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Diabetic neuropathy is a complication of diabetes that results in damage to the nervous system. It is a progressive disease, and symptoms get worse over time.

Neuropathy happens when high levels of fats or sugar in the blood damage the nerves in the body. It can affect virtually any nerve in the body, with a wide range of symptoms.

Nerves are essential to how the body works. They enable people to move, send messages about how things feel, and control automatic functions, such as breathing.

There are several types. Some involve the peripheral nerves, while others damage the nerves that supply the internal organs, such as the heart, the bladder, and the gut. In this way, it can affect many body functions.

Between one-third and a half of people with diabetes have neuropathy, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

In this article, we explore the different types, effects, and risks of diabetic neuropathy.

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Peripheral neuropathy can lead to a loss of sensation in the feet.

Four main types of neuropathy can impact on the nervous system, including:

  • Peripheral symmetric neuropathy: This affects the feet and hands. It is the most common form of diabetic neuropathy.
  • Autonomic neuropathy: This occurs in the nerves that control involuntary functions of the body, such as digestion, urination, or heart rate.
  • Thoracic and lumbar root, or proximal, neuropathy: This damages nerves along a specific distribution in the body, such as the chest wall or legs.
  • Mononeuropathies: These can affect any individual nerve.

    The symptoms of neuropathy depend on the type and the nerves involved.

    The signs and symptoms of diabetic neuropathy usually take several years to appear. Signs and symptoms will depend on which type of neuropathy and nerves it affects.

    Peripheral neuropathy

    The symptoms of peripheral neuropathy include:

    • numbness, pain, tingling, and burning sensations starting in the toes and fingers then continuing up the legs or arms
    • loss of muscle tone in the hands and feet
    • not being able to feel heat, cold, or physical injury
    • loss of balance
    • Charcot's joint, in which a joint breaks down because of nerve issues, often in the feet

    Peripheral neuropathy that affects the feet can make it difficult for a person to stand and walk. It can increase the risk of falling.

    When a person cannot feel heat, cold or injury, this can lead to new problems.

    For example, a blister on the foot can become ulcerated because the person did not feel pain in the early stages. As the infection progresses, gangrene can develop.

    Eventually, amputation may be necessary.

    Click here to find out more about peripheral neuropathy.

    Autonomic neuropathy

    The effects of autonomic neuropathy include:

    • heartburn and bloating
    • nausea, constipation or diarrhea
    • hypoglycemic unawareness, in which a person does not feel the effects of low sugar levels
    • difficulties speaking or swallowing
    • feeling full after eating small amounts of food
    • vomiting several hours after eating
    • orthostatic hypotension, or feeling light-headed and dizzy when standing up
    • a faster heart rate than normal
    • excessive sweating, even in cool temperatures or while at rest
    • bladder problems, for example, difficulty emptying the bladder completely when urinating, leading to incontinence
    • sexual dysfunction in men and women
    • dysesthesia, or a distorted sense of touch
    • significant drooping of the face and eyelids
    • muscle contractions and weakness

    Other types

    There are many types of neuropathy.

    Proximal neuropathy can lead to pain in the lower body, often on one side, and weakness in the legs.

    Symptoms of focal neuropathy can vary widely, depending on the nerve affected. Focal neuropathy and cranial neuropathy can both lead to visual disturbances, such as double vision.

    People with diabetic neuropathy often do not realize they have it until the symptoms are more advanced.

    Not all of the symptoms of peripheral neuropathy are visible, but people should be aware of any wounds on their feet.


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    A physician will carry out a foot exam and may check blood pressure.

    A physician will carry out a physical exam and foot exam to check for:

    • ankle reflexes
    • loss of sensation
    • changes in skin texture
    • changes in skin color

    Other tests may include a check of blood pressure and fluctuations in heart rate.

    If the doctor suspects diabetic neuropathy, they may run some diagnostic tests, such as:

    • an electromyogram (EMG), which records electrical activity in the muscles
    • a nerve conduction velocity test (NCV) which records the speed at which induced signals pass through the nerves

    Most types of diabetic neuropathy gets worse over time.

    The first step for people with any type is to bring blood sugars within a target range agreed with a doctor and manage high blood pressure and cholesterol levels.

    Managing glucose levels will minimize the risk of diabetic neuropathy. A key part of treatment focuses on reducing pain and managing some of the symptoms.

    Certain medications and types of physical therapy can help to control the pain of diabetic neuropathy, alongside other treatments. However, they cannot repair the nerves.

    People should also avoid or stop smoking and limit their alcohol intake to a maximum of one drink a day for women and two for men.

    Medications

    Drugs that can help to manage pain include:

    • anticonvulsant drugs
    • tricyclic antidepressants
    • opioids and nonopioid pain relief medication

    Opioid use can lead to dependency, so doctors should prescribe as low a dose as possible.

    A person with diabetic neuropathy might use other types of antidepressants, such as serotonin-norepinephrine inhibitors, to target other painful symptoms of diabetic neuropathy.

    Topical lotions, compound creams, and some supplements, such as ALA or topical capsaicin, may also provide relief.

    Capsaicin cream is available for purchase online.

    Physical therapy

    Physical therapy, used in combination with medications, might help relieve pain and reduce the risk of dependency on opioids.

    It may also help alleviate:

    • burning and tingling sensations in the legs and feet
    • muscle cramps
    • muscle weakness
    • sexual dysfunction

    Electrical nerve stimulation is a painless type of physical therapy that might help to reduce feelings of stiffness and enhance the healing of foot ulcers.

    Gait training involves relearning how to walk. It helps to prevent and stabilize foot complications, such as ulcers and injury. This type of physical re-education is crucial for people using prosthesis after losing limbs if diabetic neuropathy leads to an amputation.

    A good physical therapist will ensure that exercises for people with diabetic neuropathy do not hurt the feet, which can be sensitive.

    Other therapies include devices that a person can use to keep painful or sensitive extremities from touching the bed or chair.

    A chiropractor, massage therapist, or osteopath can carry out regular massages or manual therapy to stretch the muscles. Massage can inhibit muscle contractions, spasms, and atrophy due to poor blood supply.

    Specific exercises, such as swimming or aerobics, can help an individual develop and maintain muscle strength and reduce the loss of muscle mass.

    Therapeutic ultrasound is another type of physical therapy that uses very high-frequency sound waves to stimulate the tissue beneath the skin. This can help some people to regain sensitivity in their feet.

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    Some types of neuropathy can affect a person's vision.

    Diabetic neuropathy can contribute to a number of high-risk complications, ranging from heart rate changes to visual disturbances.

    Possible complications include losing sensation in the feet.

    This can lead to an inability to feel cuts or sores, and infection might occur as a result. Untreated infection in a limb can result in the need for amputation.

    Severe bladder and kidney infections might also occur, causing health problems.

    To prevent the complications of diabetic peripheral neuropathy, good foot care is essential.

    People with the condition should inspect their feet every day for injuries or sores.

    Smoking also increases the risk of foot problems in people with certain types of diabetic neuropathy. A podiatrist can help with foot care, and a healthcare provider can give advice on quitting smoking.

    Diabetic neuropathy is a type of nerve damage that occurs in people who have diabetes.

    There are four types: autonomic, peripheral, proximal, and focal neuropathy.

    Each affects a different set of nerves and has a different range of effects. Autonomic neuropathy harms automatic processes in the body, such as digestion. Peripheral neuropathy damages nerves in the toes, fingers, hands, and feet.

    Diagnosis includes a range of scans, and tests for ankle reflexes, sensation, and skin texture and tone.

    Treatment involves several types of physical therapy and medication to control pain and nerve conduction.

    As people with diabetic neuropathy tend not to feel injuries on the feet, regular inspection of the feet is necessary to avoid undetected infection and the possible loss of limbs.

    Q:

    I have type 2 diabetes. How do I prevent diabetic neuropathy?

    A:

    The best way to minimize diabetic neuropathy is by maintaining good blood sugar control and regular foot care. If you take Metformin for a long time, which is a commonly used medication in the treatment of type 2 diabetes, consider having a Vitamin B12 level checked as well, as Metformin can lower the B12 level which can also cause neuropathy.

    Maria Prelipcean, MD Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.