Diabetic neuropathy is nerve damage caused by diabetes. Nerves are special bundles of tissue that carry signals between your brain and other parts of your body. You can find more information below.

What is diabetic neuropathy?

Diabetic neuropathy is a type of nerve damage that can occur in the case of diabetes (diabetes) . In this case, high blood sugar (glucose) can injure nerves in your body. Diabetic neuropathy often damages the nerves in your legs and feet.

Depending on the nerves affected, diabetic neuropathy symptoms can range from pain and numbness in your legs and feet to problems with your digestive tract, urinary tract, blood vessels, and heart. Some people have mild symptoms. But for others, diabetic neuropathy can be quite painful and disabling.

Diabetic neuropathy is a common and serious complication of diabetes. But with frequent blood sugar control and a healthy lifestyle, you can prevent or slow the progression of diabetic neuropathy.

What causes diabetic neuropathy?

The exact cause is likely different for each type of neuropathy. Researchers think that over time, uncontrolled high blood sugar damages nerves and interferes with their ability to send signals, leading to diabetic neuropathy. High blood sugar also weakens the walls of the small blood vessels (capillaries) that supply oxygen and nutrients to the nerves.

However, a number of factors can lead to nerve damage, including:

  • Inflammation can occur in the nerves caused by the autoimmune response. In this case, the immune system perceives the nerves as foreign and attacks them.
  • Genetic factors unrelated to diabetes can make some people more likely to develop nerve damage.
  • Smoking and alcohol abuse damage both nerves and blood vessels and significantly increase the risk of infection.

Who is at risk?

Anyone with diabetes can develop neuropathy, but the following risk factors increase your chances of getting nerve damage:

  • Poor blood sugar control: Uncontrolled blood sugar puts you at risk for diabetes complications, including nerve damage.
  • History of diabetes: Your risk of diabetic neuropathy increases the longer you have diabetes, especially if your blood sugar is not well controlled.
  • Kidney disease: Diabetes can damage the kidneys. Kidney damage can cause this condition by sending toxins into the blood, which can cause nerve damage.
  • Being overweight: Having a body mass index (BMI) greater than 24 can increase your risk of diabetic neuropathy.
  • Smoking: Smoking narrows and hardens your arteries, reducing blood flow to your legs and feet. This makes it difficult for wounds to heal and damages peripheral nerves.

What are the types and symptoms of diabetic neuropathy?

There are four main types of diabetic neuropathy. You may have one or more types of neuropathy. Your symptoms will depend on the type you have and which nerves are affected. Usually, symptoms develop gradually. You may not notice anything until significant nerve damage has occurred.

peripheral neuropathy

Peripheral neuropathy is the most common type of diabetic neuropathy. It first affects the feet and legs, then the hands and arms. Signs and symptoms of peripheral neuropathy are usually worse at night and may include:

  • decreased ability to feel numbness, pain, or temperature changes
  • tingling or burning sensation
  • Sharp pains or cramps
  • increased sensitivity to touch
  • muscle weakness
  • Loss of reflexes, especially in the ankle
  • Loss of balance and coordination
  • Serious foot problems such as ulcers, infections, bone and joint pain

Autonomic neuropathy

The autonomic nervous system governs your heart, bladder, stomach, intestines, genitals, and eyes. Diabetes can affect the nerves in any of these areas and possibly cause:

  • The state of not being aware of low blood sugar levels (hypoglycemia)
  • Bladder problems, including urinary tract infections, urinary retention or incontinence
  • Constipation , uncontrolled diarrhea, or both
  • Slow gastric emptying (gastroparesis) causing nausea, vomiting, bloating, and loss of appetite
  • difficulty swallowing
  • Increased or decreased sweating
  • Problems controlling body temperature
  • Difficulty in transitioning from light to dark
  • Increased heart rate at rest
  • Sharp drops in blood pressure that can make you faint or dizzy after sitting or standing
  • Erectile dysfunction (impotence)
  • vaginal dryness
  • decreased sexual response
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Radiculoplexus neuropathy (diabetic amyotrophy)

Radiculoplexus neuropathy affects the nerves in the thighs, buttocks, or legs. It is more common in people with type 2 diabetes and older adults. Other names for this type are diabetic amyotrophy, femoral neuropathy, or proximal neuropathy.

Symptoms are usually on one side of the body, but can sometimes spread to the other side. In this case, you can have:

  • Severe pain in the hip and thigh that lasts for a day or more
  • Weak and contracted thigh muscles at the end
  • Difficulty getting up from a sitting position
  • Abdominal swelling if the abdomen is affected
  • weight loss

Most people improve at least partially over time, but symptoms may get worse before they get better.

Mononuropathy

Mononeuropathy, or focal neuropathy, damages a specific nerve in the face, middle of the body (trunk), or leg. It is most common in older adults. Mononeuropathy often strikes suddenly and can cause severe pain. However, it usually does not cause long-term problems.

Symptoms often go untreated for several weeks or months. Your specific signs and symptoms depend on which nerve is involved. You may have pain in the following areas:

  • leg or foot
  • lower back or pelvis
  • Thigh
  • chest or abdomen

Mononeuropathy can also cause nerve problems in the eyes and face, leading to:

  • difficulty focusing
  • double vision
  • pain behind the eyes
  • paralysis on one side of your face

Sometimes, mononeuropathy occurs when the nerve is compressed. Carpal tunnel syndrome is a common compression neuropathy in people with diabetes. It may cause numbness or tingling in your hand or fingers, with the exception of the little finger. Your hand may feel weak and you may drop something.

When should you see a doctor?

If you have the following conditions, it would be beneficial to see a doctor without wasting time:

  • you have a cut or sore on your foot that is infected or does not heal
  • You have burning, tingling, weakness or pain in your hands or feet that interferes with daily activities or sleep
  • If there are changes in digestion, urination or sexual function
  • If you experience dizziness

These signs and symptoms don’t always mean you have nerve damage. But they can be a sign of another condition that requires medical care. Early diagnosis and treatment of any health condition gives you the best chance of controlling your diabetes and preventing future problems.

How is diabetic neuropathy diagnosed?

A doctor can usually diagnose diabetic neuropathy by performing a physical exam and carefully reviewing your symptoms and medical history.

Your doctor will check the following:

  • General muscle strength and tone
  • Tendon reflexes
  • Sensitivity to touch and vibration

Also, at each visit, your doctor should check your feet for sores, cracked skin, blisters, and bone and joint problems. The American Diabetes Association recommends that all people with diabetes have a comprehensive foot exam at least once a year.

Along with the physical exam, your doctor may order or order certain tests to help diagnose diabetic neuropathy:

  • Filament test: Your doctor may or may order you to have this test to test your sensitivity to touch.
  • Quantitative sensory testing: This noninvasive test is used to determine how your nerves respond to vibration and temperature changes.
  • Nerve conduction studies: This test measures how quickly the nerves in your arms and legs transmit electrical signals. It is often used to diagnose carpal tunnel syndrome.
  • Electromyography (EMG): Usually done in conjunction with nerve conduction studies, EMG measures the electrical discharges produced in your muscles.
  • Autonomic testing: If you have symptoms of autonomic neuropathy, special tests may be done to determine how your blood pressure changes when you’re in different positions and whether you’re sweating normally.
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How is diabetic neuropathy treated?

There is no definitive cure for diabetic neuropathy and possible treatment goals are:

  • Slow progression of the disease
  • relieve pain
  • Managing complications and restoring lost function

Treatment for slow progression of the disease

Keeping your blood sugar within target range is key to preventing or delaying nerve damage. Doing so may even improve some of your current symptoms. Your doctor will determine the best target range for you based on several factors, including your age, how long you have had diabetes, and your general health.

For many people with diabetes, the American Diabetes Association generally recommends the following target blood sugar levels:

  • Between 80 and 130 mg/dL before meals
  • Less than 180 mg/dL two hours after meals

For many people with diabetes, doctors usually recommend the following target blood sugar levels before meals:

  • 80 to 120 mg/dL for people 59 years of age and younger and no other health problems
  • Between 100 and 140 mg/dL for people aged 60 and over or those with other medical conditions, including heart, lung, and kidney disease

Remember, your doctor may need to adjust these target ranges to meet your personal health needs.

Other important ways to help slow or prevent disease progression include keeping your blood pressure under control and maintaining a healthy weight and lifestyle.

Treatment to relieve pain

Many prescription medications are available for diabetes-related nerve pain, but they don’t work for everyone. Side effects are always possible. When considering any medication, you can talk to your doctor about the benefits and drawbacks to determine what might be best for you.

Pain-relieving prescription treatments may include :

  • Anti-seizure medications: Some medications used to treat seizure disorders (such as epilepsy) are also used to relieve nerve pain. Side effects may include drowsiness, dizziness, and swelling.
  • Antidepressants: Some antidepressants disrupt chemical processes in the brain that make you feel pain. A person does not have to be depressed to use these drugs to relieve nerve pain.

Sometimes an antidepressant can be combined with an anti-seizure medication or pain reliever.

Managing complications and restoring function

Your diabetes healthcare team will likely include different specialists, such as a doctor who treats urinary tract problems (urologist) and a heart doctor (cardiologist) who can help prevent or treat complications.

Treatment depends on your neuropathy-related complication, such as:

  • Urinary tract problems: Some medications can interfere with bladder function. Your doctor may suggest stopping or changing medications. It is recommended to urinate (timed urination) every few hours while applying gentle pressure to the bladder area (below your belly button). Other methods, including self-catheterization, may be needed to remove urine from a nerve-damaged bladder.
  • Digestive problems: To relieve mild symptoms of gastroparesis (such as indigestion, belching, nausea or vomiting), doctors recommend eating smaller, more frequent meals, reducing fiber and fat in the diet, and eating soups and pureed foods for many people. Dietary changes and medications can relieve diarrhea, constipation, and nausea.
  • Low blood pressure while standing (orthostatic hypotension): Treatment begins with simple lifestyle changes such as avoiding alcohol and drinking plenty of water. Sleeping with the head of the bed elevated 6 to 10 inches helps prevent fluctuations in blood pressure. Your doctor may also recommend compression stockings and the like. Various medications can be used alone or in combination to treat orthostatic hypotension.
  • Sexual dysfunction: Oral or injectable medications may improve sexual function in some men, but they are not safe and effective for everyone. Mechanical vacuum devices can increase blood flow to the penis. Women may find relief with vaginal oils.

Can diabetic neuropathy be prevented?

By keeping your blood sugar under tight control and taking good care of your feet, you can prevent or delay diabetic neuropathy and its complications.

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blood sugar control

Use a home blood glucose monitor to check your blood sugar and make sure it’s consistently within the target range. It is important to plan this on time. Changes in blood sugar levels can accelerate nerve damage.

The American Diabetes Association recommends that people with diabetes have an A1C test at least twice a year. This blood test shows your average blood sugar level over the past two to three months. You may need more frequent testing if your blood sugar is not well controlled or if you change medications.

foot care

Follow your doctor’s recommendations for good foot care. Foot problems, including non-healing wounds, ulcers, and even amputation are a common complication of diabetic neuropathy. But you can avoid many of these problems by having a comprehensive foot exam at least once a year and asking your doctor to check your feet at each visit.

To protect the health of your feet:

  • Check your feet daily: Check for blisters, cuts, bruises, cracked and peeling skin, redness and swelling. Use a mirror or ask a friend or family member to help examine the hard-to-see parts of your feet.
  • Keep your feet clean and dry: Wash your feet daily with warm water and mild soap. Avoid leaving your feet wet. Dry carefully with a soft towel.
  • Trim your toenails carefully: Trim your toenails straight and file the edges to avoid sharp edges.
  • Wear clean, dry socks: Wear socks made of cotton or moisture-wicking fibers that are not tight or have thick seams.
  • Wear well-fitting padded shoes: Always wear shoes or slippers to protect your feet from injury. Make sure your shoes fit properly and allow your toes to move.

Diabetic neuropathy complications

Diabetic neuropathy can cause a number of serious complications, including:

  • Loss of toes, feet, or legs: Nerve damage can cause you to lose sensation in your feet. Foot sores and cuts can silently become severely infected or turn into ulcers. Even minor foot sores that don’t heal can turn into ulcers. In severe cases, the infection can spread to the bone and ulcers can lead to tissue death (gangrene). It may be necessary to have a toe, foot, or even lower leg removed (amputation).
  • Joint damage: Nerve damage can cause the joint to deteriorate. This usually occurs in the small joints of the feet. Symptoms include loss of sensation and joint swelling, instability, and sometimes joint deformity.
  • Urinary tract infections and incontinence: If the nerves that control your bladder are damaged, you may not be able to empty your bladder completely. Bacteria can accumulate in the bladder and kidneys, causing urinary tract infections. Nerve damage can also cause leakage (incontinence) by not being able to control your ability to feel when you need to urinate or the muscles that release urine.
  • Hypoglycemia awareness: Low blood sugar (below 70 milligrams per deciliter or mg/dL) normally causes tremors, sweating, and a rapid heartbeat. But if you have autonomic neuropathy, you may not notice these warning signs.
  • Sharp drops in blood pressure: Damage to the nerves that control blood flow can affect your body’s ability to regulate blood pressure. This can cause a sharp drop in pressure when you stop after sitting, which can cause dizziness and fainting.
  • Digestive problems: If nerve damage affects your digestive system, you can have constipation, diarrhea, or both. Nerve damage associated with diabetes can lead to gastroparesis, a condition in which the stomach empties very slowly or not at all. This can interfere with digestion and severely affect blood sugar levels and nutrition. Signs and symptoms include nausea, vomiting, and bloating.
  • Sexual dysfunction: Autonomic neuropathy usually damages the nerves that affect the genitals. Men can experience erectile dysfunction. Women may have difficulty getting wet and aroused.
  • Increased or decreased sweating: Nerve damage can impair the work of sweat glands and make it harder for your body to control its temperature properly. Some people with autonomic neuropathy sweat profusely, especially at night or while eating. Very little or no sweating can be life-threatening.

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