An Overview of Diabetic Neuropathy

Peripheral neuropathy can cause hand pain.
Westend61/Getty Images

Diabetic neuropathy, or nerve damage, develops when nerves are impaired due to high glucose levels. There are several different types of neuropathy, with peripheral neuropathy and autonomic neuropathy being the most common. Diabetic neuropathy develops in 60 to 70 percent of people with diabetes, although it is preventable. If the condition progresses, it may require amputation.

Symptoms

The symptoms of diabetic neuropathy may range from mild numbness and tingling to pain that interferes with your normal daily activities. The full list of potential symptoms includes:

  • Loss of sensation
  • Sensitivity to touch
  • Numbness and tingling in hands and feet
  • Difficulty walking due to coordination issues
  • Muscle weakness
  • Bloating and nausea
  • Dizziness when standing up
  • Diarrhea or constipation
  • Excessive or decreased sweating
  • Bladder issues
  • Vaginal dryness
  • Erectile dysfunction
  • Inability to sense low blood sugar signs
  • Double vision
  • Rapid heart rate

Causes

Consistently elevated blood sugar levels can cause diabetic neuropathy, as, over time, uncontrolled glucose levels interfere with nerve signaling and functioning, and may lead to weakening blood capillary walls, which could starve nerves of oxygen and nutrients.

Additionally, high blood cholesterol levels, high blood pressure, and low levels of vitamin B12 can also lead to neuropathy. The diabetes medication Metformin has a side effect that reduces B12 levels in the body. Talk to your doctor about potentially supplementing with vitamin B12 to counteract this effect.

The risk of neuropathy increases with advanced age, being overweight, and duration of diabetes with the highest rates among those who have had diabetes for more than 25 years. The risk is also significantly increased with smoking and alcohol abuse, which can narrow and weaken the arteries and reduce blood flow to your extremities.

Neuropathy may also be sometimes caused by kidney disease, by a mechanical injury such as carpal tunnel syndrome, by genetic factors, by certain toxins, or by widespread inflammation, which could trigger an autoimmune response that attacks the nerves.

Diagnosis

There are several types of neuropathy that may develop in relation to diabetes.

  • Peripheral neuropathy is the most common type of neuropathy affecting the extremities, such as toes, feet, fingers, and hands, but may also affect the legs and arms. Symptoms include tingling, numbness, or pain.
  • Autonomic neuropathy affects the nerves that control body systems and are responsible for everyday body functioning, such as blood pressure, sweating, and digestion.
  • Proximal neuropathy is a rare form of nerve damage affecting the hip, thigh, or buttocks. It usually affects only one side of the body.
  • Focal neuropathy affects a single nerve, such as in the wrist or the back, and may also affect the nerve that controls the eye muscles. It is less common than peripheral or autonomic neuropathy.

Other less common forms of neuropathy include:

  • Femoral neuropathy
  • Charcot's joint or neuropathic arthropathy
  • Compression mononeuropathy
  • Cranial neuropathy
  • Thoracic or lumbar radiculopathy
  • Unilateral foot drop

Treatment

The best method for treating diabetic neuropathy is through pain management and working to prevent progression of the condition. Because the root cause of diabetic neuropathy is diabetes, it's important to treat the root cause of the problem and keep your blood sugar in the target range. While the ideal range may be different for everyone, consult with your practitioner to implement a therapeutic lifestyle plan incorporating medication and supplements, nutrition, and exercise, and keeping up with proper foot care.

Glucose Testing

Regularly test your blood glucose levels with a glucometer to establish a baseline level of your condition and to inform your daily decisions. Also, be sure to get a hemoglobin A1c lab test performed two to three times per year to provide a glimpse of your average blood sugar control over the past few months.

Medications

Not everyone with neuropathy will experience nerve pain, but over-the-counter pain-relievers like Tylenol or NSAIDs like Motrin or Aleve may be helpful if you do. Practitioners are also now recommending very low-dose tricyclic antidepressants (TCAs) such as Elavil or Antril for chronic pain, or antiepilepsy drugs (AEDs) such as Neurontin or Lyrica, which work by decreasing the frequency of nerve pain signals sent to the brain.

Foot Care

In diabetic neuropathy, the feet are at higher risk because they are not easy to see. A foreign object such as a tack can get stuck in the bottom of the foot or irritation can develop into an open wound or ulcer, and go unnoticed because of lost sensation in the foot. People with diabetes need to take special care of their feet, and regularly inspect them for problems, as poor circulation is a common problem and could lead to slower healing, ulcer, infection or tissue death (gangrene), which may require amputation.

Over half of all amputations per year are due to diabetes and diabetes-related complications. Most are lower-extremity amputations, such as foot amputation. Careful foot care, however, can prevent these operations.

  • Wash and thoroughly dry your feet and inspect them daily.
  • Always wear well-fitting shoes and clean, dry socks; avoid walking barefoot.
  • Trim toenails straight across and file the corners with an emery board, or have them trimmed by a podiatrist.
  • Don't use foot products, tools, or chemicals such as scrapers, scissors, files or wart removal treatments, as these may cause injury.
  • Let your doctor know if you have a foot injury that is not healing normally within a couple of days, or if you discover an injury of unknown origin and duration.

A Word From Verywell

If you have type 1 or type 2 diabetes, it's important to be on the lookout for signs of diabetic neuropathy. Losing feeling or noticing tingling in any part of the body is a telltale signal that something may be wrong, but actively working to keep your glucose levels under control is the best way to manage and prevent neuropathy from progressing. In some cases, neuropathy pain may not be responsive to pain medication, and this can lead to worsening, muscle weakening or more serious disability. However, help is available to you: Reach out to your healthcare team for guidance and support and to implement a care plan.

Was this page helpful?

Article Sources