About diabetic neuropathy
What is diabetic neuropathy?
Neuropathy is damage to nerves, and diabetic neuropathy is damage to nerves that occurs as a result of diabetes. Diabetes is thought to damage nerves as a result of prolonged elevated levels of blood glucose. Diabetic neuropathy can affect different parts of the body, and symptoms can range from mild to severe. Diabetic neuropathy is the most common complication of diabetes.
What are the types of diabetic neuropathy?
There are different types of diabetic neuropathy. The distinction depends upon which types and location of nerves are affected.
- Diabetic peripheral neuropathy refers to damage to peripheral nerves, most commonly the nerves of the feet and legs.
- Diabetic proximal neuropathy affects nerves in the thighs, hips, or buttocks.
- Diabetic autonomic neuropathy affects the autonomic nervous system, the nerves that control body functions. For example, it can affect nerves of the gastrointestinal, urinary, genital, or vascular systems.
- Diabetic focal neuropathy affects a specific nerve or area at any site in the body.
What are the symptoms for diabetic neuropathy?
There are four main types of diabetic neuropathy. You can have one or more than one type of neuropathy. Your symptoms will depend on the type you have and which nerves are affected. Usually, symptoms develop gradually. You may not notice anything wrong until considerable nerve damage has occurred.
Peripheral neuropathy is the most common type of diabetic neuropathy. It affects the feet and legs first, followed by the hands and arms. Signs and symptoms of peripheral neuropathy are often worse at night, and may include:
- Numbness or reduced ability to feel Pain or temperature changes
- Tingling or burning sensation
- Sharp pains or cramps
- Increased sensitivity to touch — for some people, even the weight of a bedsheet can be painful
- Muscle weakness
- Loss of reflexes, especially in the ankle
- Loss of balance and coordination
- Serious foot problems, such as ulcers, infections, and bone and joint pain
The autonomic nervous system controls your heart, bladder, stomach, intestines, sex organs and eyes. Diabetes can affect nerves in any of these areas, possibly causing:
- A lack of awareness that blood sugar levels are low (hypoglycemia unawareness)
- Bladder problems, including urinary tract infections or urinary retention or incontinence
- Constipation, uncontrolled diarrhea or both
- Slow stomach emptying (gastroparesis), causing nausea, vomiting, bloating and loss of appetite
- Difficulty swallowing
- Increased or decreased sweating
- Problems controlling body temperature
- Changes in the way your eyes adjust from light to dark
- Increased heart rate at rest
- Sharp drops in blood pressure after sitting or standing that may cause you to faint or feel lightheaded
- Erectile dysfunction
- Vaginal dryness
- Decreased sexual response
Radiculoplexus neuropathy (diabetic amyotrophy)
Radiculoplexus neuropathy affects nerves in the thighs, hips, buttocks or legs. It's more common in people with type 2 diabetes and older adults. Other names for this type are diabetic amyotrophy, femoral neuropathy or proximal neuropathy.
Symptoms are usually on one side of the body, but sometimes may spread to the other side. You may have:
- Severe Pain in a hip and thigh or buttock that occurs in a day or more
- Eventual weak and shrinking thigh muscles
- Difficulty rising from a sitting position
- Abdominal swelling, if the abdomen is affected
- Weight loss
Most people improve at least partially over time, though symptoms may worsen before they get better.
Mononeuropathy, or focal neuropathy, is damage to a specific nerve in the face, middle of the body (torso) or leg. It's most common in older adults. Mononeuropathy often strikes suddenly and can cause severe pain. However, it usually doesn't cause any long-term problems.
Symptoms usually go away without treatment over a few weeks or months. Your specific signs and symptoms depend on which nerve is involved. You may have Pain in the:
- Shin or foot
- Lower back or pelvis
- Front of thigh
- Chest or abdomen
Mononeuropathy may also cause nerve problems in the eyes and face, leading to:
- Difficulty focusing
- Double vision
- Aching behind one eye
- Paralysis on one side of your face (Bell's palsy)
Sometimes mononeuropathy occurs when something is pressing on a nerve (nerve compression). Carpal tunnel syndrome is a common type of compression neuropathy in people with diabetes. It can cause numbness or tingling in your hand or fingers, except your pinkie (little finger). Your hand may feel weak, and you may drop things.
When to see a doctor
Call your doctor for an appointment if you have:
- A cut or sore on your foot that is infected or won't heal
- Burning, tingling, Weakness or Pain in your hands or feet that interferes with daily activities or sleep
- Changes in digestion, urination or sexual function
These signs and symptoms don't always mean you have nerve damage. But they can be a sign of another condition that requires medical care. Early diagnosis and treatment of any health condition gives you the best chance for controlling your diabetes and preventing future problems.
What are the causes for diabetic neuropathy?
Damage to nerves and blood vessels
The exact cause likely differs for each type of neuropathy. Researchers think that over time, uncontrolled high blood sugar damages nerves and interferes with their ability to send signals, leading to diabetic neuropathy. High blood sugar also weakens the walls of the small blood vessels (capillaries) that supply the nerves with oxygen and nutrients.
However, a combination of factors may lead to nerve damage, including:
- Inflammation in the nerves caused by an autoimmune response. The immune system mistakes nerves as foreign and attacks them.
- Genetic factors unrelated to diabetes may make some people more likely to develop nerve damage.
- Smoking and alcohol abuse damage both nerves and blood vessels and significantly increase the risk of infection.
What are the treatments for diabetic neuropathy?
While diabetic neuropathy cannot be cured, there are treatments available to help manage some of the symptoms. Another treatment goal is keeping blood glucose levels under good control through a combination of diet and medication so that the neuropathy does not worsen. Keeping blood glucose levels under control has been shown to improve symptoms and prevent worsening of the pain.
The pain of diabetic neuropathy can sometimes be managed with certain medications. Certain prescription antidepressants and antiseizure medications have been shown to be effective in relieving pain that originates in the nerves.
For example, duloxetine (Cymbalta) is an antidepressant that can relieve the pain of diabetic neuropathy in some people. The tricyclic antidepressant drugs, including 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) are drugs that can also work to relieve pain in people with diabetic neuropathy.
In severe cases, opioid analgesic medications may be needed.
Other kinds of treatment for nerve pain include patches containing the topical anesthetic agent lidocaine. Capsaicin cream is an over-the-counter topical agent that has been shown to relieve nerve pain.
Medications can also help manage the troublesome symptoms of autonomic neuropathy. For example, antispasmodic or anticholinergic drugs can help prevent urinary incontinence. Drugs to treat erectile dysfunction like sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) may help some men with ED due to diabetic neuropathy. For women, vaginal estrogen creams and lubricants may provide relief of vaginal dryness and irritation.
Botulinum toxin (Botox) injections have been used to treat abnormal sweating.
What are the risk factors for diabetic neuropathy?
Anyone who has diabetes can develop neuropathy, but these risk factors make you more likely to get nerve damage:
- Poor blood sugar control. Uncontrolled blood sugar puts you at risk of every diabetes complication, including nerve damage.
- Diabetes history. Your risk of diabetic neuropathy increases the longer you have diabetes, especially if your blood sugar isn't well-controlled.
- Kidney disease. Diabetes can damage the kidneys. Kidney damage sends toxins into the blood, which can lead to nerve damage.
- Being overweight. Having a body mass index (BMI) greater than 24 may increase your risk of diabetic neuropathy.
- Smoking. 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 peripheral nerves.
Is there a cure/medications for diabetic neuropathy?
To date, There is no cure for diabetes-related neuropathy.
- However, an individual can manage nerve pain with the help of medication, exercise, and apt nutrition.