What is diabetic neuropathy?
Diabetic neuropathy is a type of nerve damage that can occur if you have diabetes. High blood sugar (glucose) can injure nerve fibers throughout your body, but diabetic neuropathy most often damages nerves in your legs and feet.
Depending on the affected nerves, symptoms of diabetic neuropathy can range from pain and numbness in your extremities to problems with your digestive system, urinary tract, blood vessels and heart. For some people, these symptoms are mild; for others, diabetic neuropathy can be painful, disabling and even fatal.
How common is diabetic neuropathy?
Diabetic neuropathy is a common serious complication of diabetes. Yet you can often prevent diabetic neuropathy or slow its progress with tight blood sugar control and a healthy lifestyle. Please discuss with your doctor for further information.
What are the symptoms of diabetic neuropathy?
The common symptoms of diabetic neuropathy are:
These may be minor at first, and therefore may remain unnoticed as the condition develops gradually. However, in some types of diabetic neuropathy, the onset of the pain will be sudden and severe.
Further symptoms may include:
- Wasting of muscles in feet or hands
- Indigestion, nausea and vomiting
- Urinary problems
- Vaginal dryness
- Weakness of the limbs
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
When should I see my doctor?
You should contact your doctor if you have any of the following:
- A cut or sore on your foot that doesn’t seem to be healing, is infected or is getting worse
- Burning, tingling, weakness or pain in your hands or feet that interferes with your daily routine or your sleep
- Changes in your digestion, urination or sexual function
These signs and symptoms don’t always indicate nerve damage, but they may signal other problems that require medical care. Early diagnosis and treatment offer the best chance for controlling symptoms and preventing more-severe problems.
Even minor sores on the feet that don’t heal can turn into ulcers. In the most severe cases, untreated foot ulcers may become gangrenous — a condition in which the tissue dies — and require surgery or even amputation of your foot. Early treatment can help prevent this from happening.
What causes diabetic neuropathy?
Damage to nerves and blood vessels
Prolonged exposure to high blood sugar can damage delicate nerve fibers, causing diabetic neuropathy. Why this happens isn’t completely clear, but a combination of factors likely plays a role, including the complex interaction between nerves and blood vessels.
High blood sugar interferes with the ability of the nerves to transmit signals. It also weakens the walls of the small blood vessels (capillaries) that supply the nerves with oxygen and nutrients.
Other factors that may contribute to diabetic neuropathy include:
- Inflammation in the nerves caused by an autoimmune response. This occurs when your immune system mistakenly attacks part of your body as if it were a foreign organism.
- Genetic factors unrelated to diabetes that make some people more susceptible to nerve damage.
- Smoking and alcohol abuse, which damage both nerves and blood vessels and significantly increase the risk of infections.
What increases my risk for diabetic neuropathy?
There are many risk factors for diabetic neuropathy, such as:
- Poor blood sugar control. This is the greatest risk factor for every complication of diabetes, including nerve damage. Keeping blood sugar consistently within your target range is the best way to protect the health of your nerves and blood vessels.
- Length of time you have diabetes. Your risk of diabetic neuropathy increases the longer you have diabetes, especially if your blood sugar isn’t well-controlled.
- Kidney disease. Diabetes can cause damage to the kidneys, which may increase the toxins in the blood and contribute to nerve damage.
- Being overweight. Having a body mass index greater than 24 may increase your risk of developing diabetic neuropathy.
- Smoking narrows and hardens your arteries, reducing blood flow to your legs and feet. This makes it more difficult for wounds to heal and damages the integrity of the peripheral nerves.
Diagnosis & treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is diabetic neuropathy diagnosed?
Diabetic neuropathy is usually diagnosed based on your symptoms, your medical history and a physical exam. During the exam, your doctor is likely to check your muscle strength and tone, tendon reflexes, and sensitivity to touch, temperature and vibration.
Your doctor may also conduct tests that include:
- Filament test. Sensitivity to touch may be tested using a soft nylon fiber called a monofilament.
- Nerve conduction studies. This test measures how quickly the nerves in your arms and legs conduct electrical signals. It’s often used to diagnose carpal tunnel syndrome.
- Electromyography (EMG). Often performed along with nerve conduction studies, electromyography measures the electrical discharges produced in your muscles.
- Quantitative sensory testing. This noninvasive test is used to assess how your nerves respond to vibration and changes in temperature.
- Autonomic testing. If you have symptoms of autonomic neuropathy, your doctor may request special tests to look at your blood pressure in different positions and assess your ability to sweat.
The American Diabetes Association recommends that all people with diabetes have a comprehensive foot exam — either by a doctor or by a foot specialist (podiatrist) — at least once a year. In addition, your feet should be checked for sores, cracked skin, calluses, blisters, and bone and joint abnormalities at every office visit.
How is diabetic neuropathy treated?
Diabetic neuropathy has no known cure. Treatment for diabetic neuropathy focuses on:
- Slowing progression of the disease
- Relieving pain
- Managing complications and restoring function
Slowing progression of the disease
Consistently keeping blood sugar within a target range can help prevent or delay the progression of diabetic neuropathy and may even improve some of the symptoms you already have. Your doctor will determine the best target range for you based on several factors, such as your age, how long you’ve had diabetes, and your overall health and the presence of other medical conditions.
For many people who have diabetes, Mayo Clinic generally recommends target blood sugar levels that are:
- Between 80 and 120 mg/dL, or 4.4 and 6.7 mmol/L, for people age 59 and younger who have no other underlying medical conditions
- Between 100 and 140 mg/dL, or 5.6 and 7.8 mmol/L, for people age 60 and older, or those who have other medical conditions, such as heart, lung or kidney disease
To help slow nerve damage:
- Follow your doctor’s recommendations for good foot care
- Keep your blood pressure under control
- Follow a healthy-eating plan
- Get plenty of physical activity
- Maintain a healthy weight
- Stop smoking
- Avoid alcohol or, if drinking is allowed, drink only in moderation
Several medications are used to relieve nerve pain, but they don’t work for everyone and most have side effects that must be weighed against the benefits they offer. There are also a number of alternative therapies, such as capsaicin cream (made from chili peppers), physical therapy or acupuncture, that may help with pain relief. Doctors frequently use them in conjunction with medications, but some may be effective on their own.
Pain-relieving treatments may include:
- Anti-seizure medications. Although drugs such as gabapentin (Gralise, Neurontin), pregabalin (Lyrica) and carbamazepine (Carbatrol, Tegretol) are used to treat seizure disorders (epilepsy), they’re also prescribed for nerve pain. Side effects may include drowsiness, dizziness and swelling.
- Tricyclic antidepressant medications, such as amitriptyline, desipramine (Norpramin) and imipramine (Tofranil), may provide relief for mild to moderate symptoms by interfering with chemical processes in your brain that cause you to feel pain, but they also cause a number of side effects, such as dry mouth, sweating, weight gain, constipation and dizziness.For some people, antidepressants called serotonin and norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta), can relieve pain with fewer side effects. Possible side effects of SNRIs include nausea, sleepiness, dizziness, decreased appetite and constipation.
Managing complications and restoring function
Specific treatments exist for many of the complications of neuropathy, including:
- Urinary tract problems. Antispasmodic medications (anticholinergics), behavioral techniques such as timed urination, and devices such as pessaries — rings inserted into the vagina to prevent urine leakage — may be helpful in treating loss of bladder control. A combination of therapies may be most effective.
- Digestive problems. To relieve mild signs and symptoms of gastroparesis — indigestion, belching, nausea or vomiting — doctors suggest eating smaller, more-frequent meals, reducing fiber and fat in the diet, and, for many people, eating soups and pureed foods. Dietary changes and medications may help relieve diarrhea, constipation and nausea.
- Low blood pressure on standing (orthostatic hypotension). This is often helped with simple lifestyle measures, such as avoiding alcohol, drinking plenty of water, and sitting or standing slowly. Your doctor may recommend an abdominal binder, a compression support for your abdomen, and compression stockings. Several medications, either alone or together, may be used to treat orthostatic hypotension.
- Sexual dysfunction. Sildenafil (Revatio, Viagra), tadalafil (Adcirca, Cialis) and vardenafil (Levitra) may improve sexual function in some men, but these medications aren’t effective or safe for everyone. Mechanical vacuum devices may increase blood flow to the penis. Women may find relief with vaginal lubricants.
Lifestyle changes & home remedies
What are some lifestyle changes or home remedies that can help me manage diabetic neuropathy?
The following lifestyles and home remedies might help you cope with diabetic neuropathy:
- Keep your blood pressure under control. People with diabetes are more likely to have high blood pressure than are people who don’t have diabetes. Having both high blood pressure and diabetes greatly increases your risk of complications because both damage your blood vessels and reduce blood flow. Try to keep your blood pressure in the range your doctor recommends, and be sure to have it checked at every office visit.
- Make healthy food choices. Eat a balanced diet that includes a variety of healthy foods — especially fruits, vegetables and whole grains — and limit portion sizes to help achieve or maintain a healthy weight.
- Be active every day. Daily activity protects your heart and improves blood flow. It also plays a major role in keeping your blood sugar and blood pressure under control. The American Diabetes Association generally recommends about 30 minutes of moderate exercise a day at least five times a week.If you have severe neuropathy and decreased sensation in your legs, your doctor may recommend that you participate in non-weight-bearing activities, such as bicycling or swimming.
- Stop smoking. If you have diabetes and use tobacco in any form, you’re more likely than are nonsmokers with diabetes to die of heart attack or stroke. And you’re more likely to develop circulation problems in your feet. If you use tobacco, talk to your doctor about finding ways to quit.
If you have any questions, please consult with your doctor to better understand the best solution for you.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Review Date: July 28, 2017 | Last Modified: September 13, 2019
Diabetic neuropathy. http://www.mayoclinic.org/diseases-conditions/diabetic-neuropathy/basics/definition/con-20033336. Accessed July 31, 2017.
Neuropathy. http://www.diabetes.co.uk/diabetes-complications/diabetes-neuropathy.html. Accessed July 31, 2017.