Diabetic Neuropathy
Topic OverviewWhat is diabetic neuropathy?Neuropathy means
nerve disease or damage. Diabetic neuropathy is nerve damage caused by
diabetes. People who have diabetes often have high blood
sugar levels. Over time, high blood sugar levels can damage nerves throughout
your body. There are three kinds of diabetic neuropathy. - Peripheral neuropathy is damage to
peripheral nerves. These are the nerves that 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 is damage to
autonomic nerves. These nerves control things like
your heartbeat, blood pressure, sweating, digestion, urination, and sexual
function.
- Focal neuropathy affects just one
nerve, usually in the wrist, thigh, or foot. It may also affect the nerves of
your back and chest and those that control your eye muscles. This type of nerve
damage usually happens suddenly.
What causes diabetic neuropathy?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.
So controlling your blood sugar throughout your life is very important. The older you get, and the longer you have diabetes, the more likely you
are to have nerve damage. People who have diabetes who drink too much alcohol are
also more likely to have nerve damage. What are the symptoms?Your symptoms will depend
on which nerves are injured. You may not be able to feel pain, especially in
your feet. This can lead to serious infections, because sores or other problems
may not get treated. When other parts of your body are affected,
symptoms may include: - Problems with digestion, such as bloating,
belching, constipation, nausea and vomiting, diarrhea, and belly pain.
- Problems with body temperature, such as heavy sweating at night
or when you eat certain foods. Some people may have reduced sweating,
especially in their feet and legs.
- Problems with urination, such
as finding it hard to tell when your bladder is full or finding it hard to
empty your bladder completely.
- Sexual problems, such as erection
problems in men and vaginal dryness in women.
- Heart and blood
vessel problems, leading to poor circulation or low blood pressure. This may
cause dizziness, weakness, or fainting when you stand or sit up from a
reclining position.
- Trouble sensing when your blood sugar is low.
How is diabetic neuropathy diagnosed?Your doctor
will check how well you feel light touch and temperature and will test your
strength and your reflexes. Tests such as
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. How is it treated?Treatment involves keeping
blood sugar levels in your target range. This will not cure the nerve damage, but it can
help keep the damage from getting worse, and the pain might get better. Other treatment
depends on your symptoms: - Pain may be treated with medicines.
- Digestive system problems or blood vessel problems may be treated
with medicines.
- Blood pressure problems may be treated with
medicines and by wearing support stockings (also called compression stockings).
- Sexual problems may be helped with medicines or devices to
improve erections or with lubricating creams that help vaginal dryness.
- A splint or brace may be used for a pinched nerve.
When you have diabetes, you could have a sore or other foot problem without noticing it. Check
your feet every day. An untreated problem on your foot can lead to a serious
infection or even amputation. Be clear with your doctor about
what is helping you feel better and what is not. You and your doctor can work
together to find the treatment that helps you the most. Can diabetic neuropathy be prevented?Keeping your
blood sugar levels in your target range, set with your doctor, may help prevent neuropathy from ever
developing. The best way to do this is by checking your blood sugar and adjusting your treatment. It is also important to get to and stay at a healthy
weight by exercising and eating healthy foods. Frequently Asked QuestionsLearning about diabetic neuropathy: | | Being diagnosed: | | Getting treatment: | | Living with diabetic neuropathy: | |
SymptomsDiabetic neuropathy-especially
peripheral neuropathy-initially may not cause any
noticeable symptoms. If you have diabetes, it is important to have regular
medical checkups to check for signs of neuropathy and treat problems before
they become serious. Symptoms of diabetic neuropathy may vary
depending on the type of neuropathy you have. Symptoms of peripheral neuropathyPeripheral neuropathy tends to develop slowly over months or years. In general, symptoms may include: - Reduced feeling or numbness in the feet.
-
Over time, tightness, burning,
shooting, or stabbing pain in the feet, hands, or other parts of the body. Bone
and joint deformities can develop, especially in the feet (such as
Charcot foot).
- Greatly reduced or greatly increased sensitivity to light touch or
temperature.
- Weakness and loss of balance and coordination.
Symptoms of autonomic neuropathyAutonomic neuropathy may affect digestion, the body's ability to regulate
temperature, urination, sexual function, and heart and blood vessel function,
including blood pressure. Symptoms may get worse during pregnancy. In general,
symptoms may include: - Frequent bloating, belching, constipation,
heartburn, nausea and vomiting, diarrhea, and
abdominal pain. These symptoms may point to
gastroparesis, a condition that 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 the bladder is full or problems
emptying the bladder completely.
- Sexual problems, such as erection
problems in men and vaginal dryness in women.
- Dizziness, weakness,
or fainting when you stand or sit up from a reclining position (orthostatic hypotension).
- Trouble
knowing when your blood sugar is low (hypoglycemia unawareness).
Symptoms of focal neuropathySymptoms of
focal neuropathy usually appear suddenly. They may include: - Pain, weakness, and motor problems in a
single area of the body, such as a wrist, thigh, or foot. In cases of a
compressed or pinched nerve, soreness and pain may develop more gradually over
several weeks or months.
- Pain in and around one of your eyes, trouble moving an
eye, and double vision. Focal neuropathy may sometimes affect the nerves that
control your eye muscles.
Symptoms of focal neuropathy usually get better over
time. But focal neuropathy may be permanent. Exams and TestsA diagnosis of
diabetic neuropathy is based largely on your symptoms,
medical history and physical examination. During a physical exam, your
doctor may check how well you feel light touch, temperature, pain, vibration, and
movement. Your doctor may also check your strength and reflexes.
Electromyogram (EMG) and nerve conduction studies may
be done to confirm a diagnosis. These tests measure how well and how quickly
the nerves conduct electrical impulses. When nerve damage is
present, the speed of nerve function slows. Problems linked
with autonomic neuropathy-which affects the nerves that control internal
functions-can be hard to diagnose. When new symptoms develop, more
testing may be needed to diagnose the problem, identify the cause, and guide
treatment. For example, a study that measures how fast your stomach empties may
be done if symptoms like bloating, indigestion, or vomiting suggest
gastroparesis, a condition that causes the stomach to
take too long to empty. Nerve problems in people who have diabetes
may be caused by other conditions, such as kidney disease,
alcohol dependence, or a
vitamin B12 deficiency. A variety of
laboratory tests (such as a
complete blood count) may be used to screen for
conditions other than diabetes that could be causing symptoms. Your symptoms
and medical history will determine which tests are needed. Early detection For some diseases, doctors can use screening
tests to look for problems before you have any symptoms. But doctors can't
test for all types of autonomic or focal neuropathy. So it is important to
report to your doctor any pain, weakness, or motor problems you have. Also
mention any changes in digestion, urination, sexual function, sweating, or
dizziness. Your doctor will also look for signs of autonomic neuropathy during
your physical exams. The American Diabetes Association (ADA)
recommends that people who have diabetes see a doctor to examine their feet for
cracked or peeling skin, excessive or reduced sweating, blisters, calluses,
ulcers, signs of infection, bone and joint abnormalities, and walking and
balance-during each medical visit. The ADA also recommends a complete foot exam
by a doctor at least once a year.footnote 1 This examination
can detect a loss of sensation in your feet, which can lead to more serious
foot problems. Treatment OverviewGood control of diabetes over time
is the key to treating diabetic neuropathy. There is no cure for neuropathy, but keeping your blood sugar within a target range can reduce symptoms and prevent them from getting worse. To help control your diabetes, eat food that is
good for you and exercise. Controlling diabetes means maintaining blood sugar
levels (A1c) within the target range. This
will do more than anything else to help prevent diabetic neuropathy from
getting worse. Initial and ongoing treatmentTreatment for
diabetic neuropathy depends on your symptoms and the
type of neuropathy that you have. In general, treatment focuses on reducing
current symptoms and preventing the condition from getting worse by keeping
your blood sugar level within your
target range. You can keep your blood sugar levels within the target range by taking
your
insulin or oral diabetes medicine as prescribed,
checking your blood sugar levels, following your diet for diabetes, exercising,
and seeing your doctor regularly. Also, it is important to properly care for your feet when you have
diabetic neuropathy. Diabetic neuropathy may cause a loss of feeling in your
feet. It is possible for a sore or
other foot problem to go unnoticed. Without proper foot care, an untreated
foot sore can lead to a serious infection or possibly amputation. - Diabetes: Taking Care of Your Feet
It is also wise to maintain 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. Further treatment depends on the specific type of diabetic
neuropathy that you have along with your current symptoms. Peripheral neuropathyMany
people with
peripheral neuropathy have mild to severe pain in
specific parts of their bodies. Talk with your doctor about treatment that can
reduce your pain and improve your physical functioning, mood, and mental
well-being. Some people find these treatments helpful: - Medicines such as pain relievers or
creams to relieve pain. Prescription medicines often used to reduce pain from
diabetic neuropathy may include medicines that are more commonly used to treat
depression, such as tricyclic antidepressants and the antidepressant duloxetine
hydrochloride, and medicines that control seizures, such as pregabalin and
gabapentin. These medicines may be tried to reduce your pain even though you do
not have depression or seizures.
- Complementary therapies such as
acupuncture and biofeedback
- Physical therapy
such as exercises, stretching, and
massage. If you are told to use heat or ice, be
careful. Neuropathy can make it hard for you to feel changes in
temperature.
- Transcutaneous electrical nerve stimulation (TENS),
which is a type of therapy that reduces pain by applying brief
pulses of electricity to nerve endings in the skin
Autonomic neuropathyAutonomic neuropathy-which affects nerves that
regulate internal functions-can affect digestion, urination, sweating, sexual
function, blood pressure, and other involuntary body functions. Some symptoms
of autonomic neuropathy can be hard to manage, but others respond well to
treatment: - Mild constipation.
Eating small, frequent meals that are high in fiber and low in fat may
help.
- Frequent diarrhea. Eating foods that
are high in fiber may help. You may need medicines that slow the rate at which
digested food and waste travel through the intestines, or you may need
antibiotics such as amoxicillin, metronidazole, or tetracycline.
- Mild gastroparesis. This is a
condition that causes the stomach to empty very slowly. It may get better if
you eat small, frequent meals that are low in fiber and fat. Medicines that
help the stomach empty more quickly may also be needed. Controlling blood sugar
levels may reduce symptoms of gastroparesis.
- Abnormal sweating. If you
sweat a lot, try to avoid intense heat and humidity. If you don't sweat enough, you can use
moisturizers to help with dry or cracked skin. Drinking more water can prevent
overheating. Try to avoid places that are very hot or very cold.
- Lack of awareness of low blood sugar level. This is also called
hypoglycemia unawareness. You can adjust your insulin
and allow your blood sugar levels to be a little bit higher than the target
range. Usually it is recommended that you keep your A1c in a target range.
- Urinary problems. Urinary problems can be treated with antibiotics for urinary tract infections
and medicines to improve bladder control.
- Sexual problems. Your doctor may suggest using medicines or devices to improve
erections. Or you may need nonprescription lubricants and estrogen creams for
vaginal dryness.
- Blood pressure problems. High blood pressure may be
treated with angiotensin-converting enzyme (ACE) inhibitors, such as benazepril and enalapril. Low blood pressure can be treated
with medicines and by wearing support stockings (also called compression
stockings).
Treatment if the condition gets worseIf
diabetic neuropathy gets worse, you may have serious
problems such as severe
gastroparesis,
bladder infections, or
foot problems. In addition to keeping your blood sugars in your
target range and taking good care of your feet, you may need further treatment
if diabetic neuropathy progresses. Diabetic neuropathy is a major
risk factor for foot infections or foot
ulcers leading to amputation. It is possible to have permanent disfigurement in one or both
of your feet (such as Charcot foot) from diabetic neuropathy. Surgery is
sometimes needed to correct deformed joints that can result from Charcot foot.
Severe
gastroparesis may require other treatment, such as
medicines that empty the stomach more quickly or a feeding tube that is
inserted into the stomach. Severe
bladder infections or other bladder problems, such as loss of control, may
require further diagnostic testing and treatments such as medicines or surgery
to improve bladder function. Also, it is common to experience
symptoms of
depression with any chronic disease, such as diabetes
or diabetic neuropathy. Seeking help for depression may improve your overall
well-being and aid in the treatment of your condition. - Interactive Tool: Are You Depressed?
What to think aboutNo matter what you or your doctor
try, you may not be pain-free. Be clear with your doctor about what is helping
and what is not. You and your doctor can work together to find the right
combination of medicine and other treatments to help you the most. Other Places To Get HelpOrganizationsAmerican Diabetes Association (ADA) www.diabetes.org National Diabetes Information Clearinghouse (NDIC) (U.S.) 1-866-569-1162 toll-free www.diabetes.niddk.nih.gov ReferencesCitations- American Diabetes Association (2017). Standards of medical care in diabetes-2017. Diabetes Care, 40(Suppl 1): S1-S135. http://care.diabetesjournals.org/content/40/Supplement_1. Accessed December 15, 2016.
Other Works Consulted- Brannagan TH (2010). Acquired neuropathies. In LP Rowland, TA Pedley, eds., Merritt's Neurology, 12th ed., chap. 134, pp. 832-833. Philadelphia: Lippincott Williams and Wilkins.
- Brownlee M, et al. (2011). Complications of diabetes mellitus. In S Melmed et al., eds., Williams Textbook of Endocrinology, 12th ed., pp. 1462-1551. Philadelphia: Saunders.
- Freeman R (2010). Diabetic neuropathy. In RS Beaser, ed., Joslin's Diabetes Deskbook: A Guide for Primary Care Providers, 2nd ed., pp. 499-522. Boston, MA: Joslin Diabetes Center.
- Hunt DL (2011). Diabetes: Foot ulcers and amputations, search date September 2010. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
- Masharani U, German MS (2011). Pancreatic hormones and diabetes mellitus. In DG Gardner, D Shoback, eds., Greenspan's Basic and Clinical Endocrinology, 9th ed., pp. 573-655. New York: McGraw-Hill.
- Pop-Busui R, et al. (2017). Diabetic neuropathy: A position statement by the American Diabetes Association. Diabetes Care, 40(1): 136-154. DOI: 10.2337/dc16-2042. Accessed January 17, 2017.
CreditsByHealthwise Staff
Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Kathleen Romito, MD - Family Medicine
Adam Husney, MD - Family Medicine
Specialist Medical ReviewerKarin M. Lindholm, DO - Neurology Current as ofMarch 13, 2017 Current as of:
March 13, 2017 American Diabetes Association (2017). Standards of medical care in diabetes-2017. Diabetes Care, 40(Suppl 1): S1-S135. http://care.diabetesjournals.org/content/40/Supplement_1. Accessed December 15, 2016. Last modified on: 8 September 2017
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