People who are overweight or obese or have a family history of diabetes are more susceptible to type 2 diabetes. Type I diabetes is a lifelong condition that occurs because the body does not produce enough insulin.
Neuropathy can affect virtually any nerve in the body and can take on several types, depending on whether the peripheral nerves are involved in a diffuse or localized fashion or if damage occurs to the nerves supplying the internal organs, such as heart, bladder, and gut.
Around 50 percent of people with diabetes develop clinically obvious diabetic neuropathy, but symptoms may take 10 to 20 years to become clear. The highest rates of neuropathy occur in people who have had a diagnosis of diabetes for 25 years or more and in people with poorly controlled diabetes.
In this article, we explore the different types, effects, and risks of diabetic neuropathy.
Uncontrolled diabetes can lead to nerve damage.
Four main types of neuropathy can impact on the nervous system, including:
- Peripheral symmetric neuropathy: This affects the feet and hands and is the most common form of diabetic neuropathy. Assymetric involvement of multiple peripheral nerves can also occur
- 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 anatomic distribution, 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 and depend on the type of neuropathy and nerves involved
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
- 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
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 in 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
Proximal neuropathy can lead to pain in the lower body, often on one side, and weakness in the legs. Symptoms of focal neuropathy, on the other hand, vary a great deal depending on the nerve affected.
People with diabetic neuropathy often do not realize they have it until the symptoms are more advanced.
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, or a nerve conduction velocity test (NCV) that records the speed at which induced signals pass through the nerves.
Diabetic neuropathy gets worse over time.
Well controlled glucose levels minimize the risk of diabetic neuropathy. A key part of treatment focuses on reducing pain and controlling some of the symptoms.
Certain medications and types of physical therapy can help to control the pain of diabetic neuropathy, alongside other treatments.
Drug classes that can help control pain include anticonvulsant drugs, tricyclic antidepressants, opioids and nonopioid painkillers.
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.
Physical therapy, used in combination with medications, might help with pain relief and reduce the risk of dependency on opioids.
It can help alleviate pain, burning, and tingling sensations in the legs and feet. It may also help people with muscle cramps, muscle weakness, and sexual dysfunction.
Electrical nerve stimulation is a painless type of physical therapy that might assist in relieving feelings of stiffness, as well as enhancing 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 due to diabetic neuropathy.
A good physical therapist will ensure that exercises for people with diabetic neuropathy do not hurt the feet, which are sometimes 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.
Keeping blood sugar under control helps to prevent diabetic neuropathy.
Diabetic neuropathy can contribute to a number of high-risk complications.
Possible complications include losing sensation in the feet. This can lead to not feeling 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 necessary. 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 tests and scans, such as EMGs, as well as assessing 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.
I have type 2 diabetes. How do I prevent diabetic neuropathy?
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.