Filed under: Diabetes
Diabetic neuropathy is a type of nerve damage that can occur if you have diabetes. High blood sugar 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.
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.
There are four main types of diabetic neuropathy. You may have just one type or symptoms of several types. Most develop gradually, and you may not notice problems until considerable damage has occurred.
The signs and symptoms of diabetic neuropathy vary, depending on the type of neuropathy and which nerves are affected.
Peripheral neuropathy is the most common form of diabetic neuropathy. Your feet and legs are often affected first, followed by your hands and arms. Possible signs and symptoms of peripheral neuropathy include:
The autonomic nervous system controls your heart, bladder, lungs, stomach, intestines, sex organs and eyes. Diabetes can affect the nerves in any of these areas, possibly causing:
Radiculoplexus neuropathy (diabetic amyotrophy)
Instead of affecting the ends of nerves, like peripheral neuropathy, radiculoplexus neuropathy affects nerves in the thighs, hips, buttocks or legs. Also called diabetic amyotrophy, femoral neuropathy, or proximal neuropathy, this condition is more common in people with type 2 diabetes and older adults. Symptoms are usually on one side of the body, though in some cases symptoms may spread to the other side too. Most people improve at least partially over time, though symptoms may worsen before they get better. This condition is often marked by:
Mononeuropathy involves damage to a specific nerve. The nerve may be in the face, torso or leg. Mononeuropathy, which may also be called focal neuropathy, often comes on suddenly. It's most common in older adults. Although mononeuropathy can cause severe pain, it usually doesn't cause any long-term problems. Symptoms usually diminish and disappear on their own over a few weeks or months. Signs and symptoms depend on which nerve is involved and may include:
Sometimes mononeuropathy occurs when a nerve is compressed. Carpal tunnel syndrome is a common type of compression neuropathy in people with diabetes.
Signs and symptoms of carpal tunnel syndrome include:
When to see a doctor
Seek medical care if you notice:
These symptoms don't always indicate nerve damage, but they may signal other problems that require medical care. In either case, 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.
Damage to nerves and blood vessels
Prolonged exposure to high blood sugar (glucose) 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 glucose 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:
Anyone who has diabetes can develop neuropathy, but these factors make you more susceptible to nerve damage:
Diabetic neuropathy can cause a number of serious complications, including:
Loss of a limb. Because nerve damage can cause a lack of feeling in your feet, cuts and sores may go unnoticed and eventually become severely infected or ulcerated — a condition in which the skin and soft tissues break down. The risk of infection is high because diabetes reduces blood flow to your feet.
Infections that spread to the bone and cause tissue death (gangrene) may be impossible to treat and require amputation of a toe, foot or even the lower leg. More than half the nontraumatic lower limb amputations performed every year in the United States are due to diabetes.
You probably already see your primary care doctor or an endocrinologist on a regular basis. If you don't already see an endocrinologist, you'll likely be referred to one if you start showing signs of diabetes complications. An endocrinologist is a doctor who specializes in treating metabolic disorders, such as diabetes. You may also be referred to a doctor who specializes in treating nervous system problems (neurologist).
Here's some information to help you get ready for your appointment and to know what to expect from your doctor.
What you can do
Preparing a list of questions can help you make the most of your time with your doctor. For diabetic neuropathy, some basic questions include:
Don't hesitate to ask any other questions.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, such as:
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.
Other tests that may be conducted include:
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.
If you already have diabetic neuropathy, you'll likely be referred to a podiatrist or other specialist for monitoring and treatment.
Diabetic neuropathy has no known cure. Treatment for diabetic neuropathy focuses on:
Slowing progression of the disease
Consistently keeping blood sugar within a narrow target range can help delay the progression of peripheral neuropathy and may even cause an improvement in symptoms you already have. With intense glucose control you may reduce your overall risk of diabetic neuropathy by as much as 60 percent.
For intense blood sugar control, your goals will likely be:
A1C is the amount of sugar that has attached to hemoglobin — the substance that carries oxygen inside red blood cells — in your blood. The higher your average blood sugar level for the past two or three months, the higher your A1C number will be. People who don't have diabetes have an A1C between 4 and 6 percent.
To help slow nerve damage:
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) and acupuncture, that may help with pain relief. Doctors frequently use them in conjunction with medications, but some may be effective on their own.
Among the pain-relieving treatments that may be tried are the following:
Managing complications and restoring function
Specific treatments exist for many of the complications of neuropathy, including:
These measures can help reduce your risk of diabetic neuropathy:
There are a number of alternative treatments that may help relieve the pain of diabetic neuropathy, such as:
Living with diabetic neuropathy can be difficult and frustrating because there are often no outward signs, making it hard for people to understand your condition. If you find yourself getting down, it may help to talk to a counselor or therapist. Or, some people find that support groups — either in person or online — are helpful because you're talking to others who truly understand what you're going through. In addition, members of support groups can offer you encouragement, as well as advice about living with diabetic neuropathy. Ask your doctor if there any support groups exist in your area, or for a referral to a therapist. The American Diabetes Association offers online support through its website.
You can help prevent or delay diabetic neuropathy and its complications by keeping your blood sugar consistently well controlled, taking good care of your feet and following a healthy lifestyle.
Blood sugar control
Keeping your blood sugar tightly controlled every day is a big commitment. It requires constant monitoring and, if you take insulin, frequent doses of medication. But keeping your blood sugar as close to normal as possible is the best way to help prevent neuropathy and other complications of diabetes. Consistency is important because shifts in blood sugar levels can accelerate nerve damage.
For the best control, aim for a blood glucose level from 70 to 130 mg/dL (3.9 to 7.2 mmol/L) before meals and an A1C reading that is less than 7 percent. An A1C test measures your average blood sugar level over a period of two to three months. The American Diabetes Association recommends that people with diabetes have an A1C test at least twice a year if blood sugar levels are consistently in a healthy range. If your blood sugar isn't well controlled or you change medications, get tested more often.
Foot problems, including sores that don't heal, ulcers and even amputation, are a common complication of diabetic neuropathy. But you can prevent many of these problems by having a comprehensive foot exam at least once a year, having your doctor check your feet at each office visit and taking good care of your feet at home.
To protect the health of your feet:
If problems do occur, a podiatrist can help treat them to prevent more-serious conditions from developing. Even small sores can quickly turn into severe infections if left untreated.
Shoes that fit well can be costly. If you qualify for Medicare, your plan may cover the cost of at least one pair of shoes a year. For more information, talk to your doctor or diabetes educator.
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