What Is Diabetic Neuropathy?

Diabetic neuropathy is nerve damage caused by prolonged elevated levels of blood glucose in people with diabetes.

Neuropathy is damage to nerves, and diabetic neuropathy occurs as a result of diabetes. Diabetes damages nerves due to prolonged elevated blood glucose levels. Diabetic neuropathy can affect various parts of the body, with symptoms ranging from mild to severe. It is the most common complication of diabetes.

• Types of diabetic neuropathy include:

• Peripheral neuropathy
• Focal neuropathy
• Autonomic neuropathy
• Proximal neuropathy

What are the different types of diabetic neuropathy?

Diabetic neuropathy can be categorized into different types depending on which nerves are affected and their location.

• Diabetic peripheral neuropathy affects peripheral nerves, most commonly those in the feet and legs.
• Diabetic proximal neuropathy affects nerves in the thighs, hips, or buttocks.
• Diabetic autonomic neuropathy affects the autonomic nervous system, which controls body functions. It can impact nerves in the gastrointestinal, urinary, genital, or vascular systems.
• Diabetic focal neuropathy affects a specific nerve or area of the body.

What are the symptoms and signs of diabetic neuropathy?

The symptoms and severity of diabetic neuropathy depend on the type of neuropathy present. Symptoms may vary among affected individuals.

Signs and symptoms of diabetic peripheral neuropathy:

• Numbness or tingling in the feet and lower legs
• Pain or burning sensations
• Loss of sensation in the feet or lower legs
• Less commonly, these symptoms may occur in the hands or arms

Signs and symptoms of diabetic proximal neuropathy:

• Pain, usually on one side, in the hips, buttocks, or thighs
• Weakness of the legs

Signs and symptoms of diabetic autonomic neuropathy vary according to the affected organ system and may include:

• Nausea and/or vomiting
• Diarrhea
• Constipation
• Dizziness
• Fainting
• Feeling full after eating a small amount
• Erectile dysfunction in men
• Urinary incontinence
• Inability to empty the bladder completely
• Decreased vaginal lubrication in women
• Profuse sweating, e.g., when eating or at night
• Bloating
• Difficulty swallowing
• Low blood pressure upon sudden standing (orthostatic hypotension)
• Rapid resting heartbeat

Signs and symptoms of diabetic focal neuropathy depend on the affected nerve’s location.

Symptoms can appear suddenly but often improve over weeks to months without causing long-term problems. They may include:

• Chest pain
• Eye pain
• Changes in vision
• Bell’s palsy (paralysis on one side of the face)
• Pain in a localized area of the body

QUESTION

What causes diabetic neuropathy?

The cause of nerve damage in diabetes is not well understood. Long-term exposure to high levels of blood glucose is the primary factor that damages nerve tissue, although the exact reason is uncertain.

Can diabetic neuropathy be reversed?

Nerve damage cannot typically be reversed once it occurs. However, medications and self-care measures can help manage the symptoms of diabetic neuropathy.

How is diabetic neuropathy diagnosed?

• Diabetic neuropathy is usually diagnosed clinically based on symptoms, medical history, and physical examination. Additional tests may be performed for a definitive diagnosis by measuring nerve function loss.
• Nerve conduction studies measure nerve signal speed in the arms and legs, while electromyography measures electrical discharges in muscles. Other tests assessing nervous system function may also be conducted.
• Approximately 45% to 50% of diabetes patients are eventually diagnosed with some form of neuropathy.

What are the treatments for diabetic neuropathy?

• Though diabetic neuropathy cannot be cured, treatments are available to manage symptoms.
• Controlling blood glucose levels through diet and medication is a treatment goal to prevent worsening of neuropathy.
• Tight control of blood sugar levels has been shown to improve symptoms and prevent pain from worsening.

What natural home remedies help relieve pain?

There are self-care measures that can be taken to relieve diabetic neuropathy symptoms, such as:

• Using a bed cradle to keep bed covers off sensitive feet and lower legs
• Applying heat or cold patches, taking care to avoid burns or freezing due to damaged sensory nerves
• Eating small, frequent meals and avoiding fatty foods to alleviate digestive symptoms
• Standing up slowly or using elastic compression stockings to improve orthostatic hypotension
• Engaging in exercises, stretching, or massage to relieve pain

What are the most effective medications for diabetic neuropathy?

Prescription antidepressants and antiseizure medications can help manage the pain associated with diabetic neuropathy. Medications that have shown effectiveness in alleviating nerve-related pain include:

• Duloxetine (Cymbalta), an antidepressant
• Tricyclic antidepressants like nortriptyline (Pamelor, Aventyl) and desipramine (Norpramin) have also been used for this purpose
• Anti-seizure drugs such as gabapentin (Neurontin), carbamazepine (Tegretol), and pregabalin (Lyrica)

In cases of severe pain, opioid analgesics may be necessary. Other treatment options for nerve pain include patches containing the topical anesthetic agent lidocaine. Over-the-counter capsaicin cream has also been shown to relieve nerve pain.

Medications can also manage autonomic neuropathy symptoms. For example, antispasmodic or anticholinergic drugs can help prevent urinary incontinence. For men with erectile dysfunction due to diabetic neuropathy, drugs like sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) may help. Vaginal estrogen creams and lubricants can provide relief from vaginal dryness and irritation in women. Botulinum toxin (Botox) injections have been used to treat abnormal sweating.

Can diabetic neuropathy be prevented?

• Keeping diabetes under control is the best approach to prevent or stop the progression of diabetic neuropathy. Your doctor can advise you on the target range for blood glucose levels, achieving tight control within this range helps prevent neuropathy and other diabetes-related complications.
• Other measures such as avoiding smoking, regular exercise, and maintaining a healthy diet can also contribute to better long-term outcomes for individuals with diabetes.

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