Neuropathy means
nerve disease or damage. Diabetic neuropathy is nerve damage caused by
diabetes. People with 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 neuropathyis 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 neuropathyis damage to
autonomic nerves. These nerves control things like
your heartbeat, blood pressure, sweating, digestion, urination, and sexual
function.
Focal neuropathyaffects 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 with diabetes who drink too much alcohol are
also more likely to have nerve damage.
About half of all people
with diabetes end up getting diabetic neuropathy.1
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 near normal. This will not cure the nerve damage, but it can
help keep the damage from getting worse.
The type of 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.
It is common in diabetes to lose some feeling in your
feet. 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 near normal may help prevent neuropathy from ever
developing. The best way to do this is by getting to and staying at a healthy
weight by exercising and eating healthy foods.
Diabetic 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 neuropathy
Peripheral
neuropathy tends to develop slowly over months or years. Symptoms may get worse
during pregnancy. In general, symptoms may include:
Tingling, numbness, tightness, or burning,
shooting, or stabbing pain in the feet, hands, or other parts of the body. Bone
and joint deformities can develop, especially of the feet (such as
Charcot foot). See a picture of
Charcot foot.
Reduced feeling or numbness, most often in the feet.
Check your feet every day for skin problems (chapped,
broken skin or excessive dryness) or minor injuries (blisters, calluses, or
ingrown toenails). People who have had diabetes 10 or more years, who have poor
blood sugar control, or who have blood vessel, kidney, or eye complications are
at increased risk for foot and leg sores and possible amputation.
Greatly reduced or greatly increased sensitivity to light touch or
temperature.
Weakness and loss of balance and coordination.
Symptoms of autonomic neuropathy
Autonomic 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 indicate
gastroparesis, a condition that causes the stomach to
empty much slower than normal.
Profuse sweating of the torso, face,
or neck at night or while eating certain foods, such as spicy foods and cheese.
Alternatively, some people may have reduced sweating, especially in their feet
and legs.
Difficulty sensing when the bladder is full or difficulty
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).
Symptoms 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, difficulty moving the
eyes, 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.
A diagnosis of
diabetic neuropathy is based largely on your symptoms,
medical history, and
neurologic examination. During a neurologic exam, your
doctor will check how well you feel light touch, temperature, pain, and
movement. Your doctor will 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 and muscles conduct electrical impulses. When nerve damage is
present, the speed of nerve function slows.
Problems associated
with autonomic neuropathy—which affects the nerves that control internal
functions—can be difficult to diagnose. When new symptoms develop, further
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 with 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 cannot
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.
Screening for peripheral neuropathy can help
prevent foot ulcers and amputation. 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.2 This examination
can detect a loss of sensation in your feet, which can lead to more serious
foot problems.
There is currently no cure for
diabetic neuropathy. When you have it, treatment is
done to keep the disease from getting worse. Good control of diabetes over time
is the key to treating neuropathy. Getting to and staying at a healthy weight
is a good start.
To help control your diabetes, eat food that is
good for you and exercise. Controlling diabetes means maintaining blood sugar
levels within the target range—near normal hemoglobin A1c (HbA1c) levels. This
will do more than anything else to help prevent diabetic neuropathy from
getting worse.
Treatment 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 a narrow
target range—hemoglobin A1c (HbA1c) levels near
normal. 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. For more information, see the topics
Type 1 Diabetes: Living With the Disease or
Type 2 Diabetes: Living With the Disease.
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.3 For more information, see:
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. Additional treatment depends on the specific type of diabetic
neuropathy that you have along with your current symptoms.
Many
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. These treatments may include:
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. Acupuncture has not been well studied as
a treatment for diabetic neuropathy. But some studies show that it may help
with pain.4
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.
Autonomic 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 tetracycline, amoxicillin, or
metronidazole.
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.5
Abnormal sweating. If you
sweat a lot, try to avoid intense heat and humidity. If you sweat severely
while eating certain foods, anticholinergic medicines may help. But these
medicines have side effects that may sometimes be more troublesome than the
abnormal sweating.
Botulinum toxin (Botox) injections may also
help.6 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 normal
range. Usually it is recommended that you keep your hemoglobin A1c (HbA1c) at
near normal levels.
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. For more information, see
sexual problems.
Blood pressure problems.Blood pressure problems can be treated
with medicines and by wearing support stockings (also called compression
stockings).
Ongoing treatment
Ongoing treatment for
diabetic neuropathy includes making sure your blood
sugar levels stay tightly controlled within a narrow
target range. Tight blood sugar control means a near
normal level of hemoglobin A1c (HbA1c). You also need to practice wise health
habits such as seeing your doctor regularly, controlling your blood pressure,
getting regular exercise, limiting or avoiding alcohol, and not smoking. Also,
take good care of your feet so that foot sores and
other foot problems do not develop. For more information, see:
Other treatment is tailored to your specific symptoms
and the type of diabetic neuropathy that you have.
Many people
with peripheral neuropathy—which affects nerves that supply
sensation and touch—have mild to severe pain in specific parts of their bodies.
Treatment can reduce pain and improve physical functioning, mood, and mental
well-being and may include:
Medicines such as nonprescription pain
relievers or creams to relieve pain. The most common medicines used to treat
symptoms of diabetic neuropathy include anticonvulsant drugs such as pregabalin
and gabapentin, tricyclic antidepressants, and the antidepressant duloxetine
hydrochloride.
Complementary therapies such as
acupuncture. Acupuncture has not been well studied as
a treatment for diabetic neuropathy. But some studies show that it may help
with pain.
Physical therapy such as exercises, stretching, and
massage. If you are told to use heat or ice, be
careful. Neuropathy makes it hard for you to feel changes in
temperature.
Autonomic neuropathy—which affects nerves that
regulate internal functions—can cause problems with 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 tetracycline, amoxicillin, or
metronidazole.
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.5
Abnormal sweating. If you sweat a lot,
try to avoid intense heat and humidity. If you sweat severely while eating
certain foods, anticholinergic medicines may help. But these medicines have
side effects that may sometimes be more troublesome than the abnormal sweating.
Botulinum toxin (Botox) injections may also
help.6 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 normal
range. Usually it is recommended that you keep your hemoglobin A1c (HbA1c) near
normal.
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. For more information, see
sexual problems.
Blood pressure problems.Blood pressure problems can be treated with medicines and by wearing support
stockings (also called compression stockings).
Treatment if the condition gets worse
If
diabetic neuropathy gets worse, you may have serious
problems such as severe
gastroparesis,
bladder infections, or
foot problems. In addition to striving for tightly controlled
target range blood sugar levels—hemoglobin A1c (HbA1c)
near normal—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.3 It is possible to have permanent disfigurement in one or both
of your feet—Charcot foot—from diabetic neuropathy. Surgery is
sometimes needed to correct deformed joints that can result from Charcot foot.
See a picture of
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.5
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.
What To Think About
No 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.
In addition to having regular medical
checkups, the best way to avoid the progression of
diabetic neuropathy is to control your blood sugar,
take good care of your feet, and practice wise health habits.
Control your blood sugar level
The single most
important step you can take to prevent the development and progression of
diabetic neuropathy is to keep your blood sugar level consistently within a
tightly controlled and narrow
target range. Tight blood sugar control means a near
normal level of hemoglobin A1c (HbA1c).
Diabetic neuropathy affects
the feet more often than any other part of the body. Diabetes interferes with
your body's ability to fight infection, so that even a minor foot injury such
as a blister, a scratch, or
athlete's foot can lead to serious infections or
amputation. But serious foot problems are the most preventable complications of
diabetes.
Because the nerve damage caused by diabetic neuropathy
may make you less likely to notice minor problems with your feet, it is wise to
inspect your feet every day. Protect them from injury by wearing properly
fitted shoes and socks at all times. If vision problems from
diabetic retinopathy or another eye disease make it
difficult for you to examine your feet, have someone assist you.
You can also buy an Indicator Plaster Neuropad (IPN). This 10-minute exam
results in a color change when neuropathy is present. Ask your doctor to check
your feet at each visit, and have a thorough medical examination of your feet
at least once a year. For more information, see:
If you have severe numbness, a history of skin sores, or
bone and joint deformities (such as
Charcot foot), you may benefit from custom-fitted
shoes. Medicare and some health insurance plans will pay for these shoes if
they are needed.
Practice wise health habits
Many doctors believe
that you can further reduce your risk of getting severe neuropathy if
you:
See your doctor regularly. Your doctor will be able to note any changes in your health
more easily when you plan regular visits. It will be easier for you and your
doctor to find problems early and to take care of them right away.
Exercise regularly and stay at a healthy weight. Exercise and weight control can help your body use insulin
better. This helps keep your blood sugar level within a tightly controlled and
narrow target range, which may help prevent the development and progression of
nerve damage. Talk to your doctor and have a thorough exam of your feet before
beginning an exercise program. Foot problems, blood pressure problems, or
certain other problems associated with neuropathy may raise unique
concerns about exercising safely, such as whether you
should avoid repetitive, weight-bearing exercises.
Limit your alcohol intake. Having four or more drinks a week
may make neuropathy and its symptoms worse.
Eat a balanced diet. Consider taking a
daily multivitamin to ensure that you are meeting your nutritional needs. A
balanced diet can also help you maintain a healthy weight. If you have
gastroparesis, eat several small meals a day instead
of three regular meals.
The American Diabetes Association (ADA) is a national organization
for health professionals and consumers. Almost every state has a local office.
ADA sets the standards for the care of people with diabetes. Its focus is on
research for the prevention and treatment of all types of diabetes. ADA
provides patient and professional education mainly through its publications,
which include the monthly magazine Diabetes Forecast,
books, brochures, cookbooks and meal planning guides, and pamphlets. ADA also
provides information for parents about caring for a child with diabetes.
National Diabetes Education Program
(NDEP)
1 Diabetes Way
Bethesda, MD 20814-9692
Phone:
1-800-438-5383 to order materials (301) 496-3583
E-mail:
ndep@mail.nih.gov
Web Address:
http://ndep.nih.gov
The National Diabetes Education Program (NDEP) is
sponsored by the U.S. National Institutes of Health (NIH) and the U.S. Centers
for Disease Control and Prevention (CDC). The program's goal is to improve the
treatment of people who have diabetes, to promote early diagnosis, and to
prevent the development of diabetes. Information about the program can be found
on two Web sites: one managed by NIH (http://ndep.nih.gov) and the other by CDC
(www.cdc.gov/team-ndep).
National Diabetes Information Clearinghouse
(NDIC)
1 Information Way
Bethesda, MD 20892-3560
Phone:
1-800-860-8747
Fax:
(703) 738-4929
TDD:
1-866-569-1162 toll-free
E-mail:
ndic@info.niddk.nih.gov
Web Address:
http://diabetes.niddk.nih.gov
This clearinghouse provides information about research
and clinical trials supported by the U.S. National Institutes of Health. This
service is provided by the National Institute of Diabetes and Digestive and
Kidney Disease (NIDDK), a part of the National Institutes of Health (NIH).
Feldman EL, et al. (2003). Somatosensory neuropathy.
In D Porte Jr et al., ed., Ellenberg and Rifkin's Diabetes Mellitus, 6th ed., pp. 771–788. New York: McGraw-Hill.
American Diabetes Association (2004). Preventive foot
care in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S63–S64.
Boulton AJM, et al. (2004). Diabetic somatic
neuropathies. Diabetes Care, 27(6): 1458–1486.
Vinik AI, et al. (2003). Diabetic autonomic
neuropathy. In D Porte Jr et al., eds. Ellenberg and Rifkin's Diabetes Mellitus, 6th ed., pp. 789–804. New York:
McGraw-Hill.
Restivo DA, et al. (2002). Improvement of diabetic
autonomic gustatory sweating by botulinum toxin type A. Neurology, 59(12): 1971–1973.
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Boulton AJM, et al. (2005). Diabetic neuropathies: A
statement by the American Diabetes Association. Diabetes Care, 28(4): 956–962.
Brownlee M, et al. (2008). Complications of diabetes
mellitus. In PR Larsen et al., eds., Williams Textbook of Endocrinology, 11th ed., pp. 1417–1498. Philadelphia: Saunders Elsevier.
Frykberg RG, et al. (2006). Diabetic foot disorders: A
clinical practice guideline. Journal of Foot and Ankle Surgery, 45(Suppl 5): S1–S66. Also available online:
http://www.acfas.org/pubresearch/cpg/diabetic-cpg.htm.
Ganchi PA, Eriksson E (2005). Diabetes mellitus and
wound healing. In CR Kahn et al., eds., Joslin's Diabetes Mellitus, 14th ed., pp. 1133–1144. Boston: Joslin Diabetes Center.
Ganguli SC, Tougas GN (2001). Diabetes and the
gastrointestinal tract. In HC Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care, pp. 545–567. Hamilton, ON:
BC Decker.
Hunt D (2006). Foot ulcers and amputations in
diabetes, search date September 2006. Online version of BMJ Clinical Evidence. Also available online:
http://www.clinicalevidence.com.
Masharani U, German MS (2007). Pancreatic hormones and
diabetes mellitus. In DG Gardner et al., eds., Greenspan's Basic and Clinical Endocrinology, 8th ed., pp. 716–746. New York:
McGraw-Hill.
Molitch ME, Genuth S (2006). Complications of diabetes
mellitus. In DC Dale, DD Federman, eds., ACP Medicine,
section 9, chap. 3. New York: WebMD.
Ropper AH, Brown RH (2005). Diseases of the peripheral
nerves. In Adams and Victor's Principles of Neurology,
8th ed., pp. 1110–1177. New York: McGraw-Hill.
Tentikiyrus N, et al. (2008). Evaluation of the
self-administered indicator plaster neuropad for the diagnosis of neuropathy in
diabetes. Diabetes Care, 31(2): 236–237.
Wong M, et al. (2007). Effects of treatments for
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(doi:10.1136/bmj.39213.565972.AE).
This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
