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.
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.
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:
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.
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:
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.
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.
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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.
Peripheral neuropathy tends to develop slowly over months or years. In general, symptoms may include:
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:
Symptoms of focal neuropathy usually appear suddenly. They may include:
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 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 use disorder, 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.
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. This examination can detect a loss of sensation in your feet, which can lead to more serious foot problems.footnote 1
Good 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.
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 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.
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.
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. Some people find these treatments helpful:
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:
If 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.
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.
- American Diabetes Association (2019). Standards of medical care in diabetes—2019. Diabetes Care, 42(Suppl 1): S1–S193. Accessed December 17, 2018.
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.
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