Condition Basics

What is diabetic neuropathy?

Diabetic neuropathy is nerve damage caused by diabetes. People who have diabetes often have high blood sugar levels. Over time, this can damage nerves throughout your body.

There are several types of diabetic neuropathy.

Peripheral neuropathy.

This is damage to peripheral nerves. These nerves sense pain, touch, hot, and cold. They also affect movement and muscle strength. The nerves in the feet and lower legs are most often affected. This type of nerve damage can lead to serious foot problems. The damage usually gets worse slowly, over months or years.

Autonomic neuropathy.

This is damage to autonomic nerves. These nerves control things like your heartbeat, blood pressure, sweating, digestion, urination, and sexual function.

Atypical neuropathies.

These are types of nerve damage to one or more nerves in the body. One type affects just one nerve. This is called mononeuropathy. It often affects a nerve in the wrist or foot. It can also affect a nerve that controls the eye muscles. Another type affects many nerves. This is called polyradiculoneuropathy. It often affects nerves in the back and chest. These types of nerve damage happen all of a sudden. And they can get better with time.

What causes it?

Over time, high blood sugar levels from diabetes can damage nerves throughout your body. The higher your blood sugar levels, the more likely you are to have nerve damage. Also, the older you get and the longer you have diabetes, the more likely you are to have nerve damage.

What are the symptoms?

Symptoms depend on which nerves are injured. You may not be able to feel pain, especially in your feet. This can lead to serious infections if sores and other problems aren't treated. Other symptoms may include problems with digestion or urination, and blood vessel problems that can lead to poor circulation or low blood pressure.

How is it diagnosed?

Your doctor will check how well you can feel light touch and temperature and will test your strength and reflexes. Tests such as an electromyogram and nerve conduction studies may be done to confirm the diagnosis. Your doctor will want to know about any symptoms such as pain, weakness, or urinary or digestive problems.

How is diabetic neuropathy treated?

Treatment involves keeping blood sugar levels in your target range. This will not cure nerve damage. But it can help keep the damage from getting worse, and the pain might get better.

Other treatments depend on your symptoms. They may include:

• Medicines to treat pain, digestive problems, or blood vessel problems.
• Medicines or the use of compression stockings to treat blood pressure problems.
• Treatments for sexual problems. Medicines or devices may help improve erections. Or lubricating creams may help vaginal dryness.
• A splint or brace to help treat a nerve problem.

When you have diabetes, you could have a sore or other foot problem without noticing it. So check your feet every day. An untreated problem on your foot can lead to a serious infection or even amputation.

Work together with your doctor to find the treatment that helps you the most.

Can it be prevented?

Keeping your blood sugar levels in your target range recommended by your doctor may help prevent diabetic neuropathy. The best way to do this is by checking your blood sugar and adjusting your treatment. It's also important to get to and stay at a healthy weight by exercising and eating healthy foods.

Cause

Over time, high blood sugar levels from diabetes can damage nerves throughout your body. The higher your blood sugar levels, the more likely you are to have nerve damage.

Also, the older you get and the longer you have diabetes, the more likely you are to have nerve damage. People with diabetes who drink too much alcohol are also more likely to have nerve damage.

Symptoms

Peripheral neuropathy

Symptoms of peripheral neuropathy can occur slowly over time. The most common ones are:

• Numbness, tightness, and tingling, especially in the legs, hands, and feet.
• Loss of feeling.
• Burning, shooting, or stabbing pain in the legs, hands, and feet. Often the pain is worse at night.
• Weakness and loss of balance.

Autonomic neuropathy

Autonomic neuropathy may affect certain processes in the body. This includes digestion, urination, sexual function, your body's ability to regulate temperature, and heart and blood vessel function, including blood pressure. Symptoms may include:

• Frequent bloating, belching, constipation, heartburn, nausea and vomiting, and belly pain. These symptoms may be a sign of gastroparesis. This causes the stomach to empty much slower than normal.
• Extreme sweating of the torso, face, or neck at night or while eating certain foods, such as spicy foods and cheese. Some people may have reduced sweating, especially in their feet and legs.
• Trouble sensing when your bladder is full or problems emptying your bladder completely.
• Sexual problems. For example, men may have erection problems. Women may have vaginal dryness.
• Dizziness, weakness, or fainting when you stand or sit up from a reclining position.
• Trouble knowing when your blood sugar is low.

Atypical neuropathies

The type of symptoms you have depends on the kind of atypical neuropathy you have.

Mononeuropathy can cause:

• Pain in a single, limited area of the body. This may be in the wrist or foot.
• Pain in and around one of the eyes, trouble moving the eyes, and double vision. This occurs when one of the cranial nerves is affected.

Polyradiculoneuropathy can cause:

• Pain that occurs in a band-shaped area around the chest or belly.
• Weakness and pain in the lower back. It often goes down to the thigh (femoral neuropathy).

These symptoms may be caused by other serious conditions. See your doctor right away if you have any of these symptoms.

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Examinations and Tests

During a physical examination, your doctor may check how well you can feel light touch, temperature, pain, vibration, and movement. Your doctor may also check your strength and reflexes. Tests such as an electromyogram and nerve conduction studies may be done to confirm the diagnosis. You may need other tests to see which type of neuropathy you have and to help guide your treatment.

Doctors can't test for all types of nerve damage. So it's important to tell your doctor about any pain or weakness you feel. Also mention heavy sweating or dizziness and any changes in digestion, urination, and sexual function.

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Treatment Overview

Treatment for diabetic neuropathy involves keeping blood sugar levels in your target range. This will not cure nerve damage. But it can help keep the damage from getting worse. And it may help relieve pain.

It helps to have healthy habits, such as seeing your doctor regularly, controlling your blood pressure, eating a balanced diet, exercising regularly, not smoking, and limiting or avoiding alcohol.

Other treatments depend on your symptoms. They may include:

• Medicines to treat pain, digestive problems, or blood vessel problems.
• Medicines or the use of compression stockings to treat blood pressure problems.
• Treatments for sexual problems. Medicines or devices may help improve erections. Or lubricating creams may help vaginal dryness.
• A splint or brace to help treat a nerve problem.

When you have diabetes, you could have a sore or other foot problem without noticing it. So check your feet every day. An untreated problem on your foot can lead to a serious infection or even amputation.

Work together with your doctor to find the treatment that helps you the most.

Treatment if the condition gets worse

If diabetic neuropathy gets worse, you may have serious problems such as severe gastroparesis, bladder infections, or foot problems. Along with keeping your blood sugars in your target range and taking good care of your feet, you may need more treatment.

Diabetic neuropathy is a major risk factor for foot infections or foot ulcers. This may lead to amputation. It is possible to have permanent damage in one or both of your feet (such as Charcot foot) from diabetic neuropathy. Surgery is sometimes needed to repair deformed joints that can result from Charcot foot.

Severe bladder infections or other bladder problems may require more testing and treatment.

Also, it is common to have symptoms of depression with any long-term (chronic) disease. Getting help for depression may improve your overall well-being and help you treat your condition.

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Self-Care

• Take your medicines exactly as prescribed. Call your doctor or nurse advice line if you think you are having a problem with your medicine.
• Try to keep blood sugar in your target range.
  • Follow your meal plan to know how much carbohydrate you need for meals and snacks. A registered dietitian or certified diabetes educator can help you plan meals.
  • Try to get at least 30 minutes of exercise on most days.
  • Check your blood sugar as many times each day as your doctor recommends.
• Take and record your blood pressure at home if your doctor tells you to. To take your blood pressure at home:
  • Ask your doctor to check your blood pressure monitor to be sure it is accurate and the cuff fits you. Also ask your doctor to watch you to make sure that you are using it right.
  • Do not use medicine known to raise blood pressure (such as some nasal decongestant sprays) before taking your blood pressure.
  • Avoid taking your blood pressure if you have just exercised or are nervous or upset. Rest at least 15 minutes before you take a reading.
• Do not smoke. Smoking can increase your chance for a heart attack or stroke. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
• If you drink alcohol, try to drink less. Your risk of harm from alcohol is low if you have 2 drinks or less per week. Work with your doctor to find what is right for you.
• Eat small meals often, rather than 2 or 3 large meals a day.

To care for your feet

• Prevent injury by wearing shoes at all times, even when you are indoors.
• Do foot care as part of your daily routine. Wash your feet and then rub lotion on your feet, but not between your toes. Use a hand-held mirror or magnifying mirror to inspect your feet for blisters, cuts, cracks, or sores.
• Have your toenails trimmed and filed straight across.
• Wear shoes and socks that fit well. Soft shoes that have good support and that fit well (such as tennis shoes) are best for your feet.
• Check your shoes for any loose objects or rough edges before you put them on.
• Ask your doctor to check your feet during each visit. Your doctor may notice a foot problem you have missed.
• Get early treatment for any foot problem, even a minor one.

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