What is diabetic neuropathy?

When beginning to discuss diabetic neuropathy, the most important thing is to understand the condition. Diabetic neuropathy causes long-term damage caused to the blood vessels that deliver oxygen to the body’s nerve endings. The most common site for this kind of damage is legs and feet, although the hands are frequently cited as well.

The American Diabetes Association describes diabetic neuropathy as “more common in those who have had the disease for a number of years and can lead to many kinds of problems.” According to the AMA, about half of all people with diabetes have nerve damage.

In a Centers for Disease Control and Prevention (CDC) study, the number of diabetic patients discharged from the hospital between 1988 and 2007 with neuropathic symptoms had increased by 12% in men. During this period, it had nearly doubled in women.

Though people with type 1 and type 2 diabetes are already at risk for diabetic neuropathy, there are a number of behaviors that can make an individual more prone to developing the condition.

While nerve damage often occurs from high glucose damaging blood vessels, the damage can be accelerated by an autoimmune response that occurs when the white blood cells attack the body’s own cells by mistake.

Genetic factors can also make an individual more prone to nerve damage. Other factors that may increase the risk of diabetic neuropathy include kidney disease, obesity, poor blood sugar regulation, and engaging risky behaviors such as smoking or drinking in excess.

Neuropathy is hard to recognize because it begins with symptoms that are annoying or discomforting at first. General symptoms of neuropathy are burning, tingling and pain in the affected regions, though certain symptoms are specific to each of the four types.

Each of these neuropathies could cause serious damage without proper treatment. If left untreated for an extended period, neuropathy may even lead to amputation.

Peripheral Neuropathy

Peripheral neuropathy, the most common form of neuropathy, impacts the peripheral nervous system (PNS). Peripheral neuropathy most commonly affects the feet and legs before working its way into the arms.

Carpal tunnel syndrome may be a sign of neuropathy in diabetics. Specific symptoms of peripheral neuropathy include:

• Pain in the legs or feet
• Increased sensitivity in the feet
• Absence of pain in the feet, especially when there is an injury such as a blister
• Dramatically slowed healing of wounds on the feet or legs
• Weakness and/or loss of balance in the legs or feet

If any of these symptoms persist longer than a week or two, it’s recommended that you bring it to the attention of your doctor or family practitioner.

Autonomic Neuropathy

Autonomic Neuropathy is a subtype of neuropathy that targets the body’s automatic systems, such as the digestive, urinary, circulatory and reproductive systems.

When autonomic neuropathy impacts the digestive tract, the stomach and small intestine are often targeted. Specific symptoms of autonomic neuropathy may include:

• Loss of appetite
• Constipation
• Diarrhea
• Nausea
• Bloating
• Gastroparesis (inability to move food through the stomach)
• Loss of bowel control

Of these symptoms, gastroparesis is particularly damaging to diabetics. The condition makes it more difficult to properly intake insulin, which could lead to unpredictable blood sugar levels after meals.

When autonomic neuropathy affects the urinary system, the bladder is improperly emptied. Over time, it becomes hardened. Specific symptoms may include:

• Frequent urination
• Urinary Incontinence (loss of bladder control)
• Loss of control of the bladder
• Frequent urinary tract infections (UTIs)

The symptoms may manifest when bladder becomes paralyzed, as it’s no longer able to react to being full or empty. Another cause for these symptoms can also be weakened bladder muscles as a result of nervous deterioration.

Symptoms, which can develop in other parts of the body, may include:

• Erectile Dysfunction without the loss of libido
• Racing heart rate while at rest
• Lightheadedness or fainting shortly after standing
• Problems adjusting body temperature
• Increased or decreased sweating
• Difficulty adjusting to changes in lighting

Mononeuropathy

Mononeuropathy is neuropathy of a single nerve. A common form of mononeuropathy is compression mononeuropathy, which occurs when a section of the nerve is being crushed between two pieces of bone. A common form of compression mononeuropathy is carpal tunnel syndrome.

Mononeuropathy is more sudden than other forms of neuropathy, and it often occurs in older adults. Some common sites of mononeuropathy include the face, leg, or torso. Symptoms of mononeuropathy may include:

• Difficulty focusing one or both eyes
• Double vision
• Paralysis of one side of the face (Bell’s Palsy)
• Pain in the shin or foot
• Pain in the lower back or pelvis
• Pain in the front of the thigh
• Abdominal or chest pains

While these symptoms are often painful, they often last only a few weeks or months before disappearing.

Radiculoplexus Neuropathy

Radiculoplexus Neuropathy, also called diabetic amyotrophy, femoral neuropathy or proximal neuropathy, is a form of neuropathy most common in older adults and individuals with type 2 diabetes.

Radiculoplexus neuropathy usually only affects one half of the body, specifically impacting the thighs, hips, buttocks, and legs. Different titles are used to identify the different forms of radiculoplexus neuropathy.

Neuropathy that is painless, but when it affects both leg muscles, it’s usually identified as diabetic amyotrophy. Pain in the front of one thigh is identified as femoral neuropathy.

Despite the different types, radiculoplexus neuropathy exhibits similar symptoms. Symptoms may include:

• Sudden, severe pain in the leg, thigh, buttock, or hip
• Weak or atrophied thigh and leg muscles
• Weight loss
• Abdominal swelling
• Difficulty standing up after sitting

Though the condition can be painful and even debilitating, symptoms often improve slightly over time with care and treatment. If any of the above symptoms have persisted for an extended period of time, it is recommended that a medical professional be consulted.

What are the complications of diabetic neuropathy?

If left untreated, diabetic neuropathy can cause serious complications. Each type of neuropathy is associated with specific side effects, although there is some overlap between complications.

A lack of feeling in the feet or legs can lead to neglect of peripheral neuropathy, which could be very dangerous. Slow-healing wounds may become ulcerated or infected, ultimately requiring an amputation.

Autonomic neuropathy, on the other hand, can prevent symptoms of hypoglycemia (low blood sugar) from showing. Hypoglycemia symptoms may be a key warning sign that helps type 1 diabetics know that they need to increase their blood sugar quickly.

Additionally, physical side effects may appear from diabetic neuropathy, such as Charcot joint, instability or joint deformity. For this reason, if there is any suspicion that symptoms of diabetic neuropathy may be present, a medical professional should be consulted.

What are the treatments for diabetic neuropathy?

There's no way to repair nerves once they have become damaged as a result of diabetic neuropathy. However, there are many ways to prevent and slow the development of neuropathy.

Maintain normal blood sugar levels

One of the easiest ways to prevent damage to blood vessels from high blood glucose is to try and keep your blood sugar levels as close to normal as possible. Using tools such as a blood glucose meter for daily checks and a biannual A1C blood test to determine average blood glucose levels can go a long way to preventing nerve damage from developing.

Foot Care

The feet are the most common site for diabetic neuropathy. By practicing proper foot care, you can reduce your risk of developing neuropathy dramatically.

Even small steps such as wearing clean, dry socks, keeping your feet dry, wearing cushioned shoes, and trimming your toenails can help keep neuropathy at bay as long as they are paired up with regularly checking your feet for a loss of feeling or slow healing. Regularly seeing a podiatrist for check-ups is also an essential part of diabetic foot care.

Preventative Behaviors

There are a number of ways to prevent neuropathy from developing, specifically through healthy lifestyle changes. Exercising loosens up your blood vessels, whereas quitting smoking can stop constricting blood vessels. Even eating more fruits and vegetables can contribute to easier blood flow, which is necessary to keep nerves strong and well oxygenated.

Medication

While nerve damage cannot be undone, there are a wide variety of medications directed at alleviating nervous pain. Medications should be used at the discretion of a doctor and only as prescribed but can be a valuable tool in keeping active and living comfortably.

Moving Forward

Diabetic neuropathy is a serious concern to individuals with diabetes, but technology and medicine are making great strides to try and provide as many options for treatment and prevention as possible. The CDC and the AMA both work tirelessly to find new ways to treat neuropathy and all other symptoms of diabetes.

For more information on diabetes or Diabetic Neuropathy visit the CDC’s diabetes page at www.CDC.gov/diabetes or visit the American Diabetes Association at www.Diabetes.org