Diabetes leads to high levels of glucose in the blood. Without careful management, this can cause damage throughout the body. Diabetic neuropathy is nerve damage that results from diabetes.
Diabetic neuropathy can affect different bodily functions. According to the National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK), over 30% of people with diabetes experience problems with the autonomic nervous system, which controls automatic functions such as digestion.
Up to 50% of people with diabetes have peripheral neuropathy. This affects the peripheral nervous system, and symptoms commonly appear in the arms, hands, legs, and feet.
Another type is focal neuropathy, which includes carpal tunnel syndrome. This nerve compression in the wrist affects around 25% of people with diabetes.
Around half of all people with diabetes develop neuropathy within 25 years of their diabetes diagnosis, according to a study published in 2011.
These types of nerve damage are not reversible. However, in this article, we look at ways to slow the progression of diabetic neuropathy, ease symptoms, and reduce the risk of further harm.
Diabetic neuropathy is a family of progressive nerve disorders that can develop when a person has type 1 or type 2 diabetes.
Experts believe that this neuropathy develops when high levels of sugar and fats, such as triglycerides, in the blood damage nerve cells and fibers. When this happens, the nervous system's signaling can no longer work correctly.
High blood glucose levels can also damage the blood vessels, including the small vessels that carry oxygen and nutrients to the nerves. This, too, stops the nerves from fully functioning, according to NIDDK.
Peripheral neuropathy can cause a range of symptoms, including pain, loss of sensation, numbness, tingling, and muscle weakness.
Autonomic neuropathy can lead to problems with digestion, such as gastroparesis, in which the stomach is not able to move food into the small intestine effectively.
Controlling blood sugar levels from the earliest stages of diabetes is one way to prevent diabetic neuropathy. It can reduce the risk of nerve damage by over 50%, according to the Joslin Diabetes Center.
What are healthy blood glucose levels? We investigate.
People are more likely to have both type 2 diabetes and diabetic neuropathy if they:
- have difficulty managing their blood sugar levels
- have a poor diet and a sedentary lifestyle
- are over the age of 45
- have a high body mass index or obesity
- have high cholesterol
- have high blood pressure
- have had a diabetes diagnosis for at least 25 years
A person can often reduce the impact of these factors by making lifestyle changes.
Attending routine screening for type 2 diabetes after the age of 45 — or before, if a person has obesity or other risk factors — can tell a person whether they have high levels of blood sugar.
Glucose levels of 126 milligrams per deciliter (mg/dl) or higher indicate diabetes.
If the levels are slightly high but not yet high enough for a diabetes diagnosis, a person may have prediabetes. This means that glucose levels are 100–125 mg/dl.
It is often possible to reverse prediabetes through lifestyle changes, involving diet and exercise, for example. Making these changes can reduce the risk of complications such as diabetic neuropathy.
The following symptoms could indicate diabetic neuropathy. If a person notices any of these, they should see a doctor:
- pain, stiffness, or soreness
- reduced awareness of low blood sugar
- nausea and vomiting
- impaired sense of hunger, which may lead to overeating
- impaired sexual function
- joint damage, especially in the feet and legs
- bladder control or urinary problems
- sweating too much or too little
- muscle wasting
- low blood pressure
- frequent skin infections that take a long time to heal, especially on the feet
In a person with diabetes, these can signal the onset of diabetic neuropathy. In a person who does not have a diabetes diagnosis, these symptoms could indicate that their blood sugar levels are high and that they have the condition.
In either case, controlling blood sugar levels may help prevent the condition from getting worse.
When a person has diabetes, the doctor will work with them to develop a treatment plan, which may involve medication and lifestyle changes.
Nonmedical ways to reduce the risk of diabetes and its complications include:
Making the right dietary choices
Choosing healthful fats: Nuts, avocados, oily fish, vegetable oils, low-fat dairy products, lean meats, and poultry products contain fats that can benefit the body's cells.
However, high levels of triglycerides, a type of fat, in the bloodstream can increase the risk of nerve damage, according to NIDDK. Manufactured or added fats, especially trans fats, can increase levels of triglycerides and the risk of having high cholesterol and obesity.
Avoiding excess sugars: Highly refined carbohydrates and sugars, including fructose sweeteners, can cause sharp, sudden spikes and dips in blood glucose. Avoiding these highs and lows is key to managing blood sugar and preventing further nerve damage.
Maintaining a healthy weight
There appears to be a link between excess weight and reduced insulin sensitivity, which increases the risk of high blood sugar levels and, in time, nerve damage.
Current guidelines recommend doing at least 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous aerobic exercise every week.
Avoiding or quitting smoking
Diabetes is more common among people who smoke, although researchers are not sure exactly why.
Smoking damages the walls of the arteries, causing fat to build up, narrowing blood vessels, and impeding circulation. Poor circulation contributes to neuropathy.
Getting enough sleep
A review published in 2015 concludes that "Sleep is instrumental to metabolic regulation and disease management." The authors note that a lack of sleep or poor-quality sleep may make controlling glucose levels more difficult for people with type 2 diabetes.
A study published in Nature Reviews Endocrinology in 2017 concluded that stress is a modifiable risk factor for type 2 diabetes, as it can trigger reactions that relate to the condition, including the release of glucose into the bloodstream.
Exercise, meditation, and spending time with family and friends can all help reduce stress. Knowing as much as possible about diabetes and how to manage it can give a person a greater sense of control over their condition. This, too, may help lower stress levels.
Limiting alcohol consumption
Alcohol can cause spikes and dips in blood sugar and it often interacts with medications.
Alcoholic drinks can also be high in calories, contributing to weight gain.
A range of these therapies may help lessen neuropathy pain, improve blood flow, and reduce the chances of muscle wasting.
However, these methods are unlikely to provide long-term solutions.
Another option is transcutaneous electrical nerve stimulation, or TENS. The American Academy of Neurology (AAN) has approved this as a treatment for painful diabetic neuropathy.
Some evidence supports the use of magnetic, laser, reiki, and light therapies to reduce or control nerve pain, but the AAN do not currently recommend them.
Are there any natural treatments for diabetes? Find out here.
Over-the-counter pain relief medication often helps relieve neuropathy, but if it is not effective, a doctor may prescribe other medications.
Pain relief options include:
- topical treatments, including capsaicin creams, isosorbide dinitrate sprays, and lidocaine patches
- antidepressants, such as venlafaxine, amitriptyline, and duloxetine hydrochloride
- anticonvulsants, such as pregabalin and sodium valproate
When pain is severe, a doctor may prescribe opioids, such as morphine sulfate, oxycodone, or dextromethorphan. However, it is best to avoid these if possible, due to the risk of addiction.
Most of the drugs that doctors prescribe for diabetic neuropathy are designed to target neuropathic pain. Some can have unpleasant side effects and carry a risk of dependency. They will not reverse the condition.
Here, learn more about diabetic neuropathy.
Although it is not possible to reverse diabetic neuropathy, people can take steps to reduce the risk of severe symptoms and further complications.
Ways of doing this depend on the type of neuropathy.
This is the most common form of diabetic neuropathy. Common symptoms include pain, numbness, and tingling in the arms, hands, legs, and feet.
The loss of sensation can make wounds easy to miss. People with diabetes should check their feet every day for injuries, infections, or skin changes and keep their feet as clean as possible. They should also keep their toenails trim to avoid irritating or cutting the skin on the feet.
To prevent complications, avoid exposing the feet to damage, irritants, or germs. A person may want to stop walking barefoot or sharing hygiene tools, for example. Anyone who experiences unusual, persistent, or worrying symptoms should visit a doctor.
Without treatment, there is a risk of infection and possibly the need for amputation.
Nerve damage can result in pain in the hips, thighs, pelvis, and buttocks, as well as muscle weakness and pain in the legs.
This involves damage to a specific nerve or group of nerves anywhere in the body. Focal neuropathy often causes intense, sudden muscle weakness, pain, and loss of feeling. Carpal tunnel syndrome, which occurs in the wrist, is the most common type.
This involves damage to nerves that control involuntary bodily functions, such as heart and breathing rates, gastrointestinal activity, sexual response, and blood pressure.
Autonomic neuropathy may make it harder for a person with diabetes to notice when their blood sugar has dropped dangerously low.
Researchers continue to investigate why and how diabetic neuropathy occurs. They are also looking for more precise treatment options, for example, drugs that block or change specific pain signals.
The results of a laboratory study published in 2013 suggest that medications targeting T-type calcium channels may help reduce the pain associated with diabetic neuropathy, without risk of addiction or dependency.
A 2015 study found that when scientists blocked certain membrane proteins in rats, the rats perceived less pain in the region of the brain most often involved in processing pain signals.
Scientists are also looking into spinal cord stimulation (SCS) therapies. A 2016 study in rats found that early, repetitive SCS could help reduce and reverse neuropathic pain by stimulating the endocannabinoid system and activating certain receptors.
Medications that target molecules called gangliosides, which are attached to the surface of nerve cells, might offer a cure for neurodegenerative disorders, some researchers suggest. Gangliosides appear to influence the brain's ability to form new nerve connections.
Authors of a study from 2016 found that depleting a specific ganglioside improved wound healing and fully reversed neuropathic pain in mice.
There is currently no way to reverse diabetic neuropathy, although scientists are working on future treatments.
For now, the best approach is to manage blood sugar levels through medication and lifestyle changes. Keeping glucose within target levels can reduce the risk of developing neuropathy and its complications.
Blood glucose monitor kits for home use are available for purchase online.