Diabetic Neuropathy

What is diabetic neuropathy?

Diabetic neuropathy is nerve damage caused by longstanding or poorly controlled diabetes mellitus (DM). Other risk factors for developing diabetic neuropathy include obesity, smoking, cardiovascular disease, and abnormal lipid levels.

Diabetic neuropathy can present as a number of distinct syndromes, including distal symmetric polyneuropathy, autonomic polyneuropathy, cranial neuropathy, or truncal neuropathy. Symptoms may include loss of sensation, weakness, pain, cardiovascular abnormalities, nausea or vomiting, diarrhea, retention of urine, and/or double vision.

The diagnosis is initially made by clinical examination. Treatment includes controlling blood sugar, medications to relieve pain, and regular foot care.

You should visit your primary care physician when convenient, a diagnosis can be made with testing. If diagnosed, your physician can create a treatment plan to manage the pain and motor restrictions that come with this condition.

Diabetic neuropathy symptoms

Diabetic neuropathy can present as a number of distinct syndromes, each with different symptoms. The common syndromes and their symptoms are described below.

Distal symmetric polyneuropathy

More than 80 percent of people have a form of diabetic neuropathy called distal symmetric polyneuropathy. People with this form of diabetic neuropathy usually first develop:

• Sensation changes in the feet and legs: A loss of touch, pain, and temperature sensation in the feet. The sensory loss will then gradually progress up the legs, and will later affect the hands and spread up the arms. Some people may develop a feeling of pain or burning in their feet.
• Motor weakness in the arms or legs: Eventually, people with this condition may develop a motor weakness in the arms or legs, although this usually develops after the sensory loss.
• Painless foot ulcers: Many people may not notice when they injure their feet and thus do not properly treat or protect the wound. This is exacerbated by poor wound healing that occurs in diabetes.
• Charcot arthropathy: This condition is also known as Charcot foot and ankle. It involves bony deformities in the foot and/or ankle that result from repeated injury to the bones and joints in the foot.
• Unstable posture: This can occur especially when anyone with this condition closes their eyes. This can occur if the neuropathy damages nerves that are responsible for sensing body position.

Diabetic neuropathy causes

Diabetic neuropathy is caused by damage to the nerves that occurs with longstanding or poorly-controlled diabetes, as well as a few other key risk factors.

Having longstanding or poorly controlled diabetes

Having diabetes for a longer period of time and having a more poorly controlled case of diabetes were both associated with a greater risk of developing diabetic neuropathy and are considered the main risks. Overall, about half of all people with diabetes will develop diabetic neuropathy. In a study of more than 1000 people with type 1 diabetes, 23.5 percent developed diabetic neuropathy at a mean follow-up of 7.3 years. Diabetes is thought to cause diabetic neuropathy due to a combination of low blood flow to nerve cells and metabolic changes such as the formation of substances called "advanced glycosylation end products" that cause inflammation.

Other risk factors

Other independent risk factors associated with diabetes include the following.

• Obesity
• Smoking
• Cardiovascular disease
• Abnormal lipid levels (hyperlipidemia): This is specifically a higher level of total cholesterol, low-density lipoprotein cholesterol, or triglycerides.

Treatment options and prevention for diabetic neuropathy

Treatment and prevention for diabetic neuropathy focus on controlling blood sugar, treating pain, and preventing the development of complications such as diabetic foot ulcers.

Control blood sugar

Controlling blood sugar is important for both preventing the development of diabetic neuropathy and slowing the progression of diabetic neuropathy once it develops. Among people with diabetes but without diabetic neuropathy, control of blood sugar has been shown to reduce the risk of developing diabetic neuropathy by about 60 to 70 percent over five years in type 1 diabetes and by about 60 percent over 15 years in type 2 diabetes.

Medications for painful neuropathy

People who develop painful diabetic neuropathy may benefit from medications to relieve the pain. Possible options include carbamazepine (Tegretol), amitriptyline (Elavil), duloxetine (Cymbalta), or pregabalin (Lyrica), among others.

Practice daily foot care

People with diabetic neuropathy should practice daily foot care to prevent the development of diabetic foot ulcers. This involves:

• Checking the feet on a daily basis
• Treating any injuries or calluses
• Going to a podiatrist (foot doctor) for regular foot examinations

When to seek further consultation for diabetic neuropathy

If you are diagnosed with diabetes you should go to your physician to establish care. He or she can help you develop a plan to control your blood sugar and reduce your risk of developing diabetic neuropathy.

If you develop symptoms of diabetic neuropathy

You should go to your physician. Your physician can perform an examination to determine if you have developed diabetic neuropathy.

Questions your doctor may ask to determine diabetic neuropathy

• Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
• Are your symptoms causing difficulty at work, socializing, or spending time with friends & family?
• Are you sleepy during the day?
• Do you currently smoke?
• Are you experiencing a headache?