuropathy. This type causes damage to nerves that control involuntary functions (autonomic nerves). These nerves carry signals that control:
  • Heartbeat.
  • Body temperature.
  • Blood pressure.
  • Urination.
  • Digestion.
  • Sweating.
  • Sexual function.
  • Response to changing blood sugar (glucose) levels.
• Focal neuropathy. This type of nerve damage affects one area of the body, such as an arm, a leg, or the face. The injury may involve one nerve or a small group of nerves. Focal neuropathy can be painful and unpredictable, and occurs most often in older adults with diabetes. This often develops suddenly, but usually improves over time and does not cause long-term problems.
• Proximal neuropathy. This type of nerve damage affects the nerves of the thighs, hips, buttocks, or legs. It causes severe pain, weakness, and muscle death (atrophy), usually in the thigh muscles. It is more common among older men and people who have type 2 diabetes. The length of recovery time may vary.

What are the causes?

Peripheral, autonomic, and focal neuropathies are caused by diabetes that is not well controlled with treatment. The cause of proximal neuropathy is not known, but it may be caused by inflammation related to uncontrolled blood glucose levels.

What are the signs or symptoms?

Peripheral neuropathy

Peripheral neuropathy develops slowly over time. When the nerves of the feet and legs no longer work, you may experience:

• Burning, stabbing, or aching pain in the legs or feet.
• Pain or cramping in the legs or feet.
• Loss of feeling (numbness) and inability to feel pressure or pain in the feet. This can lead to:
  • Thick calluses or sores on areas of constant pressure.
  • Ulcers.
  • Reduced ability to feel temperature changes.
• Foot deformities.
• Muscle weakness.
• Loss of balance or coordination.

Autonomic neuropathy

The symptoms of autonomic neuropathy vary depending on which nerves are affected. Symptoms may include:

• Problems with digestion, such as:
  • Nausea or vomiting.
  • Poor appetite.
  • Bloating.
  • Diarrhea or constipation.
  • Trouble swallowing.
  • Losing weight without trying to.
• Problems with the heart, blood and lungs, such as:
  • Dizziness, especially when standing up.
  • Fainting.
  • Shortness of breath.
  • Irregular heartbeat.
• Bladder problems, such as:
  • Trouble starting or stopping urination.
  • Leaking urine.
  • Trouble emptying the bladder.
  • Urinary tract infections (UTIs).
• Problems with other body functions, such as:
  • Sweat. You may sweat too much or too little.
  • Temperature. You might get hot easily. Or, you might feel cold more than usual.
  • Sexual function. Men may not be able to get or maintain an erection. Women may have vaginal dryness and difficulty with arousal.

Focal neuropathy

Symptoms affect only one area of the body. Common symptoms include:

• Numbness.
• Tingling.
• Burning pain.
• Prickling feeling.
• Very sensitive skin.
• Weakness.
• Inability to move (paralysis).
• Muscle twitching.
• Muscles getting smaller (wasting).
• Poor coordination.
• Double or blurred vision.

Proximal neuropathy

• Sudden, severe pain in the hip, thigh, or buttocks. Pain may spread from the back into the legs (sciatica).
• Pain and numbness in the arms and legs.
• Tingling.
• Loss of bladder control or bowel control.
• Weakness and wasting of thigh muscles.
• Difficulty getting up from a seated position.
• Abdominal swelling.
• Unexplained weight loss.

How is this diagnosed?

Diagnosis usually involves reviewing your medical history and any symptoms you have. Diagnosis varies depending on the type of neuropathy your health care provider suspects.

Peripheral neuropathy

Your health care provider will check areas that are affected by your nervous system (neurologic exam), such as your reflexes, how you move, and what you can feel. You may have other tests, such as:

• Blood tests.
• Removal and examination of fluid that surrounds the spinal cord (lumbar puncture).
• CT scan.
• MRI.
• A test to check the nerves that control muscles (electromyogram, EMG).
• Tests of how quickly messages pass through your nerves (nerve conduction velocity tests).
• Removal of a small piece of nerve to be examined under a microscope (biopsy).

Autonomic neuropathy

You may have tests, such as:

• Tests to measure your blood pressure and heart rate. This may include monitoring you while you are safely secured to an exam table that moves you from a lying position to an upright position (table tilt test).
• Breathing tests to check your lungs.
• Tests to check how food moves through the digestive system (gastric emptying tests).
• Blood, sweat, or urine tests.
• Ultrasound of your bladder.
• Spinal fluid tests.

Focal neuropathy

This condition may be diagnosed with:

• A neurologic exam.
• CT scan.
• MRI.
• EMG.
• Nerve conduction velocity tests.

Proximal neuropathy

There is no test to diagnose this type of neuropathy. You may have tests to rule out other possible causes of this type of neuropathy. Tests may include:

• X-rays of your spine and lumbar region.
• Lumbar puncture.
• MRI.

How is this treated?

The goal of treatment is to keep nerve damage from getting worse. The most important part of treatment is keeping your blood glucose level and your A1C level within your target range by following your diabetes management plan. Over time, maintaining lower blood glucose levels helps lessen symptoms. In some cases, you may need prescription pain medicine.

Follow these instructions at home:

Lifestyle

• Do notuse any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Be physically active every day. Include strength training and balance exercises.
• Follow a healthy meal plan.

Work with your health care provider to manage your blood pressure.

General instructions

• Follow your diabetes management plan as directed.
  • Check your blood glucose levels as directed by your health care provider.
  • Keep your blood glucose in your target range as directed by your health care provider.
  • Have your A1C level checked at least two times a year, or as often as told by your health care provider.
• Take over the counter and prescription medicines only as told by your health care provider. This includes insulin and diabetes medicine.
• Do notdrive or use heavy machinery while taking prescription pain medicines.
• Check your skin and feet every day for cuts, bruises, redness, blisters, or sores.
• Keep all follow up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have burning, stabbing, or aching pain in your legs or feet.
• You are unable to feel pressure or pain in your feet.
• You develop problems with digestion, such as:
  • Nausea.
  • Vomiting.
  • Bloating.
  • Constipation.
  • Diarrhea.
  • Abdominal pain.
• You have difficulty with urination, such as inability:
  • To control when you urinate (incontinence).
  • To completely empty the bladder (retention).
• You have palpitations.
• You feel dizzy, weak, or faint when you stand up.

Get help right away if:

• You cannot urinate.
• You have sudden weakness or loss of coordination.
• You have trouble speaking.
• You have pain or pressure in your chest.
• You have an irregular heart beat.
• You have sudden inability to move a part of your body.

Summary

• Diabetic neuropathy refers to nerve damage that is caused by diabetes. It can affect nerves throughout the entire body, causing numbness and pain in the arms, legs, digestive tract, heart, and other body systems.
• Keep your blood glucose level and your blood pressure in your target range, as directed by your health care provider. This can help prevent neuropathy from getting worse.
• Check your skin and feet every day for cuts, bruises, redness, blisters, or sores.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.