Diabetic neuropathy, also known as diabetic nerve damage, is a type of damage to the nerves caused by diabetes. It typically occurs after many years of having diabetes. Both type 1 and type 2 diabetes can damage nerves throughout the body, especially in the legs and feet. When high blood sugar levels are not properly controlled over a long period of time, neuropathy can develop. The high blood sugar causes damage to the walls of tiny blood vessels (microvasculature) that nourish the nerves. This affects the ability of nerves to function properly.
Symptoms of Diabetic Neuropathy
The symptoms of diabetic neuropathy vary depending on which nerves are affected. Common symptoms include:
- U.S. Diabetic Neurotherapy Symptoms Numbness or reduced sensation in the feet and hands. Feet may feel like they have "no feeling."
- Pain or discomfort in the limbs, especially the feet and legs. The pain is usually described as burning, stinging, shooting, or cramping.
- Tingling or prickling sensations in the feet, legs, hands, and arms.
- Muscle weakness in the lower legs and feet.
- Problems with erectile dysfunction in men.
- Digestive issues like nausea, stomach pain, and constipation. This is due to damage to the nerves controlling the digestive system.
- Sensations of tingling, pins and needles, or electric shocks.
- Nighttime leg cramps or restless leg syndrome.
- Problems with imbalance or coordinated movements.
- Vision changes like blurred vision due to damage to the nerves in the eyes.
Types of Diabetic Neuropathy
There are different types of diabetic neuropathy based on which nerves are affected:
- Peripheral neuropathy - This is the most common type and affects the long nerves in the legs and feet first. It causes numbness, tingling, and pain.
- Autonomic neuropathy - Damages the nerves that regulate organs like the bladder, bowel, stomach, heart, and sexual organs. It leads to severe impairment of these functions.
- Focal neuropathy - Occurs in specific areas like single nerves in the hands or feet. It causes sudden, severe pain.
- Proximal neuropathy - Uncommon but affects the large nerves in the hips and buttocks. It causes weakness and pain in the hips and thighs.
- Mononeuropathy - A single nerve like the femoral nerve is damaged, causing weakness of muscle it controls in the leg.
Risk Factors for Developing Neuropathy
Certain factors increase the risk of developing diabetic neuropathy:
- Duration of diabetes - The longer a person has diabetes, the higher the risk. After 15+ years of diabetes, over 50% will have some form of neuropathy.
- Poor blood glucose control - Higher A1C levels over time mean higher risk due to persistent high blood sugar damaging nerves.
- Obesity - Excess weight places extra strain on nerves in the legs and feet.
- High blood pressure - Also strains nerves over time if not controlled.
- High cholesterol - Nerves do not receive adequate blood flow and nutrients if cholesterol blocks blood vessels.
- Smoking - It constricts blood vessels and reduces blood flow to nerves.
- age - Elderly adults are more prone to nerve damage from diabetes.
- Family history - Genetics play a role in susceptibility to nerve damage.
Diagnosing Diabetic Neuropathy
The following tests help doctors diagnose diabetic neuropathy:
- Neuropathy exam - Involves checking reflexes, strength, sensation with monofilament, vibration with tuning fork, pinprick and temperature.
- Nerve conduction studies - Measures nerve impulses in the arms and legs to identify damaged areas.
- Electromyography - Needle test detects electrical signals in muscles controlled by affected nerves.
- Urine or blood tests - Checks for elevated glucose or A1C levels indicating poor blood sugar control that damages nerves over time.
- Vascular and nerve ultrasound - Images nerves and blood vessels for signs of damage or dysfunction.
- Biopsy of nerve - Rarely done but provides definitive evidence by examining nerve tissue under a microscope.
Treating Diabetic Neuropathy
The first step in treatment is controlling blood sugar levels with medication, insulin, diet, exercise and lifestyle changes. Additional options include:
- Pain medications - Over the counter drugs like acetaminophen, NSAIDs like ibuprofen and prescription medications.
- Antidepressants - Amitriptyline and duloxetine can relieve chronic neuropathy pain.
- Topical pain relievers - Creams containing lidocaine or capsaicin applied to skin.
- Supplements - Alpha-lipoic acid, acetyl-L-carnitine supplements may relieve symptoms.
- Physical therapy - Learning stretches and proper foot care prevents injuries.
- Nerve stimulation treatments - Exposure to high frequency electromagnetic waves blocks pain signals.
- Surgery (rare) - Sympathectomy severs nerve pathways to reduce severe, debilitating pain.
Proper diabetes management is key to preventing progression of neuropathy. With treatment, symptoms often stabilize
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